We’d like to introduce the fabulous lactation consultant at MILKALICIOUS Breastfeeding Boutique, JENNIFER RITCHIE. Jennifer and her co-founder JENNIFER KUSIMER are committed to increasing long-term breastfeeding rates by offering breastfeeding support to new mothers. Both founders of Milkalicious are certified through UCSD as Lactation Professionals, and Jennifer Ritchie is currently the Vice President of the Orange County Breastfeeding Coalition.
Milkalicious has offered to host an online forum to answer all your breastfeeding questions this week. Please post any related questions or concerns here.

Tags: breastfeeding, lactation, milkalicious

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EVERYONE who is breastfeeding or preparing to breastfeed should know about this wonderful website it's www.kellymom.com



Nursing your newborn — what to expect in the early weeks
This information is also found as part of the professional Breastfeeding Logs.

By Kelly Bonyata, BS, IBCLC

The First Week
Weeks two through six
Additional information
The First Week
How often should baby be nursing?

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 - 12 times per day (24 hours). You CAN'T nurse too often--you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)--don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first--wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.

Is baby getting enough milk?

Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom's milk comes in, the average breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often--this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy.

Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once mom's milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.

Breast changes

Your milk should start to "come in" (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don’t skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side. To decrease discomfort from engorgement, use cold and/or cabbage leaf compresses between feedings. If baby is having trouble latching due to engorgement, use reverse pressure softening or express milk until the nipple is soft, then try latching again.

Call your doctor, midwife and/or lactation consultant if:

Baby is having no wet or dirty diapers
Baby has dark colored urine after day 3
(should be pale yellow to clear)
Baby has dark colored stools after day 4
(should be mustard yellow, with no meconium)
Baby has fewer wet/soiled diapers or nurses less
frequently than the goals listed here
Mom has symptoms of mastitis
(sore breast with fever, chills, flu-like aching)




Weeks two through six
How often should baby be nursing?
Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns need to nurse 8 - 12+ times per day (24 hours). You CAN'T nurse too often—you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)—don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy—wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing. Once baby has established a good weight gain pattern, you can stop waking baby and nurse on baby's cues alone.

The following things are normal:
Frequent and/or long feedings.
Varying nursing pattern from day to day.
Cluster nursing (very frequent to constant nursing) for several hours—usually evenings—each day. This may coincide with the normal "fussy time" that most babies have in the early months.
Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 - 10 days, 2 - 3 weeks and 4 - 6 weeks.
Is baby getting enough milk?
Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: Expect 3-4+ stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often--this is normal, too. The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 - 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining well, this is normal.

Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby's bladder capacity grows.

Milk supply?
Some moms worry about milk supply. As long as baby is gaining well on mom's milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.



Page last modified: 10/10/2005
Written: 2/27/03


--------------------------------------------------------------------------------

Additional information
@

Breastfeeding Logs

Hunger Cues - When do I feed baby?

Resources: Is Baby Getting Enough Milk?

Normal Growth of Breastfed Babies

Breastfeeding - Getting Started

Information is Your Ally in preparing to breastfeed: 10 Tips for Success by Eva Lyford

Tips for juggling a newborn and toddler

Frequent Nursing


Worried about milk supply?
Is your milk supply really low?

My breasts feel empty! Has my milk supply decreased?

How can I find help for my breastfeeding problem?


@ other websites
The Importance of Colostrum by Paula Yount

What is Normal? by Paula Yount

Breastfeeding as Baby Grows by Becky Flora, IBCLC

Straight Talk About Real Babies: Defining New-Mom Expectations by Ann Calandro, BSN, RNC, IBCLC

Breastfeeding Through the Ages by Teresa Pitman

Copyright© 1998 - 2009 kellymom and its licensors. All Rights Reserved.
http://www.kellymom.com/lcdirectory/index.html

Lactation Consultant Directory by state
http://www.kellymom.com/bf/supply/milkproduction.html

HI, this page didn't paste well here is the link above.

How does milk production work?
By Kelly Bonyata, BS, IBCLC

To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works...

For the most part, milk production is a "use it or lose it" process.
The more often and effectively your baby nurses, the more milk you will make.


In the Beginning...
Endocrine (Hormonal) Control of Milk Synthesis -- Lactogenesis I & II

Milk production doesn’t start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven – this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

During the latter part of pregnancy, the breasts are making colostrum, but high levels of progesterone inhibit milk secretion and keep the volume “turned down”. At birth, the delivery of the placenta results in a sudden drop in progesterone/estrogen/HPL levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels cues Lactogenesis II (copious milk production). Other hormones (insulin, thyroxine, cortisol) are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Lactogenesis II commences approximately 30-40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk "coming in") until 50-73 hours (2-3 days) after birth.

These first two stages of lactation are hormonally driven – they occur whether or not a mother is breastfeeding her baby.




Established Lactation...

Autocrine (Local) Control of Milk Synthesis -- Lactogenesis III

After Lactogenesis II, there is a switch to the autocrine (or local) control system. This maintenance stage of milk production is also called Lactogenesis III. In the maintenance stage, milk synthesis is controlled at the breast -- milk removal is the primary control mechanism for supply. Milk removal is driven by baby’s appetite. Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.

By understanding how local/autocrine control of milk synthesis works, we can gain an understanding of how to effectively increase (or decrease) milk supply.



What does current research tell us about milk production?
Current research suggests that there are two factors that control milk synthesis:

Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) – the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).






The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites – thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through - thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.


Both of the above factors support research findings that tell us:
FULL
Breast = SLOWER
Milk
Production
EMPTY
Breast = FASTER
Milk
Production



Research indicates that fat content of the milk is also determined by how empty the breast is (emptier breast = higher fat milk), rather than by the time of day or stage of the feed.


How does milk supply vary throughout the day?
Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses. Fat content tends to increase as the day progresses (Hurgoiu V, 1985). These observations are consistent with current research if we assume the researchers were observing babies with a fairly typical nursing pattern, where baby has a longer sleep period at night and gradually decreases the amount of time between nursing as the day progresses.

Storage capacity: Another factor that affects milk production and breastfeeding management is mom’s milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby's growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby’s appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

Think of storage capacity as a cup - you can easily drink a large amount of water throughout the day using any size of cup - small, medium or large - but if you use a smaller cup it will be refilled more often.

What does the research tell us about increasing milk supply?
Milk is being produced at all times, with speed of production depending upon how empty the breast is. Milk collects in mom's breasts between feedings, so the amount of milk stored in the breast between feedings is greater when more time has passed since the last feed. The more milk in the breast, the slower the speed of milk production.

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings:
EMPTY
Breast = FASTER
Milk
Production





In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.

To accomplish this goal and increase milk production:
Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)
Empty the breasts as thoroughly as possible at each nursing/pumping session.
To better empty the breasts:
Make sure baby is nursing efficiently.
Use breast massage and compression.
Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.
Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Are you having problems with oversupply?
Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by "block nursing" - mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby's nursing frequency is not limited.

See also:
Frequently Asked Questions about Milk Production

I'm confused about foremilk and hindmilk - how does this work?

Anatomy of the human breast. Diagram by DT Ramsay, RL Hartmann, PE Hartmann



Note: the graphics above are copyrighted. Do not use without express written permission.

Many thanks to Denise Fisher of Health e-Learning for the valuable feedback!

Page last modified: 05/11/2007
Written: 05/20/2001


--------------------------------------------------------------------------------

Additional information
Anatomy of a Working Breast by Anna Edgar, from New Beginnings, Vol. 22 No. 2, March-April, pp. 44-50.

How Mother's Milk is Made by Linda J. Smith, BSE, FACCE, IBCLC.

Anatomy of the Breast and How the Breast Makes Milk by Marie Davis, RN, IBCLC

How the breasts make and deliver milk from AskDrSears.com

Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

Finish the First Breast First by Melissa Clark Vickers

Human Milk and Lactation by Carol L Wagner, MD


References
Cox DB, Kent JC, Casey TM, Owens RA, Hartmann PE. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationships. Exp Physiol. 1999;84(2):421-34.

Cox DB, Owens RA, Hartmann PE. Studies on Human Lactation: The Development of the Computerized Breast Measurement System. June 1998. Accessed May 28, 2004.

Cox DB, Owens RA, Hartmann PE. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996 Nov;81(6):1007-20.

Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume and duration between feeds in women breastfeeding their full-term infants over a 24 h period. Exp Physiol. 2002 Mar;87(2):207-14.

Hartmann PE, Owens RA, Cox DB, Kent JC. Breast development and control of milk synthesis. Tokyo, Japan: United Nations University Press; 1996 Dec. 17(4).

Hartmann PE, Prosser CG. Physiological basis of longitudinal changes in human milk yield and composition. Fed Proc. 1984 Jun; 43(9): 2448-53.

Hurgoiu V, Marcu A, Sopon E, Olariu M. Dynamics of the composition of lipids in human milk during lactation. [French]. Pediatrie. 1985 Apr-May;40(3):201-5.

Ingram J, Woolridge M, Greenwood R. Breastfeeding: it is worth trying with the second baby. Lancet. 2001 Sep 22;358(9286):986-7.

Marasco L, Barger J. Cue Feeding: Wisdom and Science. Breastfeeding Abstracts. 1999 May;18(4):28-29






Laura Renauld said:
My son is 10 weeks old. We had difficulty nursing at first and he lost too much of his birth weight so we have been nursing and formula-feeding, alternately, ever since. I was never able to build my milk supply up enough to breastfeed exclusively. Two questions:
1. Will I be able to continue this feeding routine for the long-term or will my milk supply eventually dwindle?
2. When he nurses, he has to suck vigourously the whole time. My milk does not flow on its own. Is this a result of our initial trouble or is this a problem with me that will occur again with my next child?
Hello Jacqueline,
Believe it or not, the amount of milk that a woman makes is most dependent on regular milk removal from the breast, not really influenced by a mothers nutrition and water intake. There is little to no scientific evidence to support the effect of a mothers nutrition on the amount of milk she produces. This helps explain how a mother is able to nourish their babies even under terrible conditions. Breastfeeding is demand and supply, so not enough nipple stimulation and empting of the breast can lead to a sudden drop in supply. We also experience a natural decrease in prolactin levels 2 weeks after we give birth. If a drop in supply is noticed, and the mom is putting the baby to breast 8 or more times every 24 hours, I would recommend Galactogogues. What the heck is a Galactogogue? This can be a food, herb, or drug that help boost your milk supply. Galactogogue foods include: oatmeal (not instant) brown rice, and beans; Galactogogue herbs include fenugreek , blended thistle, and goads rue, and Galactogogues drugs include Motilum and Reglan. The company Motherlove sells a special blend of these herbs in a liquid and capsule form, and many of my clients have had success using it. The two most common Galactogogue drugs are metoclopramide (Reglan) and domperidone (Motilium). Both work by raising prolactin, but Reglan does cross the blood brain barrier and can cause depression. Domperidone does not have this problem.

Hope that helps solve the mystery!

Best Regards,
Jennifer Ritchie
Milkalicious
www.milkalicious.org
I am Due July 9 2009 (planning a Home birth) just wanted to make contact so if I have any questions I can contact you ! Also reading over other questions others have asked may be very helpful!
Thanks,
Becky
First I would like to explain that I have a rare kidney problem called Nephrogenic Diabetes Insipidus. I have had it since birth. The disease has to deal with that fact that my kidneys do not function correctly where the water does not return to the body. I dont not really retain much water at all. I drink 4 to 6 gallons of water a day just to keep hydrated.

I am 35 years old and have a 2 year old daughter. I was able to lacatate with her some when she was born. For the first two weeks then had to go to formula with it until she was two months old. When my daughter was born had her see a ped. that understood my problem to make sure she didnt have it. He mentioned to be that since I dont retain water that it would be very hard for me to breastfeed fully. (which I am hoping I find a new way with my daughter). I am pretty well endowed and she had a hard time latching on. I tried manual pumps and one electrical pump but was not able to get suction. My nipples didnt seem to fit into the cup. I dont know if there is a way to get more if my son (est. date of delivery 10/17/09) to be able to have my breast milk since it has also been a deep to have that kind of bond between mother and child.

I am hoping that you might have some suggests for me for the possible be able to produce enough milk for my child and to also know if there is a pump or a way to help him to latch on to have the experience I so dream to have with my child.

Thank you for Your time.

Lisa Grubbs
Hello, I am a new graduate RN but I am also really interested in becoming a lactation consultant. I'm not sure what the process is to becoming a certified lactation consultant and I'm having trouble locating information on this topic. I live in NJ. Just wondering if you have any advice/information.
Thankyou!! Maureen
I had a home birth with my second child in November. Our first was born in a hospital. A home birth was the best thing my husband and I decided to do! It was beautiful! I can answer any questions too!

Becky L Maher said:
I am Due July 9 2009 (planning a Home birth) just wanted to make contact so if I have any questions I can contact you ! Also reading over other questions others have asked may be very helpful!
Thanks,
Becky
Do you have links to the studies that show maternal nutrition and hydration have nothing to do with the quality or quantity of breastmilk?

Jennifer Ritchie said:
Hello Jacqueline,
Believe it or not, the amount of milk that a woman makes is most dependent on regular milk removal from the breast, not really influenced by a mothers nutrition and water intake. There is little to no scientific evidence to support the effect of a mothers nutrition on the amount of milk she produces. This helps explain how a mother is able to nourish their babies even under terrible conditions. Breastfeeding is demand and supply, so not enough nipple stimulation and empting of the breast can lead to a sudden drop in supply. We also experience a natural decrease in prolactin levels 2 weeks after we give birth. If a drop in supply is noticed, and the mom is putting the baby to breast 8 or more times every 24 hours, I would recommend Galactogogues. What the heck is a Galactogogue? This can be a food, herb, or drug that help boost your milk supply. Galactogogue foods include: oatmeal (not instant) brown rice, and beans; Galactogogue herbs include fenugreek , blended thistle, and goads rue, and Galactogogues drugs include Motilum and Reglan. The company Motherlove sells a special blend of these herbs in a liquid and capsule form, and many of my clients have had success using it. The two most common Galactogogue drugs are metoclopramide (Reglan) and domperidone (Motilium). Both work by raising prolactin, but Reglan does cross the blood brain barrier and can cause depression. Domperidone does not have this problem.

Hope that helps solve the mystery!

Best Regards,
Jennifer Ritchie
Milkalicious
www.milkalicious.org
Sometimes if the flow is too fast for a baby they will bob off the breast to catch their breath. You can lean back in the chair while feeding to stop it from flowing so fast by using gravity against it. Your breasts don't have to change size to produce enough milk. With your second baby your body is more efficient at knowing exactly how much milk to produce so you might not have the same surplus you did with your first baby but if you breastfeed often and on demand you should not have a prob producing enough milk. Make sure you pump each time you give the baby a bottle to keep up the supply.

Kelly Martell Scovel said:
When I had my son 3 years ago, I was overflowing with milk. My breasts went from a B to about a D and I had no problem breastfeeding and did so for about a year. Now, with my 3 month old daughter, I have barely ANY milk, and I don't feel I have done anything different. I am trying to only give her 3oz. of formula a day, but most days it ends up being 6oz. (two bottles) She is very frantic when she breastfeeds, and pulls herself off every couple seconds. I know the milk is coming out because when she pulls away it shoots out! I just want to know what I can do to make more milk for her, and how to encourage her to relax.
I have been visiting Milkalicious ever since my 12 week old daughter was born. They have helped me with numerous breastfeeding issues as well as general support as a first time mom. Their entire staff is wonderful!

Thank you!!!
Two years ago, I experienced what doctors would call a subareolar abcess that I believe came from an ingrown hair around my nipple. It became inflamed and needed to be lanced and drained. It had since went away, only to resurface when I got pregnant. I've had it lanced and drained a couple more times during my pregnancy and again it has gone down and is no longer swollen or draining profusely. However, it does still leak a small amount of pus everynow and then, the nipple sometimes leaks and itches and the fluids still smell like infection. I'm 28 yrs old and 37 weeks with my first child. My midwives have informed me that I should be okay and that my son will be able to nurse normally but since this forum is open, I was wondering for myself and any other mothers out there, is it really okay for my son to nurse from a nipple that might still be infected. Will mastitis be more eminent being my history with this breast? And, how can I clear up the infection that is apparently deep within the breast without antibiotics? I get yeast infections seems like upon sheer mention of them!!! I eat alot of garlic, drink apple cider vinegar and lead a great diet consuming only fish and hormone/antibiotic free turkey and a little chicken. This has been my only issue throughout my pregnancy. No sickness or ill feelings at all!!! But, I do want to nurse my son and just want to make double sure that it will be safe...!!! Thanks, Milkalicious!!!!

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