By: Natalie Borden IBCLC CD/PCD(DONA)
Originally Posted From: Devoted Doula Birth & Breastfeeding Services
I am a firm believer in that if you understand the why of things, you are better able to manage hurdles as they come. The calibration of milk production follows a generally predictable pattern given frequent and effective removal of milk from the breast. I will provide some insight into how milk production is calibrated under the preferred circumstances below.
Before we can talk about calibration once baby is born, we need to take a moment to acknowledge the incredible capabilities the body already has during the pregnancy period. By approximately 16 weeks gestation, the breasts are already beginning to produce milk. This is colostrum, which is milk. This milk is produced and absorbed within the body as the pregnancy continues. It is an amazing milk. What it lacks in volume (water/sugar) it makes up for in age specific components. This means if your baby is born at 35 weeks gestation, the milk is calibrated to that age of baby. That means that milk produced at 38 weeks is slightly different in composition than that of milk produced at 40 or 41 weeks.
With the delivery of your placenta begins a waterfall of hormonal changes within the body. Progesterone and estrogen within the placenta that was holding back prolactin’s ability to produce milk is no longer holding that role. As a result, prolactin begins to surge and the transition to mature milk begins. This starts right at the delivery of your placenta but normally it isn’t obviously felt by us until roughly 3-5 days postpartum. Another important factor to keep in mind in how hormones are helping to increase milk volumes is the idea of prolactin receptors. Now that prolactin is able to surge inside the body, it only means so much without prolactin receptors. A simple way to understand this is to compare it to a lock and key. Prolactin is the key and prolactin receptors are the locks. Frequent stimulation of the breast in the early days postpartum help lay down more locks for the keys to fit into. They turn and milk production continues. Without that frequent stimulation, fewer locks are set down and production calibration can falter. This is also why many individuals who are having subsequent babies report milk transitioning quicker. Those receptors haven’t totally gone away and as a result, they have the infrastructure in place and are actually adding to it. In the first few days postpartum the milk production machine is largely dictated by hormonal factors. Without frequent and effective stimulation of the breasts though the machine begins to slow down and stop.
When your baby is born, they are born full. The sensation of being hungry isn’t something they are familiar with. What they are born with is the instinctual reflex to find the breast and suckle. The advice on how frequently to feed in the first 24hours varies quite a bit from care provider to care provider. In this time period, the average babe consumes roughly 2-10mls per feed. These quantities are tiny. What these tiny quantities allow your baby to do is practice their suck/swallow/breathe coordination. A skill that they couldn’t practice yet in utero. With small volumes at this time they are able to work on this skill prior to the ramp up of milk volumes.
Between 24-48 hours old your baby will consume roughly 5-15mls per feed. The frequency should be at least 8 times but, 10 or more is not unusual. The first sleepy 24hours has passed and many babies are taking the opportunity to “Call in their orders”. They are telling the body to keep the milk production machine running on high. It does not necessarily mean that your body isn’t making enough for them. It also doesn’t look like an even and organized feeding pattern. Many feel that their baby will feed every 3 hours on the dot and if they are fussy or cuing before then that their baby either isn’t hungry or that the body is somehow not keeping up with baby’s need. Some feeds are a drink, some are a snack and some are large meals. As long as feeds aren’t extremely long or if you are feeling pain, following their cues really does eliminate the guesswork of if you should feed them or not. Where this can get confusing is the group of babes who aren’t as vocal about calling in their orders. These are the babes who sleep in long stretches and are difficult to rouse. As they consume less calories, they shut down further and cue less – not more. These are the ones we try to watch out for and why it is encouraged to ensure at least 8 feeds per 24hours and why it is discouraged to let them sleep in long stretches until they have proven their ability to gain weight in the first 2 weeks of life. After we are sure babe is able to effectively gain weight, we can be a little more relaxed but are still ensuring we are encouraging our milk production machine to run at a high level.
By 48-72 hours old your baby will be taking in 15-30ml per feed and by weeks end that quantity will be more like 30-60ml. That is a big jump from the 2-10mls from day 1. During weeks 2 and 3 the volumes per feed are more like 60-90ml per feed and by the time your baby is a month old, that volume is approximately 90-120ml per feed. This volume will stay steady until about 6 months of age when solids are introduced.
The above information is how things normally progress, stage by stage. As with anything though, there are hurdles and roadblocks that can get in the way. Some of those can be a difficult labour, separation, maternal or infant illness, infrequent/inefficient stimulation or pre-glandular concerns. There are tips and strategies for these situations though and why early support can be extremely beneficial.