Milk Supply: How Do I Know if My Newborn Baby is Getting Enough Breast Milk?

Once your newborn is at least 6 days old, there are some guidelines to help you be sure of your milk supply.  Note that insufficient milk supply is rare.  What is more common are practices that can hinder your milk supply or baby's feeding which I will detail at the end of this post.

To assess good milk transfer, answer the following:

1. Is the baby wetting 6-8 diapers in 24 hours? (Disposable diapers are so absorbent, that it might be hard to tell.  If you are unsure, take a clean diaper in one hand and the removed diaper in the other and you should be able to tell by the slight weight difference.)
   Yes  |  No
2. Is the baby having 3-4 bowel movements in 24 hours that are mustard yellow with curds in them? (These shold be silver dollar size or larger, not just a stain.)
   Yes  |  No
3. Do the breasts feel full before feeding and softer after feeding? 
4. Yes  |  No
5. Do you hear swallowing when the baby is breastfeeding?
   Yes  |  No
6. Is the baby eating at least 8 times in 24 hours?
   Yes  |  No
7. Does the baby seem satisfied after a feeding?
   Yes  |  No
8. After the initial weight drop, has your baby started gaining 3/4 - 1 ounce per day?
   Yes  |  No                                                               
9. If tyou had some nipple soreness, is gone?                                                                                    Yes  |  No

Practices that hinder milk supply include "scheduling".  Making an infant wait for feedings, lowers milk supply and slows weight gain.  Infants may need to eat at 1-3 hours apart during the day, especially between day 10 and three weeks when the first grown spurt occurs.  The only scheduling that should occur is if the infant has not asked to be fed at the 3 hour mark from the beginning of the last feeding, it is time to nurse.  A mininum of eight times a day is normal for a newborn.  The longest stretch you could hope for is one 5 hour stretch.  It is common for newborns to feed up to 12 times per day during a grown spurt.  This practice ensure a healthy milk supply for a growing baby as milk supply follows a demand and supply principle.

Other practices that can hinder milk supply are the use of a nipple shield.  While they have a time and place to assist in latch.  They are not a cure for sore nipples and should not be used unless necessary and discontinued as soon as possible.  When using a nipple shield, a cut out ultra thin silicone nipple shield is best.  Place the cut out at the baby's chin so that the skin to skin can elevate your hormone response which increases milk supply.

Another practice than can reduce milk supply is unresolved engorment.  When the milk first comes in 3-5 days postpartum, softening the breasts with warm moist heat from a compress or disposable diaper doused with hot water and warmed in the microwave is essential before nursing or pumping so that milk is more effectively extracted.  Milk that is not extracted actually reduces milk supply as your body is being signaled that you do not need the milk.  That is why the practice of waiting for an insurance pump is not the best idea.  If your insurance company will not allow you to get a pump until after the birth, go with a private pay DME.  That way, you can order the breast pump on the day of the baby's birth and it will be at your doorstep between 3-5 days when you need it most.  You then have to file for reimbursement with your insurance company, but it beats waiting around for a company to bill your insurance and you may not have your pump when you need it most. 

Here is to a Healthy Milk Supply, Mamas!
Tanya

Breast Shield Size - Do You Need a Small 15 mm or 19 mm Breast Flange?

Recently, we have been researching the effectiveness of small breast flanges for moms who are trying aftermarket brands in 15mm.  Most manufacturer's do not offer flanges that small.  This mom in particular was having difficulty because even a 15mm was too large.  A smaller flange can often be too large if too much of the areola is being pulled in and the milk sinuses are not being compressed properly at the breast shield.
This problem can ofte be solved with a silicone insert or silicone breast shield.  So where a 15mm plastic flange may be too large, a 15-19 mm silicone breast shield such as the x-small and small super shields by Pumpin' Pal will work very well.  The reason is the material.  Silicone helps hold the breast tissue in place whereas the hard plastic flange will allo the tissue to be draw in too far.
If you have tried a silicone shield, and still need to the areola to be held in place more efficiently, rolling the silicone so that it suctions to the breast is often the answer.  See the image below which is from Pumpin' Pal's 2018 Quick Start Instruction Guide.

Not only are the SuperShields angled for a more comfortable pumping position, they are available in x-small 15-19 mm breast shields and small 20-23 mm breast shields in silicone for better adhesion to your breast.

These are now also available for use with popular Spectra breast pump when using the Spectra flange adapter.

Here is to better pumping!

Tanya

Troubleshooting: When to Replace Breast Pump Parts & Accessories

If your breast pump is not suctioning the way it used to, the problem often lies in one of two breast pump parts.  Most breast pumps have a valve plus a diaphragm, filter or backflow protector.  The number one cause of low suction is a dirty, torn or worn out valve.  If you valve is the type that has a valve head and membrane shown here, it is imperative that you remove these parts when cleaning.  The valve membrane will retain a build up that decreases the suction.  Taking the membrane apart from the head is essential to remove this build-up.  If you see that the membrane will no longer close completely with the head or if it has a tear, replace it as soon as possible.

If your breast pump has a duckbill valve (shown below) which in most cases is a clear or white valve, the tip of the duckbill must be able to close completely.  If it remains open, the amount of pressure your pump can provide is decreased.  As a rule, if you are pumping three times per day or more, replace duckbill valves every six to eight weeks at minimum.  This is a small maintenance expense that will reward you in the dividend of a healthier milk supply.

One example of essential breast pump parts that need replacement are the Spectra S2 parts that include the white duckbill valve and the backflow protector.  These two parts are the most commonly replaced parts for Spectra breast pumps and if either of these parts is used for longer that eight weeks, the amount of pressure your breast pump has can be decreased.  The longer you use a breast pump with parts that are not functioning at capacity, the greater the chance of decreasing milk supply.

The most commonly replaced parts for each brand are listed below:

Spectra - duckbill valve, backflow protector
Ameda - duckbill valve, diaphragms

Motif - duckbill valve, diaphragms 
Hygiea - duckbill valve, bacteriostatic filter
ARDO - duckbill valve, membrane pot
PJ's Limerick - micron filter, silicone gasket
Bailey Nurture III - filter

Breast pumps that do not have closed systems such as Medela do not need parts replaced as often, but open system can lead to exposure of bacteria to breast milk so we do not recommend these pumps.

Lactation Connection offers subscription services for replacement parts on our most popular brands so that you don't forget to replace them on a regular basis.  We only sell authentic manufacturers parts for Spectra, Ameda, Hygeia, ARDO, Limerick, Bailey, Rumble Tuff and BelleMa to ensure quality of performance in your breast pump.

Salud! Here is to a healthy milk supply!
Tanya