Tuesday, February 27, 2018

Milk Supply: How Do I Know if My Newborn 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 absorbant, 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!

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