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I wanted to write this blog, so mothers can get a full sense of what it’s like to breastfeed and pump to increase, decrease, or maintain supply. Our second daughter Florence was born on Sept 9, 2023, in a hospital in Los Angeles. The birth was not straightforward and we were both hospitalized with blood infections, so pumping, dumping, and supplementing became part of our story. As a new Mom to our first daughter Lyla, I painfully discovered and shared that breastfeeding could be difficult. In spite of how complicated breastfeeding can become we really only need a single breast and a baby to succeed. Breastfeeding is naturally occurring, but a learned experience for mother and baby, so between children I decided to take a lactation counseling course.
What I found to complicate this relationship was my prior lack of basic breastfeeding knowledge and the voracious modern-day breastfeeding tools that confuse this rather straightforward process. We all have access to breastfeeding classes and social media to watch real-life videos of positioning, latching, and identifying babies’ hunger cues, so this article is not meant to replace those lessons. Rather it offers heartfelt knowledge from another mother and counselor to fill the gap on the anatomy of the breast, the role hormones play, and the composition of breast milk. In writing this I not only better defined my reasons to breastfeed, but also I learned how to support those around me, my WOMOM community, and my friends.
Congratulations on the birth of your baby! If you have added a request in your birth plan to have the first hour after birth alone with your baby it is time to initiate feeding. No matter the birth we most likely had interventions that have adverse risks to breastfeeding i.e. c-section offers a delayed start while an epidural can make them sleepy during the critical golden hour. Fortunately, when our second daughter Florence was born, she took to the breast efficiently and latched well. Even though, I asked the nurses to check for a tongue tie and lip tie in their observation as this is another inhibitor to their suckle. The first milk, colostrum, comes in as a tiny amount for the baby’s pea-sized stomach, yet provides everything it needs. It’s important to make sure you have skin-to-skin during these early feeds and that you are both comfortable. We are mammals, so touch and attachment are a fundamental part of our well-being. After the first couple of days when transitional milk, and eventually full milk, comes in the body will continue to create a timely amount with the exact nutrients the baby needs for as long as there is a demand.
So how do we feed our children? Beyond the anatomy of the breast, it’s important to address our natural bodily functions because the volume of breast milk or output is in response to how much demand there is. Are there two babies or more to feed? We could feed as many as needed if needed. Believe it! Your body begins to produce prolactin early in pregnancy; however, it is only until you birth the placenta that this hormone takes charge. Whether we give birth vaginally or via cesarean we have the same hormonal shift that prompts the breasts to start producing milk. There is no need to collect colostrum prior to delivery unless recommended by your doctor. When your baby suckles for about 30 seconds it stimulates the nerves that tell your body to release prolactin, which makes milk, and oxytocin, which causes muscle contractions that push out of the alveoli and through the milk ducts. This process is called ‘let down’. Stress and discomfort inhibit these hormones at work.
The baby communicates its needs when it latches through contact and the nipple pores. Demand is measured in frequency, duration, and strength. Frequency is how often you feed/pump as a session. Duration is how often and for how long you feed/pump in a session. Strength can be measured by how old the baby is and how strong the pump level is. For example, the demand I am putting on my body right now is much more than feeding only 8 times a day on the clock. As I have oversupply I need to maintain a good breastcare routine. Here are two examples from consecutive days.
*see ‘clogged ducts’ chapter for milk collector explanation
*using Medelda Pump in Style strength level 2 for 7 min
No wonder breastfeeding is a full-time job. The extra load on our bodies is tremendous, 600 additional calories to be exact. In the beginning, you will want to log on paper or by app the details of your feed. Otherwise, I just use a scrunchie to remember which breast I fed them last. Left hand, left breast. Now with my second baby, this all comes more intuitively. The days of colostrum are when our demand is being established. If we are feeding and pumping our body believes we have more demand and will make more milk. This is the first understanding of breastfeeding, supply = demand.
How often should we breastfeed? Typically a nurse will tell you to feed a newborn every 3 hours starting from when they eat for about 30-40 minutes in total. This creates a rhythm of feeding 8 times a day, so at minimum we should be bringing the baby to the breast or pumping 8 times a day. If we don’t we risk missing a critical window to substantiate the volume of breastmilk needed. Later on, once our supply is established we must continue this rhythm or risk being engorged for too long triggering mastitis. While pumping gives us the freedom to be away from the baby the rule of feeding every 3 hours means we need to be feeding/pumping throughout the night. Typically it takes the body around 3 days of a new demand to gradually adjust the milk volume output for the baby. If you want more supply, create more demand by increasing the frequency, duration, and/or strength and you will have more supply.
The most holistic practice especially when establishing supply is to feed on demand. Allowing the baby to demonstrate their hunger cues (freeing their arms) is key for this communication as when a baby is crying they’re already hangry. Think about it, as adults, we eat when we are hungry and not when the clock hits the hour. We eat when we are hungry because we get uncontrollably cranky. A newborn baby should eat every 3 hours at minimum, but of course, if the baby is showing hunger cues before then it should be allowed to be at the breast for an unlimited amount. While a baby mostly sleeps as a newborn (the first 3 months of life) this time should not be taken for granted. Staying home with the baby to avoid appointments, exercising, and working for this period of time to allow us to rest, heal, and establish a good feeding relationship.
Many of us believe our milk supply is low even though our supply is fine. A baby’s needs can be overwhelming and worrisome. Will I have enough? Am I doing enough? It’s difficult to stay on top of everything, but believe me you will regulate and you are creating exactly what your child needs in that moment. Not because you have a breast full of milk, which is not an indicator of having enough, but because your body creates exactly what it needs from moment to moment.
Our greatest supply is in the mornings when we are rested. Pumping just before a feed creates more demand as we are removing more milk from the breast than a baby would on their own. Another option would be to pump or manually collect on a breast when the baby is feeding on the other. More demand = more supply. I have found that a breast care massage during pumping also helps too. Hands-free breast pumps are extremely popular nowadays; however, they do not require touch which helps to stimulate the breast. When I am pumping my breast does not fit the flange shape, so I will lift the breast tissue into the flange area which helps to drain that area of milk.
If you suspect a low milk supply or want to speak with someone about breastfeeding a lactation counselor is the first person you should speak to. Take a look at this information page on increasing low milk supply for more information on whether your supply is really low, and ways to increase your milk supply without herbs or medications. I would not recommend increasing supply unless there is a planned separation from the baby i.e. you need to take a trip. If you are going back to work it is not necessary to have a full freezer of milk (there is no golden standard!). Typically a couple of days stored up is sufficient. A 6-month-old baby doesn’t require the components of a 3-month-old breastmilk. Whenever you are back make a point to latch as often as possible by only offering the breast and leaving the bottle to others. Babies communicate the amount of demand needed as soon as they latch, so there is no need to worry about increasing supply entirely. Pump when you are away and breastfeed when you are not. If the latch is good and the baby is eating efficiently, even with separation, we will always have enough to feed our baby.
If you are a mama with too much milk I see you. I wrote this article about handling oversupply with my first baby. Controlling demand and staying on top of breast health is key. As the baby gets older they will help you to remove enough milk to balance out. Until then the manual collector is your best friend. For me, the breast does not recognize the collector as a demand and can even out in a day or so after solely using it instead of pumping. When a baby can take more than a few ounces you can use the collector first to soften the breast, then let the baby feed. If they need more put them on to the other until they are full. The communication of the baby’s fullness on the other breast will communicate to your body that they are producing too much.
When they are young they are not as efficient with eating as they are sleepy, weaker, and cannot control their neck. Latching should never be painful and should be observed every time a baby takes to the breast. Asking the doctor to check for tongue tie, and lip tie while in the hospital is a good way to make sure the baby is clear to feed without any issues. Pressure from a bra, wearing a baby, or not draining the breasts fully at times from infrequent feedings or pumping can lead to blocked milk ducts.
The truth is we all get them. The best way to clear and maintain them is to pump/feed more frequently and until the breast is empty on the affected side, avoid tight clothes or bras, drink more water, and take sunflower lecithin. A cool compress can work to ease soreness and reduce inflammation as well as a silicone milk collector. I prefer Haakaa or Nature Bond. I like to feed or pump on one breast and simultaneously collect milk at the other. The stimulation by the baby/pump helps both sides let down and you can visually see the manual collector suctioning out the clogged ducts. If a milk duct is unblocking a stream or squirt of milk comes out of a nipple pore. Do save this milk as you may even get an extra full feed to store.
Breast is always best for babies, pumped or donor milk is second, and third is formula. As mothers, our circumstances are always different, so what is best for the baby is not always best for us. Of course, we all feel mom guilt sometimes as we are always trying to do our best and do what is expected of us; however, the reality is that we have to live, work, and take care of ourselves. With my second daughter, I had to pump and dump for 48 hours during her first few days of life and, because I didn’t have enough stored to feed her through that time, we supplemented with formula. Thinking back I could have asked for donor milk. Supplementation is the fastest and usually the easiest way to get your baby fed. Infant formula is, of course, a safe alternative to breast milk—and formula-fed babies also thrive. As they say ‘fed is best’.
For a myriad of reasons, this term refers to a baby who only drinks from the breast. A a huge commitment for the mother. For some reason, my first child gave up taking the bottle, and since I had an oversupply, I allowed her to take it from my breast exclusively. This required that she go everywhere with me and rely on me for everything. We became extremely connected, but also our bond didn’t allow for Daddy to care for her as much. Establishing supply can take months, so typically it is recommended to only introduce bottles in the first month if necessary. A baby’s suckle moves differently to remove milk from a breast than a bottle. Observing the baby on the breast, there is a nutritive suckle and a nonnutritive suckle. A nutritive suckle has a swallow every 3-5 suckles. On a bottle, there is a swallow for every suckle. Babies are smart. Even if they don’t recognise the difference in the beginning they will when they become more alert to efficiently modify their latch from breast to bottle. In any case, a mother should always do what is best for the family and the baby will fit in perfectly.
This is also a tough one for any mother. Pumping exclusively means the baby does not take to the breast, so there is no real-time feedback from the baby. This can affect the letdown, supply, and duration of feeding breastmilk. As we are in symbiosis when a baby latches if we are stressed, anxious, or worried about breastfeeding the baby will pick up our cues. Knowing our personal values when it comes to breastfeeding is something we may discover along the way. If it’s something we really want we will persist. If it isn’t, that’s okay too. There are plenty of ways to feed our babies.
Whenever possible it’s always best to eat real whole food, and this does not differ in the case of feeding our babies. A baby on breastmilk eats what we eat; however, their stomach lining is sensitive. Babies are gassy to varying degrees and need to be burped after every feed as newborns. Our pediatrician mentions that the most difficult weeks for this are weeks 6 & 7. Words like colic are easy to throw around, but if you simply have a fussy baby because they are gassy or are difficult to burp, then using gripe water and gaspasser will help to relieve them. The most common sensitivity is to dairy as a newborn, but can often be reintroduced into the mother’s diet at 3 months old. This is not a diagnosis for your child and you should always consult with your pediatrician before eliminating foods in your diet for baby or when considering formula.
Besides hormones, breast milk contains antibodies that pass from mother to baby. This is because breastmilk is alive, so it’s just not possible to try to recreate the precise composition of breast milk in infant formula. Our immune system is complex and works in many capacities. Natural antibodies are proteins that are the backbone of the immune system. It responds to viruses, bacteria, fungi, and parasites (also called pathogens) that you come across every day. Because the pathogens each person encounters are unique, each person’s antibodies are different than each other. As a mother and her child are often in the same environments and therefore exposed to the same pathogens this is a huge benefit for antibodies in breastmilk—they are customized to protect the baby against the specific pathogens they are most likely to be exposed to.
When the baby or I am ill I label the milk bag, so I can use that milk again when the baby needs an immunological boost when bottle feeding. Most medications are compatible with breastfeeding because only the tiniest amount if any would pass into the baby’s meal. Most drugs, in typical doses, appear to have no effect on a nursing baby at all. Others have a mild, temporary effect, and very few can be significantly harmful.
If a product has to have health claims to vouch for it then it is definitely not a healthy product. Think about it, there are no health claims to broccoli because there is no brand of broccoli to profit from. Stress and maternal mental health are huge contributors to formula use – some say financial status, but actually breastmilk is free. Rest assured that even a low-quality maternal diet produces high-quality breast milk. Even supplementation should be heavily considered as many of the reasons are not evidence-based. How do we know the baby will always get what they need? Simply through TRUST. Trust in our bodies and trust in our babies. I did have to supplement Florence during her time in the NICU which has flourished her gut microbiome making her sensitive to dairy and others. Without what-ifs and regrets, I will persist with breastmilk for as long as she and I mutually desire. Florence is almost 2 months now and I am beginning to regulate, meaning my body and brain are syncing with hers outside of my body. It took me 2 months to lessen my oversupply which brings me to believe we have more time than we think to settle into our new role of breastfeeding mama.
As with the decision to begin, it is entirely the mother’s decision on how long to breastfeed their children. It is recommended to breastfeed for 1-2 years but, in today’s modern world, 2 years is considered extended breastfeeding. Surprisingly I received hurtful comments from women who called it “overhyping breastmilk” when I shared that I was still breastfeeding at 9 months on social media. Still, I wrote a personal piece on weaning my first daughter Lyla at 19 months. For an hour, to a day, to a year from what we know about breastmilk, any amount is beneficial for a baby. With all I have shared hopefully, there is enough information to support a mother on her breastfeeding journey.
I hope you feel all my love and support.
*This article is written personally by Liv. Please consult your doctor if you need medical advice or a lactation counselor if you need personal assistance with breastfeeding.
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