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How to Establish Breastfeeding to Maintain Milk Supply

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Many women struggle to maintain a strong milk supply and end up ceasing breastfeeding before they intend to do it, but you don’t have to. Read on to learn how to establish breastfeeding to maintain milk supply.

“Am I going to make enough milk for my baby”? That’s a common worry of new moms when they bring their babies home.

Research shows that at least 83% of new moms choose to breastfeed their babies (1). As time goes, a sharp decline occurs not only in full breastfeeding but also in partial breastfeeding each month after birth and only 50% babies are fully breastfed by 3 months.

One of the most common reasons given by mothers for supplementing or giving up breastfeeding is a perception of insufficient milk production (2,3).

While certain women can not maintain their milk supply due to biology of their breast, others just have to work harder – nurse or pump more often – to make same mount of milk.

The purpose of this article is to guide new mothers on how to establish breastfeeding at each stages of lactation in order to maintain strong milk supply for long term.

This article will help you on how to successfully establish breastfeeding/pumping to maintain milk supply and guide you to helpful resources, plus provide sample breastfeeding and pumping schedule.

Let’s first understand,

How is Milk Supply Regulated?

To understand how milk supply is regulated, it is important to know three stages of milk production. In order to maintain milk supply long term, breastfeeding and/or pumping frequently throughout these lactation stages is crucial to successfully establish breastfeeding.

Let’s look at three stages of milk production and how milk supply is regulated at each phase.

  1. During third trimester of pregnancy and in the first few days after the birth of your baby, your breast produces colostrum. Quantity of Colostrum produced initially is low because of high level of hormone progesterone present throughout pregnancy.
  2. Soon after your baby is born and placenta is delivered, estrogen and progesterone levels drop dramatically and prolactin level increases significantly. which is when your initial milk comes in at 1-3 days.
  3. Then after, the milk production process switches to breastfeeding supply and demand cycle meaning amount removed from the breast by baby or breast pump is equally proportional to amount of milk produced by your breast.

Initial two stages of milk production are regulated by hormones and as hormonal effects taper off, milk supply is regulated by supply and demand cycle.

Most important thing to remember when you are establishing your breastfeeding is that your breast makes milk on supply and demand basis. How often and how much milk you remove from your breast by nursing or pumping (demand) is directly proportional to how much milk your breasts going to make (supply).

So during each stage of milk production, it is important to continue frequent breastfeeding or pumping to give your body a signal to make enough milk.

Why It Is Important to establish Breastfeeding Right Away?

  • It starts supply and demand feedback cycle, which is very essential to establish initial milk supply.
  • Your baby starts receiving colostrum (initial milk), which is incredible nutritional source for your baby, and it provides protection against infection and disease.
  • It can make mother confident about breastfeeding
  • Your baby starts learning sucking right away
  • Research studies also suggest that’s breastfeeding initially set the groundwork for maintaining your milk supply for later (4,5).
  • Baby’s digestion and bowels are stimulated
  • Establishing breastfeeding right away has non-nutritive benefit to newborn. When you are breastfeeding your newborn, you are holding them skin-to-skin, which helps them regulate their body temperature and blood glucose level (6), helps infants cope with pain (7) and also reduces level of stress hormone in newborn (8).

Tips and Tricks to Establish Breastfeeding to Maintain Milk Supply

1. Feed, Feed and Feed

For the first 3-4 weeks, nursing is your priority. Feed your baby on demand rather than sticking to every 2-3 hours feeding schedule (9). Remember- more you feed, more milk you will make!

Look for hunger cues -smacking lips, sucking on hands, crying, searching for breast.

Your baby is efficient in emptying your breast than any pump available in the market. Avoid pumping unless it is recommended for medical reason or you are away from your baby.

2. Breastfeed at Night

During the first few days after birth, it is very important to feed baby during night specially while you are still in initial building phase of lactation to maintain your milk supply.

Reason being hormone responsible for milk production (prolactin) is present at higher level at night. So nursing at this time can boost your milk supply.

3. Lots of skin-to-skin

For the first few weeks, keep your baby skin-to-skin as much as you can. As mentioned above keeping baby skin-to-skin not only help them breastfeed better, but also keep them calmer and they have better blood sugar level.

4. Keep them awake

Babies are very sleepy in the first few days. They are awake only for 2-3 hours per day. You may need to wake your newborn if they fall asleep at the breast to ensure they are getting enough amount of milk at feeding.

Try tickling them, changing diapers, undressing your baby to keep them nursing. Try switch nursing (more on it below) to keep them awake.

5. Offer Both Breasts at each Feeding

At each feeding offer both breasts. If you think that your baby is not draining your breast well, offer both breast at each session. Make sure to alternate the breast you start breastfeeding on each time you feed your baby since the first breast usually gets more stimulation.

While you are switching breast, don’t forget to burp them to avoid gas pain in babies.

6. Switch Nursing

If it is hard to keep your baby awake during nursing session, try switch nursing. Instead of letting your baby drain the breast and does off, switch to another breast when their intensity of suck diminishes.

While switching them to another breast, sit them up, burp them and offer another breast. You can do this 2-3 times at each feeding session. This will ensure both breasts to make enough milk at each feeding.

7. Check your Baby for proper latch

Baby can efficiently drain your breast when they are latched on properly. Make sure baby’s mouth is wide open before they latch on to your breast. If your baby is not latching on correctly, get a help from lactation consultant.

8. Sore Nipple

It is normal to have sore nipple in the beginning. But if you have pain while breastfeeding or cracked nipple, it is a sign of poor latch. If it is not addressed on time, it may increase your chances of clogged milk duct or mastitis. Check with your lactation consultant for any pain in your nipple. Use Nipple crème from day one to save yourself from nipple pain.

9. Breast compression

To get your baby interested in nursing or wake up a sleepy baby, use breast compression to keep milk flowing when baby is nursing. Check out this video to learn this technique.

 

10. Avoid supplementing

Before your breastfeeding is well established avoid pacifiers and bottles. It might decrease your milk supply.

In order to establish your milk supply, you need to empty your breast and your baby is best at emptying your breast than breast pump.

If you need to add pumping session to your breastfeeding to boost your milk supply, always do it after you are done feeding your baby (more on it below).

11. Don’t stress about building your Freezer Stash

If you are going to be away from your baby for few hours, or start working, you need a little freezer stash to feed your baby while you are away.

Don’t get carried away with other moms bragging about having a thousand ounces of frozen breast milk.

You can start pumping 2 times a day after feeding your baby to build your freezer stash (Breastfeeding and pumping schedule below).

12. Your baby is getting enough milk

If your baby is gaining 155-240 grams or 5.5-8.5 ounces weight per week until four months of age and have enough wet and dirty diapers than you can tell that they are getting enough breast milk.

Look for one wet diaper at day one, 2 wet diapers at day 2 and 3 wet diapers at day 3. By the time your baby is five days old, she will have more frequent wet diapers around 5-6 a day.

Baby’s stools transition to yellow with a loose and seedy texture by day five. Baby should have 3-4 stools every day by four days of age.

13. Get as much help as you can

Breastfeeding is hard and you don’t have to do it alone. Ask help from your partner or family members to take care of chores around the house for the first few days so you can concentrate on establishing breastfeeding.

Join a local breastfeeding support group or take a help from experienced mom friends.

14. Avoid Stress

Breastfeeding in the first few days can be stressful. Getting accustomed with life with a newborn and breastfeeding around the clock can stress you out. But when you are establishing breastfeeding and maintaining your milk supply, taking care of yourself is very important.

It may be hard to get a straight 8 hours of sleep when you have a newborn but try to sleep when your baby sleeps.

Frequent stress can actually suppress milk production and reduce your milk supply, so try to get plenty of rest when you can and take care of yourself.

How to Establishes Breastfeeding to Maintain Milk Supply?

Baby’s need for breast milk and mother’s ability to produce just the enough milk is nature’s greatest example of the law of supply and demand. Knowing how to avoid things that upset the balance of supply demand is important when establishing breastfeeding to maintain milk supply.

Here are important things to consider when establishing and Maintaining your Milk supply.

Prepare Yourself for Breastfeeding Before your Baby Arrives

The biggest mistake that new moms-to-be makes that jeopardize their chances of breastfeeding success is leaving everything to nature instead of being well-prepared.

Breastfeeding comes with lots of challenges in the first few days and you are highly likely going to make common breastfeeding mistakes if you are not prepared for it.

Learning as much as you can about breastfeeding before your baby is born is very essential to build confidence and realistic expectations about breastfeeding. Gaining valuable knowledge about breastfeeding can help you breastfeed most efficiently when your baby arrives.

One of the most valuable resource to learn about breastfeeding before arrival of your baby is taking this Breastfeeding class. This class with prepare you on how your milk production works to how to latch your baby to breastfeeding position to deal with common breastfeeding issue.

Read my full review on Best Online Breastfeeding Class for New Mom here

Knowledge you gain here will ensure that your milk has been completely and efficiently removed from your breast during each feeding or pumping session, as this is the most important factor in order to produce sufficient amount of milk for your baby and maintaining your milk supply overtime.

Related article: How to Prepare for Breastfeeding Before Birth

Breastfeeding in the first Hour

Research studies suggests that initiating feeding within an hour of childbirth helps ensure increased milk volume in subsequent days (10).

Here is what you need to do;

  • Keep your baby skin-to-skin with you right after birth
  • Watch out for early feeding cue
  • Delay newborn check ups and test until after first breastfeeding
  • Colostrum (initial milk) is nutrient dense and your baby do not need much at the first hour and other feedings that day.

Related article: Breastfeeding in the first few days: Make it a positive experience

Breastfeeding in First 24 hours

It is normal for babies to become very sleepy after their first feed. It is important to wake your baby every three hours for a feed.

Here is what you need to keep in mind;

  • Feed your baby on demand rather than fixed schedule and do not limit their feed
  • Feeding may last up to 40-45 min initially
  • Offer both breast at each feeding.
  • Let your baby empty first breast before offering another breast
  • Learn the best breastfeeding position to get a proper latch
  • Make sure their latch is perfect
  • If their latch is not perfect, unlatch them and try again
  • Do not offer pacifier or bottle until breastfeeding is well established
  • Do not supplement your baby with formula until it is absolutely necessary
  • Be patience, you and your baby will learn breastfeeding slowly
  • Trust yourself – you can make enough milk for your baby
  • If you are separated from your baby, pump your breast to make up for feeding session and store your milk

Breastfeeding in the First week

Once you are home with your baby, get accustomed with life with a newborn. In the first few weeks, you will spend most of your time feeding and taking care of your baby.

Here are the things to keep in mind;

  • Keep your baby skin-to-skin as much as you can
  • Remember that breastfeeding is your priority
  • Continue to co-sleep safely so you can get some rest to speed up your postpartum recovery
  • Watch for hunger cues – smacking lips, crying
  • Feed your baby on demand
  • Find a most comfortable breastfeeding position to feed your baby
  • Check if your baby is latched on correctly
  • Sore nipple can be sign of poor latch
  • Keep yourself hydrated
  • Eat nutritious food regularly
  • Be patience – you and your baby will get a hang of breastfeeding soon
  • Call lactation consultant if you have any concern or if your baby is not getting enough milk
    • For Canada, Click here to find Lactation Consultant in your area
    • For USA, Click here to find Lactation Consultant in your area

Do I need a Breastfeeding Routine?

For the first few weeks, it is best not to have breastfeeding routine. Let her be your guide and feed her on demand rather than sticking to every 2-3 hours feeding schedule (11).

When you are establishing your breastfeeding, it is best to stay flexible and offer breast to your baby when she shows hunger cues. On demand feeding also help you increase your milk supply to meet your growing baby’s nutritional needs.

As your baby grows older, a breastfeeding routine schedule will evolve naturally. Your baby may go longer stretches between feedings.

Your baby’s 2-3 month breastfeeding schedule may look like this,

5 AM – Feed
7 AM – Feed
9 AM – Feed
11 AM – Feed
1 PM – Feed
3 PM – Feed
5 PM – Feed

7 PM — Feed

9 PM — Feed
11PM — Feed
+ 1-3 night feedings

Do I Need A Breast Pump to Establish and Maintain Milk Supply?

It is good to have a breast pump available when needed, but not everyone needs it. A breast pump is needed

  • If your baby is premature or not nursing well. A good quality breast pump is must to establish and maintain milk supply.
  • If you need to increase your supply
  • If you plan to be away from your baby for more than a couple of hours
  • If you plan to return to work
  • If you can not breastfeed and you want to feed your baby expressed milk

In any of the above situation, if your infant is not draining the breasts adequately or with sufficient frequency, you need a breast pump.

How to use Breast Pump to Establish and Maintain Milk Supply?

Including pumping session into your breastfeeding routine will help establish and improve your milk supply. As mentioned above, milk producing hormone -prolactin level is higher at night so including pumping session after first feeding in the morning will boost your milk supply drastically.

Pump after Feedings

Try pumping 2-3 times after feeding session. You should pump until last drop of milk drains from your breast, then continue for additional five minutes to stimulate your breast.

Power Pump

if you suspect your milk supply is very low  then try power pumping. It happens for one hour only once a day at same time every day. You can do it for few days to signal your body to make more milk. This is how it works,

  • Pump 20 minutes
  • Rest 10 minutes
  • Pump 10 minutes
  • Rest 10
  • Pump 10

Pump Both Breast Simultaneously

Research has shown that pumping both breasts simultaneously rather than one breast at a time not only saves time but also increase milk yield. Simultaneous pumping was also shown to be associated with more milk ejections, more efficient and more effective milk removal and improved drainage of the breasts (12,13). Use double electric breast pump like THIS one to pump both breasts simultaneously.

You can also use this Silicon Hakka cup to catch leaking breast milk from the breast that is not being nursed on. Instead of the breast milk leak out into a breast pad, catch it using this silicon cup and add it to your freezer stash.

Research has also shown that breast massaging combined with breast pumping can increase the amount of expressed milk (14).

Below is a sample newborn breastfeeding and pumping schedule to give you a better idea of how to go about including pumping into your breastfeeding sessions.

5 AM Breastfeeding – Pumping 10 min

7 AM – Breastfeeding

9 AM – Breastfeeding
11 AM – Breastfeeding – Pumping 10 min
1 PM – Breastfeeding
3 PM – Breastfeeding
5 PM – Breastfeeding
7 PM – Breastfeeding
9 PM – Breastfeeding
11 PM – Breastfeeding – Pumping 10 min

+ 1-3 night feedings

What are the Signs of an Established Milk Supply?

It takes up to 12 weeks postpartum to establish milk supply in majority of cases. When your supply regulates, you may notice the following:

  • Your breast will feel softer
  • You don’t leak that often
  • You don’t feel engorgement or less frequent

When your milk supply is established, your body will only produce enough amount of milk that you remove from your breast through nursing or pumping. If you skip nursing session before your milk supply is established, you may notice decrease in your milk supply. So it is important to feed your baby on demand when you are trying to establish your milk supply.

What Should You Do If Your Milk Supply is Established and You Lose Supply?

It could happen if you are not careful in the first few weeks about supply and demand cycle. But do not freak out, you can still maintain your milk supply with following tips.

  • If you are not on a breastfeeding or pumping schedule yet, get on one now. Make sure you are including enough breastfeeding sessions (every 2-3 hours) and pumping schedule (2-3 times a day for 10-20 min after feeding your baby) as shown above.
  • Take a galactogogues in addition to feeding or pumping schedule. Oatmeal, Fenugreek, Mother’s milk tea and other beverages can be helpful in boosting your milk supply.

Final Thoughts

Here you go mamas!! I hope you are taking away many helpful tips on how to establish breastfeeding and maintain milk supply for this article.

Breastfeeding isn’t as natural as intended it to be, but comes with a steep learning curve for both moms and babies.

Breastfeeding can be sometime challenging, but with adequate knowledge of hows and whys of breastfeeding, you can establish breastfeeding and maintain your milk supply for long run.

So, don’t let yourself go into this bumpy journey without taking Some form of breastfeeding training – like this Best Online Breastfeeding class by Milkology before your baby is born or at least while they are still very little.

How About You?

Do you have any tips to establish breastfeeding to maintain milk supply? Please leave your comment below.

References:

  1. Centers for Disease Control and Prevention, 2018; https://www.cdc.gov/media/releases/2018/p0820-breastfeeding-report-card.html
  2. Amir, L. H. (2006). Breastfeeding–managing ‘supply’ difficulties. Australian Family Physician, 35(9), 686–689
  3. Gatti, L. (2008). Maternal perceptions of insufficient milk supply in breastfeeding. Journal of Nursing Scholarship, 40(4), 355–363
  4. de Carvalho, M., S. Robertson, R. Merkatz, and M. Klaus. 1982. Milk intake and frequency of feeding in breastfed infants. Early Hum. Dev. 7:155-163.
  5. Salariya, E.M., P.M. Easton, and J.I. Cater. 1978. Duration of breastfeeding after early initiation and frequent feeding. Lancet 2:1141-1143. [PubMed]
  6. Anderson GC, Moore E, Hepworth J, Bergman N. 2003. Early skin-to-skin contact for mothers and their healthy newborn infants (Cochrane Review). In: The Cochrane Library, Issue 2 2003.
  7. Kostandy R, Anderson GC, Good M. 2013. Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-termneonates. Neonatal Netw. 32(4):274-80
  8. Beijers R, Cillessen L, Zijlmans MA. 2016. An experimental study on mother-infant skin-to-skin contact in full-terms. Infant Behav Dev. 2016 May;43:58-65.
  9. KidsHealth (Nemours). Breastfeeding FAQs: How much and how often. Updated November 2019.
  10. Liu Y, Yao J, Liu X , Luo B, Zhao X. 2018. A randomized interventional study to promote milk secretion during mother-baby separation based on the health belief model: A consort compliant. Medicine (Baltimore). 97(42):e12921
  11. KidsHealth (Nemours). Breastfeeding FAQs: How much and how often. Updated November 2019.
  12. Prime, D. K., Garbin, C. P., Hartmann, P. E., & Kent, J. C. (2010). A comparison of simultaneous and sequential breast expression in women. Journal of Human Lactation, 26(4), 433.
  13. Prime, D. K., Geddes, D. T., Spatz, D. L., Robert, M., Trengove, N. J., & Hartmann, P. E. (2009). Using milk flow rate to investigate milk ejection in the left and right breasts during simultaneous breast expression in women. International Breastfeeding Journal, 4, 10.
  14. Morton, J., Hall, J. Y., Wong, R. J., Thairu, L., Benitz, W. E., & Rhine, W. D. (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, 29(11), 757–764

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