Lactation 101
The key ingredient to successful nursing is patience. It is a learning curve for both Mom and Baby! Every mom and baby are different and so different things work for different people. It is important to have the right expectations, a basic understanding and access to resources when starting to nurse to make it as successful for mom and baby as possible.
Milk Supply:
It seems that one major factor of why mom's choose to discontinue nursing is because they think they have insufficient milk supply.
The cycle of how breast milk is produced:
Lactogenesis I is initiated by giving birth and results in colostrum being released, which lasts for 2 days (1) Colostrum is a very nutrient rich high in protein, low in sugar and fats that is only produced in small amounts (see blog post) (5). This may lead a mother to assume she is not making enough milk supply. It takes a few days for the consistency of the colostrum to change from a thicker, yellowish texture to creamy white more milk like consistency. Lactogenesis II follows 40 hours after birth as a result of prolactin release and the infant sucking on the breast, which releases oxytocin and allows the milk to let down (1). When this happens it is also known as the "coming in" of milk and the milk is called "transitional milk" (5). During this stage the body should start making 500-1000 mL (17-33 ounces) of breast milk a day (1). During the nursing process feedback inhibitor of lactation (FIL) collects in the breast eventually causing the blockage of prolactin (1). Lactogenesis III is the process of the breasts being emptied and then filled as a result of the infant nursing and stop nursing (1).
The breast milk adjusts to the babies digestive capabilities over time and keeps doing so. Once the milk comes in your breast may often feel engorged making it hard for your baby to nurse. To help this you may want to have a pump ready to express some milk and alleviate the pain and engorgement.
The biggest impact on increasing milk supply is the stimulation of the infant suckling on the mothers breast. It is important to take care of yourself! You need to rest whenever you can and eat a well balanced diet as well as drink lot's of water.
Once parents bring their baby home they find themselves with many questions and often on new terrain. To make this transition easier especially in regard to nursing questions or nursing trouble, seek out the help of a lactation consultant or visit a nursing group in your community. The hospital you delivered in or the La Leche League may be able to help you find the support you need. The benefits of the group environment are that you will also be able to meet other mom's who are going through the same thing.
Findings in studies of how mother's view their milk supply and how much it is a factor in terminating nursing:
According to one study the three top reasons why mother’s chose to cease nursing their infants between 1-2 months of age were ‘Baby had trouble sucking and latching on’, 'Breast milk alone did not satisfy my baby’ and ‘I didn’t have enough milk’ (2). The two top reasons for mothers to stop nursing their infants of 3-8 months of age were the how the mother viewed her infant satisfaction by breast milk exclusively and concerns about the mother’s milk supply (2). At age 9 months at up mother’s reported that as the top 3 reasons that ‘breast milk alone did not satisfy the baby’, ‘baby began to bite’ or ‘baby lost interest in nursing or began weaning’ (2). According to this study most frequently mentioned were lactation and nutritional reasons that lead mothers to cease nursing. One of the interventions that was most successful in extending the time a mother would nurse was to seek out help from a lactation consultant (2).
According to the study "Nursing Trouble" 2-5 % of mothers fall under primary nursing insufficiencies, where the body cannot make enough milk to properly nurture a baby and is often caused by surgery, hormonal imbalances and breast tissue issues among others (3). In these cases women do often have no other chance than to supplement feed their infants. The secondary nursing insufficiencies effect 10-15% of women and are considered breastfeeding problems like for example milk let-down difficulties, damaged nipple tissue and an infant’s problems to suckle (3). These problems are easier to overcome with proper help though they can also contribute to the milk supply depletion if they are not overcome. The study further suggests that herbal supplements may be a solution for some nursing mothers (3).
Another study focused on a mothers “Perceived Insufficient Milk Supply” in relation to a mother’s “Insufficient Milk Supply” (4) The subjective assessment of mothers on their milk supply and their infant’s satisfaction hugely impacted their decision to either stop nursing or start supplementing with formula. This was especially obvious when they mother’s ended the weigh in period with the baby, where a scale could reassure them that the baby was getting adequate milk from them. The mother’s own satisfaction and confidence in their ability to nurse had a great impact on their perceived insufficient milk supply judgment. An interesting finding was that 16.7% of the population stopped nursing before leaving the hospital because of their perceived insufficient milk supply (4). At this time the body is still transitioning between lactogenesis I and II, where it switches from producing colostrum to milk and a huge increase in milk supply is immanent (4). The results of this study lead correlate the important of proper lactation education in the hospital settings (4).
It seems that one major factor of why mom's choose to discontinue nursing is because they think they have insufficient milk supply.
The cycle of how breast milk is produced:
Lactogenesis I is initiated by giving birth and results in colostrum being released, which lasts for 2 days (1) Colostrum is a very nutrient rich high in protein, low in sugar and fats that is only produced in small amounts (see blog post) (5). This may lead a mother to assume she is not making enough milk supply. It takes a few days for the consistency of the colostrum to change from a thicker, yellowish texture to creamy white more milk like consistency. Lactogenesis II follows 40 hours after birth as a result of prolactin release and the infant sucking on the breast, which releases oxytocin and allows the milk to let down (1). When this happens it is also known as the "coming in" of milk and the milk is called "transitional milk" (5). During this stage the body should start making 500-1000 mL (17-33 ounces) of breast milk a day (1). During the nursing process feedback inhibitor of lactation (FIL) collects in the breast eventually causing the blockage of prolactin (1). Lactogenesis III is the process of the breasts being emptied and then filled as a result of the infant nursing and stop nursing (1).
The breast milk adjusts to the babies digestive capabilities over time and keeps doing so. Once the milk comes in your breast may often feel engorged making it hard for your baby to nurse. To help this you may want to have a pump ready to express some milk and alleviate the pain and engorgement.
The biggest impact on increasing milk supply is the stimulation of the infant suckling on the mothers breast. It is important to take care of yourself! You need to rest whenever you can and eat a well balanced diet as well as drink lot's of water.
Once parents bring their baby home they find themselves with many questions and often on new terrain. To make this transition easier especially in regard to nursing questions or nursing trouble, seek out the help of a lactation consultant or visit a nursing group in your community. The hospital you delivered in or the La Leche League may be able to help you find the support you need. The benefits of the group environment are that you will also be able to meet other mom's who are going through the same thing.
Findings in studies of how mother's view their milk supply and how much it is a factor in terminating nursing:
According to one study the three top reasons why mother’s chose to cease nursing their infants between 1-2 months of age were ‘Baby had trouble sucking and latching on’, 'Breast milk alone did not satisfy my baby’ and ‘I didn’t have enough milk’ (2). The two top reasons for mothers to stop nursing their infants of 3-8 months of age were the how the mother viewed her infant satisfaction by breast milk exclusively and concerns about the mother’s milk supply (2). At age 9 months at up mother’s reported that as the top 3 reasons that ‘breast milk alone did not satisfy the baby’, ‘baby began to bite’ or ‘baby lost interest in nursing or began weaning’ (2). According to this study most frequently mentioned were lactation and nutritional reasons that lead mothers to cease nursing. One of the interventions that was most successful in extending the time a mother would nurse was to seek out help from a lactation consultant (2).
According to the study "Nursing Trouble" 2-5 % of mothers fall under primary nursing insufficiencies, where the body cannot make enough milk to properly nurture a baby and is often caused by surgery, hormonal imbalances and breast tissue issues among others (3). In these cases women do often have no other chance than to supplement feed their infants. The secondary nursing insufficiencies effect 10-15% of women and are considered breastfeeding problems like for example milk let-down difficulties, damaged nipple tissue and an infant’s problems to suckle (3). These problems are easier to overcome with proper help though they can also contribute to the milk supply depletion if they are not overcome. The study further suggests that herbal supplements may be a solution for some nursing mothers (3).
Another study focused on a mothers “Perceived Insufficient Milk Supply” in relation to a mother’s “Insufficient Milk Supply” (4) The subjective assessment of mothers on their milk supply and their infant’s satisfaction hugely impacted their decision to either stop nursing or start supplementing with formula. This was especially obvious when they mother’s ended the weigh in period with the baby, where a scale could reassure them that the baby was getting adequate milk from them. The mother’s own satisfaction and confidence in their ability to nurse had a great impact on their perceived insufficient milk supply judgment. An interesting finding was that 16.7% of the population stopped nursing before leaving the hospital because of their perceived insufficient milk supply (4). At this time the body is still transitioning between lactogenesis I and II, where it switches from producing colostrum to milk and a huge increase in milk supply is immanent (4). The results of this study lead correlate the important of proper lactation education in the hospital settings (4).
References:
1. Zapantis A, Steinberg J, Schilit L. Use of Herbals as Galactagogues. Journal Of Pharmacy Practice [serial online]. April 2012;25(2):222-231. Available from: Academic Search Premier, Ipswich, MA. Accessed October 18, 2014.
2. Ruowei L, Fein S, Jian C, Grummer-Strawn L. Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the First Year. Pediatrics [serial online]. October 2, 2008;122:S69-S76. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
3. Greenberg S. Nursing Trouble. Newsweek [serial online]. March 2, 1999;133(9):24. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
4. Gatti L. Maternal Perceptions of Insufficient Milk Supply in Breastfeeding. Journal Of Nursing Scholarship [serial online]. 2008 4th Quarter 2008;40(4):355-363. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
5. Meek J, Tippins S. New Mother's Guide to Breastfeeding. American Academy of Pediatrics. 2002: 22-23
1. Zapantis A, Steinberg J, Schilit L. Use of Herbals as Galactagogues. Journal Of Pharmacy Practice [serial online]. April 2012;25(2):222-231. Available from: Academic Search Premier, Ipswich, MA. Accessed October 18, 2014.
2. Ruowei L, Fein S, Jian C, Grummer-Strawn L. Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the First Year. Pediatrics [serial online]. October 2, 2008;122:S69-S76. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
3. Greenberg S. Nursing Trouble. Newsweek [serial online]. March 2, 1999;133(9):24. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
4. Gatti L. Maternal Perceptions of Insufficient Milk Supply in Breastfeeding. Journal Of Nursing Scholarship [serial online]. 2008 4th Quarter 2008;40(4):355-363. Available from: Academic Search Premier, Ipswich, MA. Accessed October 17, 2014.
5. Meek J, Tippins S. New Mother's Guide to Breastfeeding. American Academy of Pediatrics. 2002: 22-23