Supply and Demand

As natural as it is, breastfeeding can often be confusing to a new mom. The colostrum may not look as you expected. Your baby may fall asleep before he gets anything to eat. Your breasts may become so engorged that they hurt. You may start to wonder if you’ll ever establish a good breastfeeding rhythm with your baby.

In reality, the efficient supply-and-demand rhythm of normal breastfeeding—in which your baby’s increased demand for milk spurs greater milk production from you and her diminished suck ling decreases your milk supply—nearly always takes a while to establish fully and requires readjustment as your baby grows.

As your baby’s suckling time increases, milk production will also increase. Her suckling stimulates nerve endings in your breast, sending a message to your brain that results in the release of the hormone prolactin. This plays a major role in stimulating milk to be created in your breasts using substances obtained from your bloodstream. While she breastfeeds, your prolactin levels surge, ensuring continued production of milk. If breastfeeding is decreased—if your infant is fed on a restricted schedule or given supplemental formula, water, sugar water, or even a pacifier to satisfy her suckling urge—your milk production will decrease accordingly.

Continued milk production depends not only on how much your baby suckles but also on how much milk she actually removes from your breast. If you were to breastfeed from only one breast, for example, the other breast would stop producing milk even though the hormones stimulated by nursing affect both breasts. This is one reason it’s a good idea to alternate which breast you use to begin nursing. A baby who takes only the nipple into her mouth, or who otherwise attaches incorrectly and doesn’t remove much milk, doesn’t stimulate that breast to continue producing an adequate supply of milk. In fact, the protein contained in the residual milk remaining in the breast actually suppresses further milk production. To prevent this from happening, it’s important to feed frequently from the very beginning.

The small early feedings are important to stimulate the greater milk production your baby will require in a few days’ time. Newborns are born with extra water in their bodies, and weight loss normally occurs in the early days as the baby gets rid of this extra water, so they do not need much additional fluid. As your baby’s need for fluid increases, a few days after delivery, your milk will increase in water (or fluid) content, and the composition of your milk will change. Over the next week or so, the protein content will decline and the fat and lactose content increase as your milk gradually changes color from yellow to creamy white. By ten days to two weeks after childbirth, your body will have begun producing fully mature milk, in even greater abundance than before. This watery white or bluish milk contains all the nutrients your baby needs and will increase and decrease in volume according to her fluctuating demands.

Just as when learning to drive a car we sometimes push the accelerator a little too hard and then not hard enough, it may take a while for your body to adjust to your child’s appetite changes. Many mothers are surprised to see how little colostrum is available initially and how much milk fills their breasts just a few days later. This increase in milk production can lead to a tight, overfull feeling called engorgement. The solution to this problem is to feed your infant frequently—eight to twelve times every twenty-four hours, around the clock—even if you have to wake her to nurse. If she sleeps for stretches of longer than four hours in the first two weeks, wake her for a feeding. If she continues to sleep this long at a stretch, repeatedly falls asleep soon after starting to breastfeed, or seems listless or has a weak cry, inform her pediatrician right away. Don’t wait until your baby cries to feed her; keep an eye out for early hunger cues such as smacking of lips, sucking on her hands, and increased activity. You may also need to express some milk by hand or with a pump to ease your discomfort and to soften the nipple and areola enough so that the baby can latch on.

Eventually (usually quite soon), your milk production will adjust to the level your infant currently requires. During periods when she feeds more frequently-usually in response to growthspurts—your milk production will increase. (Growth spurts most commonly occur at approximately three weeks, six weeks, three months, and six months of age, but this varies from baby to baby.) Your milk supply will decrease again when her feeding sessions decrease. You will become expert at having her suckle a little longer or more frequently when you are concerned that you may not be producing enough milk and adding a few brief “topping-off ” feedings on those days when you feel somewhat engorged. This ability to tailor your milk production to both her and your needs is one of the marvels of breastfeeding.