Gina Penque
Center for Lactation @ Mt St Mary's Hospital IBCLC Lewiston, NY
How the Breast Makes Milk. For a look at the internal structures of the breast see: Anatomy of the Breast Lactogenesis Lactogenesis (the beginning of milk production) occurs in three phases. Stage I occurs about 12 weeks before delivery. There are increases in lactose, total protein, immunoglobulins and decreases in sodium and chloride content along with the gathering of substrates for milk production in the breast (Lawrence and Lawrence 65-66). The initiation of Stage II Lactogenesis begins with the sudden withdrawal of pregnancy hormones at the delivery of the placenta. Stage II occurs at 2 to 3 days postpartum, paralleling the time when "the milk comes in. " This stage includes increases in blood flow, oxygen, glucose and citrate in the breast.
Three major factors are necessary to maintain the milk supply: Neuro-Endrocrine Intact neuro-hormonal pathways Suckling, breast stimulation, Autocrine Milk Removal. Hormonal Controls of Lactation Prolactin Oxytocin Milk Ejection Response (Let-down) Supportive Hormones Colostrum. Hypoplasia/Insufficient Glandular Tissue. By Diana Cassar-Uhl, IBCLC Used with permission. “Maybe you just need to try a little harder.” “Have you tried fenugreek?” “You’re probably not drinking enough water.” Mothers who struggle with milk production hear advice like this from well-meaning friends and family members (and sometimes, from breastfeeding supporters who should know better).
While the vast majority of milk production problems can be remedied by addressing issues of breastfeeding management, there are some for whom making enough milk to sustain their babies is difficult or impossible. Why don’t some mothers make milk? Lactation failure can be classified into three categories: preglandular, glandular, and postglandular (Morton, 1994). Do I have hypoplasia/IGT? Image credit: Lisa Bartee Hypoplastic breasts may be small or large.
In a study of 34 mothers by Huggins, Petok, & Mireles (2000), a correlation between the following physical characteristics and lower milk output was found: Why did this happen to me? References Books: Tongue tie. Complementary and Alternative Medicine in Breastfeeding Therapy - iBreastfeeding.com. By Nikki Lee, RN, MS, IBCLC, CCE, CIMI, CST (Appl. Cert.) Mother and baby breastfeeding issues do not always fit neatly into a management protocol. Sometimes you have to think outside the box and look at complementary and alternative therapies to solve problems. In Complementary and Alternative Medicine in Breastfeeding Therapy, author Nikki Lee describes a variety of complementary and alternative therapy techniques that may help breastfeeding mothers and babies with issues not easily resolved with current lactation management protocol. By tapping into other therapies, Lee has found a multitude of new techniques to add to her breastfeeding toolkit.
Therapies covered include: Creating a healing environment Skin-to-skin, touch, and breastfeeding massage Acupuncture Chiropractic Craniosacral therapy Remedial co-bathing Homeopathy Excerpt: Imagine being a new mother, trying to connect with your baby in the intimate act of breastfeeding. How safe would a person need to feel to make love? Common issues. Borstvoeding. Structure. Nipplephobia: When Mammals May Not Feed Their Young. By Danelle Frisbie © 2009 We, as humans, are the only mammal that would ever be crazy enough to look down on the natural, normal, healthy feeding of our own kind. Much to our detriment. In her new book, Ina May's Guide to Breastfeeding, Ina May Gaskin discusses nipplephobia in the United States.
She asks, "In what species besides our own would adult males or females harass a mother in the act of nourishing her young? Such behavior would not occur to any other creature. " I wholeheartedly agree with her next observation: I find this kind of behavior neurotic at best, but when it represents the norm for millions of people, I think we have reached the realm of near-psychosis - mass mental illness. Although really, the psychotic manner in which we treat breastfeeding mothers and their young is not even 'infantile.' I was recently reminded through a real-life example of the powers and 'magic' of human milk. Increasing Low Milk Supply. The Case for Cue Feeding. By Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC posted with permission It is now commonly accepted that infants, most especially breastfed infants, thrive best when allowed to feed as they indicate their needs. Breastfeeding is, after all, a dynamic process between every unique mother-baby dyad, for which man cannot possibly do a better job than God in designing how infant feeding should work.This has not been the general consensus throughout the twentieth century, however.
Even in the late nineteenth century, there were those, mostly male physicians, who began to believe that infant feeding should be regulated by the clock. As artificial baby milk became all the rage in the twentieth century, both formulations of this milk and schedules to feed babies came into popularity. Endocrine vs. Autocrine control theoryThere is also a second level of potential problems with scheduled feedings. These comments are very telling. How much expressed milk will my baby need? By Kelly Bonyata, BS, IBCLC Image credit: Jerry Bunkers on flickr How much milk do babies need? Many mothers wonder how much expressed breastmilk they need to have available if they are away from baby. In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts). Current breastfeeding research does not indicate that breastmilk intake changes with baby’s age or weight between one and six months.
The research tells us that exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. We can use this information to estimate the average amount of milk baby will need at a feeding: Example: If baby usually nurses around 8 times per day, you can guess that baby might need around 3 ounces per feeding when mom is away. (25/8=3.1). What if baby is eating solid foods? Fast flow bottles. Be patient. Breastfeeding and science.