Rockville Lactation

Lynnette Hafken, MA, IBCLC

Lactation Consultant

text/call: (240) 888-2123   |   se habla español

[email protected]

Coronavirus policy: Consultations are available both in home and over encrypted video-chat. For in-home visits, I ask that household members over the age of 9 wear a mask and wash their hands prior to my visit. If anyone in your household or mine develop a cough, cold or flu-like symptoms, loss of smell, shortness of breath, or a fever, we will cancel our appointment and rebook a telehealth visit at your convenience.

Three Basic Rules for Successful Breastfeeding

Help your breastfed baby gain weight and have satisfying feedings.  Help yourself develop a robust* milk supply and enjoy breastfeeding more.


*Milk production amounts vary for individual women.  See Rule Two for more information

Breastfeeding, infant, weight, gain, enough milk, breast milk
Breastfeeding, infant, weight, gain, enough milk, breast milk

Rule One: Feed the Baby

Many breastfeeding mothers think pumping, bottles, or formula use should be a last resort; that you always need to wait until “breastfeeding is established,” a term which is kind of vague, or until your milk supply increases to be sufficient.  However, when it comes to a baby who is (a) not gaining weight well, (b) unsatisfied after breastfeeding, (c) sleepy at the breast most of the time, and/or (d) having more than twelve or fewer than eight breastfeeds a day, there may be an issue with either your milk supply or his ability to transfer the milk that you have. (It should go without saying that neither are your fault.)  Fortunately this is a solvable problem. (Note: sometimes these are signs of an underlying medical problem; always check with your pediatrician if your baby is not feeding well.)


Rule number one for solving this problem is to feed the baby to satisfaction at each and every feeding. There is nothing to be gained by waiting until your baby shows late signs of low breast milk intake, such as dehydration or persistent lack of weight gain. Our (yours, mine, and your pediatrician’s) priorities are: your baby’s health, maximizing your milk production, and giving him the energy he needs to stay awake at the breast and suck vigorously. Those three things are the foundation of breastfeeding success (along with comfortable breastfeeding for the mother).


Here is why it’s important not to wait when it is discovered that a baby is not taking enough breast milk. First of all, there are short-term medical risks to underfeeding, such as dehydration, low blood sugar, and pathological jaundice. These conditions require immediate medical assessment.  Long term, for optimal brain and organ development, it is essential for babies and children to get sufficient nutrition. 


Am I implying that breastfeeding is risky? No—provided that early, acute, and chronic signs of hunger are acted upon immediately by supplementation, breast milk is the ideal food for babies.  What is risky, however, is the misconception that maintaining exclusive breastfeeding is more important than ensuring the baby is sufficiently fed, even if some formula (also known as “science milk”) has to be used, when you had not planned or wanted to do so.  Again, the fact that breastfeeding not going as planned is not your fault!


Here are some scenarios in which supplementation is appropriate (either expressed breast milk or infant formula can be used; the important thing is to feed the baby until he is satisfied):

  • Baby is difficult to wake up and keep awake for breastfeeds
  • Baby is still losing weight at 96 hours of life
  • Baby’s weight has not stabilized or increased by 96 hours of life
  • Dehydration is suspected or confirmed (the only way to determine this for sure is by checking the baby’s sodium levels)
  • Baby has low blood sugar or high bilirubin levels 
  • Baby seems unsatisfied after feedings
  • Milk is not in at 72 hours of life (considered “delayed onset of lactogenesis II”)
  • Baby is not maintaining his growth curve
  • Baby has lost more than 75th%ile on the NEWT nomogram (for the first 30 days)

The second reason why feeding the baby sufficiently is the foundation of breastfeeding success is that ensuring sufficient calories will give him the energy he needs to stay awake and suck vigorously at the breast. This is important for developing and maintaining a full milk supply.


Waiting to fully feed the baby until there is enough breast milk risks inadequate breast stimulation, which can cause a permanent reduction in milk supply. Pumping can help, but a mechanical breast pump is not as sweet and cuddly as your baby and adds the extra chore of washing parts.


Does this mean supplementing or pumping from Day 1? Not invariably, because many mothers produce large volumes of colostrum, and many babies have tons of energy to gulp it down with gusto. But if you see signs like the bullet points above, or have a strong gut feeling that your baby is not getting enough milk, trust your gut, trust the three rules, and supplement appropriately.  (Rule number three will be to fix the breastfeeding problem, so don't panic!)

Breastfeeding, milk, infant, weight, gain, enough milk, breast milk

Rule Two: Protect Your Milk Supply

Simply put, a full milk supply usually makes breastfeeding easier by leaps and bounds.  A full supply is defined as a minimum of 440 ml (15 oz) by Day 11, and 750 ml (25 oz) by Day 15. With a full supply, your baby will not have to work that hard to take large gulps of milk, will stay awake without you having to constantly stimulate him, and will become satisfied after feedings and gain weight to everyone’s satisfaction.

 

As mentioned above, when your baby is not getting enough to eat, he will not have the energy or patience to suck vigorously and calmly at the breast.  He may fall asleep within a few minutes, come off and cry repeatedly, or even fight you when you put him to the breast.  He does not hate you or your breasts; he’s not telling you he would rather be a bottle-fed baby; your body is not broken or defective.  


There is usually a solution to low milk production, and it is almost always to empty the breasts more frequently and thoroughly. (Note that the breasts are a constantly running milk factory and can never be 100% emptied.)  If for biological or logistical reasons, you cannot increase your supply sufficiently, you can still breastfeed with supplementation, if desired.  


Aside from feeding the baby sufficiently, establishing your milk supply is the most time-sensitive aspect of breastfeeding success. Babies can learn to latch at a more relaxed pace, but in the first two weeks, your body is actively trying to figure out how much milk to make.  After that, it may be more difficult (or even not possible) to develop a full milk supply.  Everyone is different though; the only way to know for sure is to try, using the evidence-based technique of emptying the breasts more frequently and thoroughly.


One caveat that you should keep in mind is that, as a milk factory, your breasts are typically capable of producing more than your baby needs.  Much more.  Oversupply sounds like a good problem to have, but believe me that it is not.  Your life will be dominated by leaking breasts, practically drowning your baby at feedings, constant engorgement (which comes with increased risk of plugged ducts and mastitis), and sometimes a gassy, miserable baby.


After Rules 1 and 2 are satisfied, the third and perhaps most difficult rule needs to be addressed—fixing the breastfeeding problem.

Breastfeeding, milk, infant, weight, gain, enough milk, breast milk

Rule 3: Fix the Breastfeeding Problem

There are many sources from which you can find information about all manner of breastfeeding problems.  The difficulty is knowing what information or expert you can trust.  I recommend asking friends and family who have been successful with breastfeeding, interviewing several lactation consultants, speaking with your pediatrician, and reading evidence-based websites like the ones listed below.  Trust your instincts also; there will be plenty of people who say everything is fine, but if it feels like it’s not, listen to your feelings and get help.  The Tips and Tricks section on my website has some useful tidbits. 


Remember that the earlier you get help, the easier and more successful you are likely to be in solving the problem and meeting your goals. Getting Rules 1 and 2 addressed are the most time sensitive. But fixing the breastfeeding problem—especially if it is causing you pain—is important too.