It can be really hard for a parent to figure out if their baby is getting enough breastmilk. After all, with a bottle you can clearly see the volume they are drinking, whereas you can’t see through a breast or measure how much is taken! (well, you can, but not as easily). When it seems that baby is fussy and crying all the time, and wanting to eat ALL THE TIME, moms begin to feel the fear. It’s a fear that most moms will have at least once in their breastfeeding journey, and is one of the top reasons why they may choose to stop breastfeeding altogether: my baby isn’t getting enough (or, as a postpartum mom might think: I’m failing and not supplying enough for my baby). In this post, we’ll look at how you can tell if a baby is getting enough, and what to do (or not to do) to increase your supply if you’re concerned.
First, let’s look at what normal baby feeding behaviour looks like. Babies have very tiny tummies – on day 1 their stomach is about the size of a cherry. By day 3, about walnut-size. At one week, it’s about the size of an apricot, and at one month it’s about the size of a chicken egg. So it doesn’t take very much fluid for their stomach to get full. Breastmilk is also very quickly digested, taking about 1.5 hours to digest a “meal”. So it may seem that your baby is hungry ALL THE TIME in those early days, and that’s probably because s/he is! Babies also go through growth spurts in which they may want to feed even more frequently, say every 30-60 minutes. This “cluster feeding” serves two purposes – one, baby is getting more milk more often to support their rapid growth during this period (usually lasting a couple of days on average). But it also helps to increase mom’s milk supply! More on that later. Rather than following the clock, though, it is very much encouraged to watch baby’s hunger cues and follow their lead. Watch for baby’s rooting (searching for a nipple), bringing hands to their mouth and perhaps getting a bit fussy. By the time baby gets to the point of crying, they’re in the late stages of hunger – in fact, they’ve gotten HANGRY. And a hangry baby will have a much harder time getting a good latch. In addition, when you’ve waited to feed so long that your breasts have become super engorged, it will also be harder to get a good latch because the breast is hard. So, frequent feeding is in both of your best interests!
When baby is feeding at the breast, they need to have a good latch. When baby is latched on properly, breastfeeding should not hurt after the first few seconds. And, baby will be much more efficient at massaging the breast with their oral muscles (ie. suckling) to stimulate milk flow. This leads to happy babies getting enough milk, and happy mamas with happy tatas without nipple pain. If breastfeeding is painful or you are concerned that you don’t have a good latch, talk to a lactation consultant who can help guide you. There are many strategies that can help to make this more comfortable for you and baby together.
How can you tell if baby is actually getting enough breastmilk? There are some physical and visual measurements that you can look for to reassure you. First, a well-fed baby will be well-hydrated. They will be wetting at least 6 diapers per day, and the urine is clear with little odour. Their skin is plump and firm, a good colour, and bounces back when gently pinched. For you, mom will notice that the breast feels much softer after feeding, and that the nipple stays the same shape or slightly elongated (that’s a
sign of a good latch). You’ll also be monitoring your baby’s growth through their regular doctor’s visits, and able to see that they are growing at an appropriate rate after the initial post-partum weight loss.
The best way to keep up your milk supply – frequent feeding. Breastmilk production increases when the breast is emptier. Lactating breasts never get completely empty (it’s like trying to empty a river, impossible since it will keep flowing even while being emptied), but we do know that an emptier breast (that is, a good feed has been had, draining about 75-80% or so of milk stored) will flip the high speed production switch – while milk has been produced all along, that empty breast will produce milk more rapidly! So, get that baby on there as often as they want, even when they’re cluster feeding. S/he is trying to do you a favour by draining the breast further, helping to boost production even more to help meet the needs of their growing bodies!
There are some things that moms can do to help maintain or increase their supply, asides from giving baby free access to the goods. Maintaining overall good nutrition helps to maintain good supply – after all, a well-nourished mama will keep a well-nourished baby! Lactating moms need about 450-500 extra calories per day, or about 2-3 snacks per day. Keep healthy easy-to-grab one-handed snacks available, such as trail mix, cheese and crackers, hard boiled eggs, fruits and cut veggies, granola bars or energy bites. Lactating moms also need LOTS of fluids (after all, breastmilk is about 88% water!), so keep a water bottle handy, or keep pitchers and cups around the house in the areas that you know you’ll be spending a lot of time breastfeeding. And, as crazy as it sounds, get some sleep. Prolactin (the hormone that causes milk production) is highest at night. This seems very backwards to how babies operate, but again, remember how that emptier breast will refill more rapidly? At nighttime when milk production is boosted even further thanks to high levels of prolactin, your baby’s nighttime feedings are, again, doing you a favour to further boost supply. This increase in prolactin levels at night is also why women typically report having the most milk early in the morning and find that their supply drops off a bit later in the day before bed.
According to Statistics Canada and the Canadian Community Health Survey (CCHS), the most common reason that women cited for stopping breastfeeding was insufficient supply. For those who stopped breastfeeding before baby was 6 months old, 44% stopped because they felt they had insufficient breastmilk supply, and 18% had difficulty with breastfeeding technique. Whether these mothers actually had insufficient milk isn’t known, but we do know that often when a mama faces challenges with breastfeeding, her ability to breastfeed is the first thing to be called into question. And as a formerly breastfeeding mama I can tell you, there are a lot of challenges, even when you have a fairly “easy” baby. You’ll question everything you’re doing or not doing and if you’re doing the best you can do for your child.
So before I close, let me just set the record straight. Whether you have an adequate supply, oversupply, low supply, can’t breastfeed at all, want to but are unable to for any reason, or simply choose not to…
YOU. ARE. NOT. FAILING.
Your baby relies on you for everything in their life. While yes, we do know that “breast is best” because breastfeeding/breastmilk does have many benefits for both baby and mom, that doesn’t mean that you “didn’t do it right” if it’s just not working for you, or if you aren’t able to for any multitude of reasons. We are fortunate to live in a world where alternatives (ie formula) are available to ensure that baby still grows up healthy and well. Whether fed by the breast or by formula, all our babies are (hopefully) going to grow up to become productive members of society. Because that’s our job as parents, long after this stage of their life is over!
If your goal is to continue breastfeeding, don’t give up if you’re not ready to. Seek out support from a lactation consultant (often free with public health clinics) to help you figure out whether baby is getting enough and what you can do to make this relationship work for you and baby both. Concerned about nutrition and how to best fuel your body in order to best nourish your baby? Talk to a dietitian (like me!) to help you optimize your intake.
Stay strong mamas. You’ve got this 🙂