3 Principles of Lactation Management
So you've done all your prep work, went to prenatal classes, read the books, blogs and have all the apps. You've endured childbirth (you did it!) and now you've got your little baby in your arms. They get hungry. You make milk. They latch, drink, fall asleep and you change a few diapers in between. Rinse and repeat. How hard can it be? Ohhhhh the humbling journey that is parenthood. For some lucky ones, feeding your little one might resemble this, but if you're reading this, it's probably not you.
While there are a multitude of reasons why feeding your little one might go off the rails, there are really only 3 basic principles of lactation management that are applied in almost all situations:
1) Feed the baby
2) Protect the milk supply
3) Promote contact with the breast as much as possible
Here we'll take a little dive into these three strategies and how they work to ultimately help you achieve your goals.
1) Babies require an adequate amount of calories to support their growth and development. It's important to ensure that they not expending more energy trying to obtain their milk than the energy they are receiving. According to the Academy of Breastfeeding Medicine, normal newborn weight loss, typically occurring between days 2 and 3, is 5.5-6.6% in an optimally breastfed infant. If weight loss persists further than 10%, careful evaluation of the infant is required to ensure baby is not at risk of dehydration and further weight loss. If your intention is to breastfeed/chestfeed your baby exclusively, it may feel like you're failing if you learn that supplementation of your infant may be warranted, but for most families, this is a brief intervention until challenges can be identified and a plan can be put in place. This is where your lactation consultant can work with you to help you achieve your goals and ensure baby is thriving.
2) In the absence of your baby latching and feeding well and efficiently, it is essential to ensure you are frequently and effectively removing your milk so you can protect your supply. Hand expression is an effective way to remove the early, thicker colostrum produced before your milk transitions to mature milk (the thinner, whiter milk we typically think of when we think of breastmilk). Over the longer term, however, the use of a hospital grade, double electric pump is the best way to ensure adequate removal. How much you need to pump depends on whether or not baby is having any effective feeds at the breast. In the total absence of your infant directly feeding, milk removal should mimic how often the baby would typically feed in a 24 hour period which is a MINIMUM of 8 times (typically more like 10-12). If baby is having some effective feeds at the breast you will need to pump your milk less. Exclusive pumping is A LOT of work but rest assured, it is typically a temporary measure to ensure you are protecting your milk supply. In the absence of frequent, effective and early milk removal, your body quickly makes adjustments and long term, your supply can suffer. Believe me when I say it is MUCH easier to preserve a milk supply in the short term with pumping than to try to build up a milk supply that has dwindled because of lack of stimulation.
3) Even if you are having struggles with the act of feeding your baby directly at the breast, spending as much time in close proximity can help to ease the transition when the other pieces start to come together. Skin to skin (as in your baby wearing only a diaper laying on your exposed chest or belly) is one of the best way to promote this. Amongst the many benefits, when baby is skin to skin they will innately exhibit feeding reflexes like rooting and crawling towards the breast which helps them to find and latch on. Skin to skin promotes the release of Prolactin and Oxytocin both of which are hormones essential to milk production and milk removal. Time at the breast also normalizes this experience for both you and baby so that when the time comes, they've already spent a great deal of time nuzzling, suckling, smelling you and generally getting to know you better!
While there are many factors from pregnancy to childbirth to maternal anatomy to infant oral structures that can impact feeding both adversely or positively, consistently promoting the 3 basic principles of lactation management, in most cases, will dramatically increase your chances of a positive outcome. The earlier these interventions are put in place, the better the chances you'll have of meeting your goals. Ensure that someone truly hears you and advocates for you in the event you encounter feeding challenges. If there is an issue(s) identified, establishing trust with an IBCLC can help you work through difficulties collaboratively. My talented IBCLC mentor would always say that mothers are innately experts when it comes to their babies needs. We just help them to see this along the way.
