Milk Supply: From Pregnancy to First Weeks Postpartum | Advice from a Lactation Consultant
Christa: I’m so excited because we're starting a new segment with Mommy Knows Best and MomTalks with Christa. We have Kristen Sorondo here who's a lactation consultant and postpartum nurse from Florida and she's starting a new segment where she's going to answer all of your questions in regards to breastfeeding, lactation, postpartum health, and so much more. So before I talk too much longer Kristen, if you want to go ahead and introduce yourself and we'll get right through the interview.
Kristen: Hi everybody! Super great to be a part of all of this. I am a lactation consultant out of central Florida but also a nurse so I have the nurse background first. I’ve been a nurse for 16 years and a lactation consultant for 11. Very passionate about basically just helping moms in any way possible to be healthy, not only breastfeeding, postpartum, but mentally especially in the day that we're having children right now, things can be very stressful, so it's a big part of my practice just to have a lot of that major support. Super glad that I can be here to offer you guys some insight on some frequently asked questions that you typically have.
Christa: I’m excited because we get so many questions coming in so I’m really excited. I actually reached out to our followers on Instagram for a lot of these questions and also these are just some reoccurring ones that we get so here we go. What can I do to help my milk supply while pregnant?
Kristen: So during pregnancy, there's not really a lot that you can do as far as milk production wise but there's a lot of things that you can do educationally. So one of a few things when moms ask me when they reach out to me prenatally, some of the main things that I usually will talk to them about is definitely take a prenatal breastfeeding class; whether it be online or in person, it's amazing just how much you can learn in a couple of hours. The breastfeeding class that I offer basics breastfeeding, not anything that's overwhelming, is going to go into too much information but how do I know I’m doing it right and when do I need to reach out to somebody, so just some a basic breastfeeding class, couple hour, it doesn't need to be like an all-day course anything like that. The other thing that a lot of times that I see outpatient wise that moms are not aware of is sometimes if you have certain medical conditions or you don't have certain changes that you're supposed to have during pregnancy, those can actually be things that are hormonally within your body that might prevent you from actually producing good milk. Some of those things just in general had issues conceiving, moms who have pcos or polycystic ovarian syndrome, sometimes thyroid disorders, if you have gestational hypertension, a lot of those are hormonal based and also things that trigger milk production in general. If you're pregnant and you're having some of those any type of complications prior to pregnancy, during pregnancy, issues conceiving things like that, definitely would reach out to a lactation consultant prior to actually delivering. Just to say, hey I have this and this, I haven't had breast changes, that way you already have somebody you've made contact with so as soon as you deliver the baby we can start some interventions. Some of the big things are if breastfeeding doesn't go well the first couple of days it actually will hinder long-term production. We want to make sure that you're getting off to a good start. And a lot of times you're in and out at the obstetrician so quickly that they don't think to tell you, you had issues conceiving, you might have issues producing breast milk because of the inadequate of hormone levels that you have. So some they don't even talk to you about some of those things, so it's just doing some of those little base prepared things is something that can help you long term. The other thing is go ahead and get your breast pump. Pretty much 99% of all insurance companies will cover a double electric breast pump. Depending upon what type of insurance you have, they might make you wait until you actually have delivered to obtain it but at least you can have the paperwork already filled out, you can have a prescription from the doctor, and be ready to go. Some of them it doesn't matter, you could just be pregnant and they'll go ahead and give you one. Some of them it has to wait till your third trimester because if something happens that the baby is not with you, baby say is a nicu or you're having a lot of issues, we want to make sure that you are prepared for when you go home, and you have that already with you, so you have a good start getting off. So those are just some basic things not necessarily can I increase milk production while I’m pregnant? We don't want you to do anything like that because actually stimulating the breast and doing some of that actually during pregnancy can trigger labor. So we don't want to trigger labor but those are just some basic things that you can say okay nope I didn't have any medical issues, we didn't have any problems conceiving, I had breast changes, things that were looking for, did your breasts get larger? Did the areola get larger in diameter? darker in color? I’ve already got my breast pump so I’m set up, ready to go, so at least you're educated because it's going to be two of you that have had no experience, have no idea what you're doing, so at least by you having some education and knowledge, you're able to okay are things going well? Great! If they're not okay, I already have somebody that I can reach out to, right from the beginning.
Christa: When it comes to after they've had their baby, what can moms expect the first few days when it comes to their milk supply?
Kristen: So naturally all babies are sleepy the first 24 hours whether you had a vaginal delivery, C-section, a very rapid delivery, it was a long induction, all babies are sleepy. They're just adjusting to life outside of the uterus. So in the beginning, you're just going to have what's called colostrum, it's very thick and sticky, it's made that way purposely to help coat the intestinal lining, to prevent the babies from being exposed to any type of bacteria, it helps coat it so that way as they are eating, they don't have any type of gi issues, so very helpful. So you have that colostrum the first couple of days. Around day 2, day 3, your milk starts to transition what we call transitional milk so it's the colostrum and the mature milk coming together. One is leaving, the other one is coming in, breast might start to feel a little bit heavier, start to have some changes, and then usually by day 5 is when we call your milk is in per se. Your breasts are going to be full, possibly leaking, definitely heavier, and you're getting more quantity. You're going to hear gulping from the baby, you should go through those changes. If something happens, you have a 3-day induction, you ended up having to have a C-section, or you hemorrhage, any of those things. You're going to be more likely somebody who has delayed lactogenesis where the milk is more delayed than somebody who came in and had a pretty easy labor and delivered because your body has to take care of you first before it can do extra like making milk. If you're struggling, you've lost a lot of blood, your hemoglobin's low, your blood pressure is low, your body is not worried about making breast milk at that point. Your body's “okay I got to take care of you first.” So all of that can kind of also play a part as far as the process of milk production but ideally we have that colostrum and you can actually have colostrum during pregnancy. Our body makes prolactin which is your milk making hormone but it has to be triggered and told to make milk but you can actually have it during pregnancy especially third trimesters, your hormone levels start to change in anticipation for delivery, and then that transitional milk so you're going to start to see some color changes of the milk and then a little bit more as far as quantity goes, definitely by day 5 is what we're looking for. By day 5, you are having no changes, the breasts aren't feeling any heavier, they're not feeling fuller, you're not seeing any more quantity, you're definitely going to see that in the baby because the baby is going to be hungry and their urine and their stool output is going to be less. So if you're kind of getting to that point, babies losing weight, they're jaundice, you're not seeing changes, you want to make sure that you reach out to somebody. There's some reason that your body has not been able to get your milk to come in per se, so we want to make sure that you're reaching out to somebody for assistance.
Christa: When it comes to the difference between colostrum and mature breast milk, and you kind of touched on that too. Is that something that is going to be very not on schedule bond? Is it the same for everyone? Or is it kind of different when it transitions to that mature milk and how can you kind of tell?
Kristen: Moms who have produced milk before typically comes in sooner. Your body already knows how to do it as soon as that stimulation, those hormone levels change, it kind of already activates it because it stays dormant in your system until it's told to be activated but if it's already been activated once it kind of typically comes in sooner with multiple children than it is for a first-time mom. As long as the baby's feeding and you haven't had any major medical issues from delivery, it naturally will go through that process. Like I say you have colostrum like days 1 through 3, transitional milk is around day 3. Colostrum is going to be more of a yellow consistency, you're not going to see a lot of quantity and baby’s tummy the first couple of days is about the size of a gumball or a marble, it's very small and so they don't need huge quantities which is perfect because that's about all that your body's making. Around day 3, as it starts to transition, you're going to see some of that yellow kind of starting to turn a little bit more of a white color but it'll also have a halo of clear, it'll start to look more of like a watery substance, that's the transitional milk. You're going to start to also feel necessarily not I put my hands around my breast and they feel heavier but you're to start to feel changes kind of like against your chest like where your clavicle and your breastbones are. They just kind of start to feel heavier, fuller, achier there because back there is where the actual milk is produced in the lobules and the glandular tissue back there, so you're going to start to see some of those changes. And then really when your milk comes in, it really is very instantaneous. I used to say it's like the ups guy came and dropped it off while you were sleeping now I use Amazon so it's like the amazon guy drove up at your door and dropped it off while you were taking a nap. So literally you could lay down and take a nap and wake up and your breasts be super full, really big, like you had a breast augmentation, and right there, they're very predominant, definitely you're leaking milk. It's not usually this overtime long transition to when your milk comes in. Going back to what you were saying as far as if my milk doesn't come in because I wanted to touch base on that really quickly is you're going to definitely as each day, the baby gets older, their tummy grows. You're going to notice day 3, day 4 if you're not having any changes, you're going to have a really fussy baby that's crying and just wanting to eat very frequently or you're going to have the opposite a very lethargic baby, so a baby who is not getting any nutrition, so therefore it's struggling just to maintain life so it can actually be both sides of the spectrum; a very sleepy baby that's very hard to wake up and get to feed or a baby that's just fussy and crying all the time that's telling you I’m not getting enough nutrition. A couple of the big things that we look for is lactation consultants we want to make sure that they don't lose too much weight. Naturally they're going to lose weight because they're diuresing the amniotic fluid just like mom does. They're going to lose weight but we don't want them to lose more than 10% of their birth weight within the first week of life. Losing weight is normal just within that range. We want to make sure they're having wet and dirty diapers; the wet diaper lets me know how well hydrated a baby is. Just like us, if we are not feeling well and we're sleeping all day, we're not drinking, we might only go to the bathroom once or twice a day, it's going to be very concentrated, kind of a little bit of odor to it, same things with baby. If they're dehydrated, they're not going to be having those wet diapers, they won't be saturated, and they'll usually have a darker color to them, and they'll have more of an ammonia smell. Poops, all babies poop very differently so it's so hard to determine poop as far as nutrition the first couple of days but the poop is really beneficial because we want to make sure that they're stooling because that helps decrease their risk of jaundice because they're getting all that meconium out of their out of their system. We want to make sure that we're monitoring their weight, their pees, and poops. They should have one wet and one dirty diaper for however many days old they are. They are content between feedings and their jaundice level stays within a normal range, that's what we look at in the medical profession the first couple of days to determine are they getting enough for mom? And if they start to fall off of the track with any of those, then we start thinking what else in the puzzle is going wrong that we've got to try to fix? As moms, it's funny how kind of those motherly instincts do kick in and I mean if your baby's constantly feeding, you're not having those wet diapers, definitely reach out to somebody and you should be seeing the pediatrician within the first day or two days after coming home from the hospital so the good thing is you're following up with somebody pretty quickly so that way we're getting those interventions met quicker if we need to.
Christa: I also kind of wanted to talk on the other end too with milk supply. I know each week or each month, we're going to kind of go a little bit further as the baby gets older and ask different questions but I do want to talk about milk supply. By day 5, it should be the mature milk, so what can a mom do around that time if they want to increase their milk supply? Is there a need for it? What do you suggest for that time?
Kristen: Usually what I’ll tell moms and in the lactation world in general we really want to hold off on doing things to increase supply, pumping until a good couple week unless there's a need to do it earlier. The reason being remember the amazon guy is going to come and drop off your milk at the house for you, it doesn't know how much your baby needs, your body doesn't know how much your baby needs initially, which is a lot of times why moms initially go through primary fullness or engorgement where the breasts are really full, they're really swollen, it's uncomfortable because everything in there is swelling and anticipation for the milk to come in. Then when the milk comes in, it can be an overabundance for the baby that you just had because again their tummies are small, they don't need a lot of quantity, so by day 5 the milk should be starting to come in. If not in, it will continue to establish over the next 2 weeks based upon your baby's needs. So if I have a baby who doesn't need as much, it's going to start to slow down. If I have a baby who needs more, it's going to kind of increase. When at first it just drops it off, then it kind of establishes the needs and bases for your baby. We really want to try to do a lot of immediate interventions because we want your body to really regulate what your baby needs which one of the biggest things with breastfeeding that I try to tell my mom's is it's not black and white there's this huge gray area. As long as you have the fundamentals of breastfeeding down, it's whatever works for you guys. You might have a baby next door who's two weeks’ old that's drinking four ounces but your baby's two weeks old and drinks two ounces but maybe eats more frequently, that's okay! Both babies are thriving, they're doing well, so we can't necessarily compare babies to babies based upon that. Now reasons that we would want to do interventions, so say I had a mom a history of low milk supply or milk never came in or I have that mom that the baby was separated from her from deliver at delivery or she had she hemorrhaged or she has polycystic ovarian syndrome and with no breast changes, those are going to be the moms that if I was seeing them in the hospital setting, I would closely be monitoring why they were there, if not going ahead and starting some additional pumping for that extra stimulation to try to stimulate the body as much as I could. That way when her milk came in it came in sufficiently enough for her baby. Otherwise, if there's no really medical reason, the baby's feeding, the baby's doing well, they're having those wet and dirty diapers, they're meeting those milestones that we're expecting to them to meet, we want you to wait until a good 2 to 3 weeks out. That way your body knows how much milk your baby needs and it can kind of adjust because if we're over stimulating, not only are you going to have a huge quantity which I feel like it's a competition who can have the most stored milk in the freezer and they show pictures and things like that but it can actually cause other issues. If a mom has too much milk, the babies could be getting too much fore milk and not enough hind milk which is the fatty milk that's at the end of the feeding which is going to be the really the milk that's going to help them gain weight and kind of get fat. If they're getting too much for milk which is the milk that's at the beginning of the feeding then they it's kind of like skim milk, it's still going to help them gain weight but they tend to have a lot of issues with that as well. They tend to be spitty, they can cause a lot of gas, stools be really loose, so it can come with complications as well. We want to make sure that they are waiting for a good couple weeks and then at that time if they want to start say introducing a bottle or they want to kind of store up a little bit of milk for when they go back to work, then at that time it would be appropriate. So what I usually would recommend that moms do at that particular point in their breastfeeding experience with their baby is add in a couple pumping sessions a day. Your milk supply is highest in the morning, decreases after lunch into the evening hours, and then picks back up again in the middle of the night because your hormone prolactin increases and decreases throughout the day. I usually will tell them take 2, maybe 3 feedings. so you feed the baby say the baby eats at six o'clock in the morning, you feed the baby, baby's settled, you pump for about 8 to 10 minutes, just a short time frame, one to get additional stimulation, but two we call it your residual. What is left over after the baby ate, it might be a half an ounce, it might be an ounce, but your kind of taking that milk out of the breast to where you can use it later for feeding purposes. If you're going to do it do it, maybe 1 or 2 feedings in the morning and then maybe like at night, right before you go to bed, so just kind of adding in a couple of those a day, anything that you get you can, combine together, and then you can kind of start your stash based upon that. You really don't want to do the pumping in the afternoon and the evening times because that's when your supply is actually at its lowest so the baby is pretty much going to be getting everything that's there. We really don't want to be doing it during that time because we're taking actually additional milk away from the baby because there it's already at its lower supply so try not to do it during that time of the day but in the morning or at night and again if you're doing it after feeding, it's half the time that we would tell you to do a normal pumping session so about 8 to 10 minutes. If you are pumping in lieu of putting the baby to the breast, then you do a full 20-minute pumping session.
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