Milk Supply Regulation: what is happening around 6-12 weeks?
Has anyone ever told you their milk dried up overnight? Or they lost their supply after six weeks? Twelve weeks? Or somewhere in between?
Someone should have explained to them what was really happening.
Perceived Insufficient Milk Supply (PIMS) is so common, it is actually listed as one of the top reasons mothers stop breastfeeding or begin supplementing with formula. Perceived - not actual - low milk production. There is a difference.
The indicators used to assess if a baby is getting enough breastmilk are:
Sufficient wet nappies: 5 heavy disposables or 6-8 soaked cloth nappies
Frequent soft bowel motions. 3-4 per day in the first six weeks. Older babies might have less but the poo is still soft.
Good skin colour and muscle tone. If gently “pinched”, their skin bounces back.
The baby is mostly content after most feeds. Allowing for normal cluster feeding and fussy periods.
Their weight, length and head circumference growth is tracking the curve on their growth chart as expected.
However, and this is significant, the reasons parents believe their milk supply is low are often very different.
The baby feeds frequently and more often than they expected.
The baby sleeps for shorter periods and wakes at night more than they expected.
In a recent study in Western Australia, 44% of the mothers had a perception of insufficient milk supply within 3 weeks of birth. The most common reason for this perception was that their infant was not satisfied after breastfeeds.
These normal patterns of feeding and sleeping behavior are tiring and time-consuming. If you are being repeatedly told by well-meaning family, friends and health professionals that your baby should be only feeding 3-4 hourly and should be sleeping through the night, it is easy to see how breastfeeding mothers will doubt their milk supply is enough.
In the early weeks of the fourth trimester, the breasts themselves give reassuring feedback of milk abundance. Go too long between feeds and your breasts swell and feel heavy. They might even become sore and hard! If someone has told you to stretch out feeds so your baby gets more milk, then this seems to be evidence that is working! The longer you wait, the more “full” your breasts appear and the more milk you must be making.
Then, suddenly, perhaps even overnight, your breasts no longer feel full and firm. They feel soft and … empty.
If you have been routinely pumping milk in-between breastfeeds to create a “freezer stash”, the volume you can pump might plummet. You can go from getting 70 - 150ml to just … 20-50mls.
Where has all the milk gone?
This change is normal, natural and should be expected …. except nobody seems to warn you it will happen!
In the early weeks of breastfeeding, your body produces breastmilk constantly. Your breasts fill and fill and fill. Sometimes you might feel full to bursting point! Luckily, nature put a braking system in place, otherwise you probably would explode. Here’s how it works: the more full your breasts become, the more of a substance known as FIL (Feedback Inhibitor of Lactation) is excreted. This protein in the whey part of the milk signals to the milk-making glands to speed up or slow down production. Too little FIL from frequent removal of milk and your breast pumps up the volume and quickly replenishes the milk supply. Too much FIL and your breasts get the feedback that less milk is required, slow down, put the brakes on production.
Cluster feeding and power pumping use this system to increase milk production
Block feeding and weaning use this system to decrease milk production
Put very simply: soft breasts are working hard, hard breasts are hardly working!
This system is really useful as breastfeeding is being established. There are so many unknowns for the breasts: how many babies are there? Twins? Triplets? More? How big is their stomach capacity? Small? Medium? Large? When does they baby feed frequently (cluster feeding) and when do they feed less frequently? Every single baby is unique and the breasts need time to get to know them individually. Its like fine-tuning by tweaking all the levels to get the volume just right. Then lock it in. This takes around 6-12 weeks.
Lactation now works like a well-oiled machine. Your breasts can confidently produce the milk on-demand, meeting the baby’s needs efficiently and without all that attention to detail. Far from being a sign of failure, those soft breasts are the sign that your milk production is working in-sync with your baby.
Research has shown that the volume of milk a baby takes over 24 hours varies little from one month to six months. How often and how quickly they remove it might vary but the amount is pretty consistent. Not only do you not need to increase your supply but your baby isn’t even taking all the milk available.
On average, babies remove around 67% of the milk available in the breast.
Babies don’t drain or empty the breast. They feed until they are full. They actually come off the breast when one of the multiple let-downs or milk-ejections occur! Why do they change breasts? probably because the rate of flow or effort involved to remove the remaining milk seems too much like hard work, when there is a second breast sitting their ready to go! And while they feed from that one, the volume is steadily increasing in the first, for those who want to lick the plate!
Even if you go on to breastfeed for the next two years or more, your milk supply is very unlikely to decrease unexpectedly. Reasons that could happen are hormonal shifts due to pregnancy. Gradual reduction will happen as babies begin to naturally reduce breastfeeds as they wean or if mothers lead the weaning process.
Breast milk doesn’t dry up overnight. During weaning, it can take weeks, months or even years to completely stop lactating.
Having faith in breastfeeding is probably the single most important tool you can have.
