Breast Milk Production

The breast is a gland consisting primarily of connective and fatty tissues that support and protect the milk producing areas of the breast. The milk is produced in small clusters of cells called alveoli. The milk travels down ducts to the nipples.

Breastfeeding success has nothing to do with the size of your breasts or nipples. Breast size is an inherited trait and determined by the number of fat cells you have. The breasts will enlarge with pregnancy and breastfeeding. Breastfeeding is a supply-and-demand process. Therefore, the more you nurse, the more milk you produce!

Anatomy of the Female Breast

The nipple and areola (the dark area around the nipple) enlarge and darken during pregnancy. This may help your baby latch on by providing a clear “target.”

The small bumps on the areola are called Montgomery glands. They produce a natural oil that cleans, lubricates, and protects the nipple during pregnancy and breastfeeding. This oil contains an enzyme that kills bacteria and makes breast creams unnecessary.

Use only water to clean your breasts. Soaps, lotions or alcohol might remove this protective oil.

Each nipple has 15 to 20 openings for milk to flow.

When your baby nurses, the action of baby’s jaw and tongue pressing down on the milk sinuses creates suction. This causes the milk to flow out of your breast and into your baby’s mouth.

The Let-Down Reflex

How Your Body Responds to Your Baby’s Suckling

Infant suckling stimulates the nerve endings in the nipple and areola, which signal the pituitary gland in the brain to release two hormones, prolactin and oxytocin.

How Your Breast Responds to Your Baby’s Suckling

• Prolactin causes your alveoli to take nutrients (proteins, sugars) from your blood supply and turn them into breast milk.
• Oxytocin causes the cells around the alveoli to contract and eject your milk down the milk ducts. This passing of the milk down the ducts is called the “let-down” (milk ejection) reflex.
• Let-down is experienced in numerous ways including:
• Your infant begins to actively suck and swallow.
• Milk may drip from the opposite breast.
• You may feel a tingling or a full sensation (after the first week of nursing) in your breasts or uterine cramping.
• You may feel thirsty.

NOTE: There may be many let-downs during a feeding, of which you may or may not notice. Because the brain plays such a large role in the release of hormones that cause the milk to eject, it is very normal for let-downs to occur in other situations as well. For example, let-down may occur when you think about your baby, hear your or another baby cry, when it is your scheduled nursing time, when you are sexually stimulated or during orgasm.

If the let-down occurs at an awkward time, cross your arms over your chest, or press the heel of your hand over the nipple area and apply pressure until the leaking stops. It may also help to wear cotton breast pads (without plastic liners) in your bra to protect your clothing, especially during the first weeks. This type of response will usually lessen after the first few weeks of nursing.

Uterus Response Postpartum

Release of the oxytocin hormone while breastfeeding will also cause the uterus to contract. This may be more noticeable if you have previously had children. This mechanism helps your uterus return to its pre-pregnancy size quickly.

Interference With Let-Down

A variety of factors may interfere with let-down:

• Emotions such as embarrassment, anger, irritation, fear or resentment
• Fatigue
• Poor suckling from improper positioning
• Not enough time baby is actively nursing
• Stress
• Negative remarks from relatives or friends
• Pain in your breasts or uterus (i.e., sore nipples or afterbirth pains)
• Breast engorgement in the first few days

Suggestions for Creating a Supportive Nursing Environment

• Find a peaceful atmosphere for nursing. Before beginning the feeding, unplug the phone, turn on relaxing music and do deep breathing. (Take four or five deep abdominal breaths.)
• If breastfeeding in public makes you uncomfortable, insist on your privacy and/or drape a light cover over your baby and your shoulder. California law protects a mother’s right to breastfeed in public.
• Interact with friends and breastfeeding professionals who are supportive of breastfeeding. Do not let well-meaning friends and relatives who have different attitudes discourage you.
• Restrict visitors until you are comfortable.
• Be around other nursing mothers. Attend a postpartum exercise class and/or support group.
• Be sure your baby is positioned properly and allow enough suckling time.

Your Milk

Colostrum

Colustrom, the early milk made by your breasts, is present in small amounts for the first three days to match the small size of your baby's stomach. Most babies do not need additional nutrition during this time. Begin breastfeeding as soon as possible after giving birth. Breastfeed at least 8 to 12 times per 24 hours so your baby receives this valuable milk. Colostrum and mature milk are designed to meet a newborn’s special needs. Colostrum has a yellow color, is thick in consistency, and is high in protein and low in fat and sugar. The protein content is three times higher than mature milk, because it is rich in the antibodies being passed from the mother. These antibodies protect your baby and act as a natural laxative, helping your baby pass the first stool called meconium.

Mature Milk

Your milk will change and increase in quantity about 48 to 72 hours after giving birth. It may take longer depending on when you start breastfeeding and how often you breastfeed. The change in milk occurs a little earlier if you have breastfed before.

• Foremilk — When first starting to breastfeed, the first milk the baby receives is called foremilk. It is thin and watery with a light blue tinge. Foremilk is largely water needed to satisfy your baby’s thirst.
• Hind-milk — Hind-milk is released after several minutes of nursing. It is similar in texture to cream and has the highest concentration of fat. The hind-milk has a relaxing effect on your baby. Hind-milk helps your baby feel satisfied and gain weight. Feed your baby until you see a sleepy, satisfied look on your baby’s face.

NOTE: There is no such thing as “weak breast milk.” Your body will combine the exact ingredients necessary to meet your baby’s needs.

The Family's Role

The family plays a major role in the breastfeeding relationship between you and your baby. One of the most precious gifts a family can give is to take care of you and encourage and support a healthy breastfeeding relationship.

For example, family members can do the many household tasks that take your energy away from nursing the baby. They can also call your healthcare provider or look in the phone book for community breastfeeding (lactation) resources if you have any problems breastfeeding once you get home.

There are many rewarding ways for family members to be involved in caring for the baby. Burping, diapering, playing, giving the baby massages, comforting (holding and rocking, etc.) and taking the baby for a walk are wonderful ways to help. They are also a good way to get to know the baby. Bath time is a great opportunity for eye contact and play for the whole family.

As the mother, having people help and encourage you are some of the most important things you will need to breastfeed successfully. The first few weeks of breastfeeding are important. It is a time for learning what works best for you and your baby. It is also when your milk supply is being established. It can be a very frustrating time as well. You have just gone through labor and delivery and may be physically tired and emotionally drained. You and your baby may need to try several breastfeeding positions before you find ones that work. With strong support from family, friends, health professionals and volunteer counselors, mothers who may otherwise have given up on breastfeeding during the first weeks are able to succeed.

A good support network can help in many ways, such as providing accurate information about breastfeeding and helping you resolve any problems quickly. By doing other “duties,” your support network enables you to put all your energy into breastfeeding and getting to know your baby. Most important, they can help you feel confident in your ability to breastfeed your baby.

The most important support person for most new mothers is their husband or partner. Other support persons may include your mother or mother-in-law, other family members, friends who have breastfed, and health professionals, such as your physician, midwife, pediatrician or lactation consultant. Volunteer counselors from the Nursing Mothers Counsel, LaLeche League, WIC and other local breastfeeding support groups are also great resources.

How Can Your Family and Friends Provide the Best Support for You?

The best thing they can do is to attend a breastfeeding class with you. In this class, they will learn about the benefits of breastfeeding, how to establish a good milk supply, and how to manage common breastfeeding problems. Your own mother may or may not have breastfed you. Either way, she can learn new things from a breastfeeding class, as there is a lot of new information on breastfeeding and its benefits. Sometimes even well-meaning family and friends can put your milk supply at risk by giving your baby bottles and pacifiers or advising you to limit nursing time or to “get the baby on a schedule.” The more your partner and family know about breastfeeding, the more they can help you.

It is very important for your support people to provide encouragement and emotional support during the first days when you and your baby are learning how to breastfeed. Many mothers decide to give up on breastfeeding during this period. Remember that it will take time for both you and your baby to get comfortable with breastfeeding. Even if you have breastfed before, each baby is different. You and your baby will learn what works best for the two of you during the first several days or a week or two together.

Your support people can help you with other household tasks, such as cleaning, laundry, shopping and cooking. Physical fatigue from trying to do too much can affect your milk supply. Nap when your baby sleeps to help in your physical recovery. Some women feel “low” or “depressed” after delivery. Exhaustion can make this feeling worse. Let others do things for you. Only you can breastfeed your baby. You should put all of your energy into recovering from your delivery, breastfeeding and getting to know your baby.

Finally, you and your partner should both be patient about resuming intimacy. You may temporarily lose interest in having sex after giving birth. This is common and can happen whether or not you are breastfeeding. You may have concerns and negative feelings about your body after pregnancy and delivery. Breastfeeding does not “ruin your breasts.” Although you may experience breast changes after childbirth, these changes were caused by pregnancy, not by breastfeeding. Breastfeeding does not make you gain weight. In fact, it may make it easier to lose your pregnancy weight when combined with proper diet and moderate exercise.