Hello, my name is Casey, I’m an RN, IBCLC in Oregon, and have been working
as an IBCLC for the last year. I’ve posted 2 or 3 times in the last year but
have mostly been an active lurker, avidly learning and soaking in the pearls of
wisdom on lactnet.
I have a few questions regarding milk supply that I’m trying to clarify in order
to encourage more frequent breast stimulation (ideally in the form of a
latching and suckling baby) in those first 24 and 48 hours after birth.
I’m trying to clarify my reasoning on why frequent and early (i.e. first 24 hrs
and beyond) breast stimulation and milk removal is important.
Starting from the basics which I understand as - The stimulus for the onset of
lactogenesis 2 is the delivery of the placenta. Copious milk production will
begin in 3 – 5 days regardless of breast stimulation and/or milk removal.
After that point, continued milk production is dependent on breast stimulation
and milk removal, often referred to simply as supply and demand. The 2
important components of continued milk production, which generally occur
simultaneously, are milk removal and breast stimulation.
Nobody will disagree with me that during breastfeeding, if you want more milk,
you stimulate and empty your breasts more often. The less often your
breasts are emptied/stimulated, the less milk that is produced.
However, during the first 24 and 48 hours this is not theoretically the case.
The reason I am posing this query is because I suggest that at any time a
baby is given a supplement, the mom’s breasts should be stimulated. So if
somebody supplements a 12hr old baby (whether or not the baby actually
needs the supplementation is an entirely different story), I say that mom
needs to pump/express her breasts. However, it has been argued to me that
breast stimulation does not make a difference at this point as lactogenesis is
still under hormonal and not autocrine control at this point.
However, my thought is that, though frequent and early breast stimulation
does not bring the milk ‘in’ any more quickly, it is not necessarily the case that
frequent and early breast stimulation has no impact on supply.
I have noticed that moms who begin pumping immediately do see a gradual
increase in the amounts of pumped colostrum. I would imagine this is related
to both the levels of FIL as well as breast stimulation and emptying.
If a woman’s breasts are emptied every few hours will she not likely end up
with a greater total volume of colostrum at the end of 24hrs then she would if
she simply drained her breasts once at the end of 24hrs? Similarly, later in
lactation, if a woman pumped every 3 hours she may well expect to obtain 24
ounces of milk in a 24hour period. But if she only pumped once at the end of
24hrs she would not expect to pump 24 ounces at that one pumping.
So, going back to the first day or two, even though frequent breast emptying
won’t hasten the onset of copious milk production, won’t it even so increase
the total amount of colostrum that is produced? Since every time the
colostrum is removed, more colostrum is produced, right? Is this not a
component of supply and demand, even in those first few days, where
increased breast stimulation and milk removal results in an increase in the
amount of colostrum that is actually produced? So even though lactogenesis
2 will occur with or without breast stimulation, and is hormonally mediated,
that does not necessarily mean that there is not an active ‘supply and
demand’ component even immediately after birth, would that not be correct?
If a woman breastfeeds or pumps/expresses frequently from the first hour
after birth, is she not likely to have an increased amount of colostrum per
feeding 48 hours later than she would have if she had had no breast
stimulation?
The other question is in regards to the prolactin receptor theory. The same
people who would argue to me that there is no need to pump/stimulate in the
first few days when a baby is supplemented as this has no impact on milk
coming in also do not agree with me that a mom should be encouraged to
breastfeed or pump/express her breasts 8 – 10 times in the first 24 and 48
hours for the purposes of maximizing her milk supply in the long run.
What has happened is that there is much less stress on having babies nurse
every 2 – 3 hours in the first 24hrs, they are expected to have at least 3
good feedings and that is seen to be normal, which I believe it is under the
circumstances of hospitalized birth. The good news is that now we are not
poking their heels every few hours checking their blood sugars. The bad news
is that moms are not being encouraged to feed more frequently, and I’m
having a hard time convincing anyone that frequent breast stimulation (i.e.
more than 3 times, closer to 8 – 10 times) in the first 24hrs has any benefit
for milk supply. I’m just talking milk supply here, I don’t think I would have the
difficulty communicating that increased feedings will give the baby more food
and would be good for the baby, decrease jaundice, etc. I am just not
succeeding in conveying the importance of the breast stimulation itself, say
when a baby is sleepy or won’t latch or when someone thinks baby should
sleep in the nursery and have supplement grrrr.
So, does breast stimulation/colostrum removal prior to the onset of copious
milk production result in an overall increase in the amount of colostrum
produced? I think it does, is there any evidence (other than anecdotal) I can
use to substantiate this?
Could someone point me to the research that shows that increased frequency
of feeding in first 48hrs correlates with increased long term supply?
Thanks very much in advance!
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