>Dear Rachelle-
> I believe that there is a critical period within the first month or so
>during which most moms need to make a full milk supply in order to do so
>later on. I have seen many babies with initial poor latch and/or short
>frenulum who gain initially, then fall off the charts. I think that is
>because of mom's initial milk surge. Most moms produce milk abundantly in
>the first couple of weeks and any baby in the general neighborhood of the
>breast can grow---but then it's the baby's job to keep up the supply. A baby
>with a poor latch or short frenulum often doesn't hold up his end of the job,
>mom's milk supply falters, and without early intervention, it may never fully
>recover.
> In the last decade, I have worked with two mothers whose milk supply
>dramatically increased between 9 and 12 weeks post-partum. But those were
>very unusual cases. In most cases, sadly, if the milk supply isn't
>established within the first 4-6 weeks (Woolridge?), it probably won't
>increase dramatically. Sadly.
> -Debi Page Ferrarello, RN, IBCLC
Hmmmm....yes, I share the observation that when bf has not got off to a
good start (for whatever reason) then it can be a lot harder to get it to
be successful and satisfying for mother and baby later on.
I have read the prolactin receptor theory, and I think it sounds plausible.
But I cannot find a paper which is as bleak as you imply Debi - that 4-6
weeks is the window of opportunity and after that milk supply probably
won't increase dramatically. I would really appreciate a reference for
this, if you have one.
My observation is that mothers need *a lot of determination and motivation
and support* if bf still is unhappy after a few weeks, but if that is
there, then there is often no barrier to increasing supply.
I think we are mixing the physiological with the emotional and social here.
By the time a baby gets to 6 weeks, if bf is still miserable, and the
mother may already be supplementing, it requires *huge* efforts to do what
we know needs to be done to make it work
* lots of feeds, day and night
* lots of skin to skin and baby-wearing
* maybe expressing (though I never suggest this if there is any chance of
the baby feeding instead - expressing should be as well as not instead
of...)
* any soreness dealt with by adjustment of positioning and possibly
treatment for thrush
* sensible and gradual reduction of any supps
Mothers are often demoralised and lacking in family support by this time.
They may find it very hard not to supplement, or to supplement as much.
They especially find it hard to feed the baby often, when they interpret
this as 'spoiling' or proof the baby is desperately hungry. It's this, I
suspect, that prevents the improvement we want to see, rather than the body
being unable to make up a poor start.
But when the mother *can* do the right physiological things, I see very
good results. However, I am not looking for 'dramatic' improvement. I am
not looking for huge weight gains. I am looking for mother and thriving
baby feeding happily and often, with a weight gain that is consistent with
healthy growth and development, which the clinical professionals involved
can confirm.
Mothers can relactate after years of not bf; adoptive mothers can lactate,
after all - not quite the same, but an indicator of how nature can often
work well.
But I would be very interested in other observations, and research refs, on
this.
Heather Welford Neil
NCT bfc Newcastle upon Tyne UK
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