Blog 5: Expressing Milk Before Baby Is Born

As a pregnant or new mother, you may be concerned about making enough milk because of previous supply problems, breast surgery, hormonal problems, or a family history of problems But before diving into how to increase your milk let’s talk about some of the things you can do to lay a foundation for the best possible start from pregnancy onward.

Get a Head Start: Expressing Milk Before Baby Is Born

Sue Cox, AM, RM, IBCLC, a midwife and lactation consultant in Australia, recommends an old method that seems to help get things going: removing colostrum during late pregnancy.1 This method has not been validated scientifically, but at least it can provide colostrum for any supplementation that’s needed. Concern is occasionally voiced that prenatal milk expression could stimulate labor prematurely, but there is no research supporting this, and in fact, women have safely nursed during pregnancy throughout time.2 Unless you are at high risk, this practice seems to be safe for most mothers.

Begin hand expressing daily starting at the thirty-fourth week of pregnancy when you’re relaxed and warm, such as after taking a hot shower. (Stop if you have any unusually strong contractions.) Express any colostrum drops into a spoon, then use a small periodontal or similar blunt-end syringe to draw it up. You can refrigerate and reuse the same syringe for forty-eight hours, adding more colostrum as it is expressed then freeze it in an airtight zip-close bag for the hospital.

A variation on this idea is practiced in some cultures. Young husbands are taught that it is their duty to suckle their wives’ breasts during lovemaking in preparation for future babies. Some lactation consultants report that these first-time mothers seem to experience early and abundant milk production. If your partner is so inclined, it may be worth trying.

Nurse in the First Hour

Ideally, breastfeeding should begin as soon after birth as possible, when the baby is ready to nurse. When placed on their mothers’ bare abdomen immediately after birth, most newborns will find the breast and initiate suckling in fewer than fifty minutes. They seem to be able to get more colostrum during this golden time, possibly due to oxytocin from labor also affecting the breast. Separating an infant from his mother during this crucial alert period misses his first opportunity to begin breastfeeding using his instinctual abilities. Instead, he may pass to the resting phase, becoming too drowsy to try much during the next several hours. Ensuring that your baby has every opportunity to suckle right after birth will help you get a great start on your milk production, So long as baby is healthy and there are no pressing medical concerns, don’t be afraid to tell anyone who might suggest he needs to be bathed or measured or anything else that you are keeping him with you for the time being Those things can be done later. Smile, be polite and be firm. It’s your baby, not the hospital’s!

But what if you don’t have that ideal birth? If baby has any health concerns, you may not be able to spend that first hour cuddling. Even when given the opportunity, some babies don’t seem able to latch well immediately after delivery. This is often the result of mother’s labor drugs, including epidurals, that cross the placenta and affect the baby in varying degrees. Most types can temporarily diminish an infant’s spontaneous breast-seeking and nursing behaviors, and some also increase body temperature and crying.4 However, not being able to nurse the baby right after birth does not doom you to trouble; it just means that it may take a little more work to get breastfeeding started.

Mothers who have cesarean births (C-sections) should be able to nurse a healthy infant with no complications while in the recovery room after surgery. Most of these babies do well though some may be sleepier and less interested in nursing if you labored for some time with medications or received general anesthesia. Urgent cesarean births have been associated with delayed milk production, possibly related to the stress involved. However, lots of skin-to-skin contact and frequent nursing as soon as is practical will go a long way toward minimizing potential problems. It may be reassuring to know that most mothers who have had cesarean births have good milk supplies.

If you and baby are separated after birth or baby is unable to breastfeed, try to hand express or pump within the first hour after birth and at least every three hours thereafter until baby is able to begin nursing. Not only will you get more colostrum for any supplement baby needs, but expressing when your body expects it to be re moved yields more and also helps to jump-start the milk production process.

Keep Baby Skin to Skin as Much as Possible

One of the most enjoyable and beneficial things you can do as a mother is simply holding your baby “skin to skin.” With baby wearing only a diaper and your bra removed, snuggle him up right, nestled between your breasts. Your breasts will actually heat up or cool down in response to your baby’s body temperature, but if needed, a blanket can be placed around the two of you. This kind of skin-to-skin contact has been shown to help increase milk volume. An additional benefit is that baby is also more likely to nurse when he is “in the restaurant” and smelling your milk.

Delay Bathing

Baby may show more interest in breastfeeding if you delay bathing him until he has had some skin-to-skin time with you. If there are any problems, consider postponing a shower yourself for a day or two. Babies who are placed on their mothers’ chests with their hands-free after birth smear amniotic fluid onto the breasts as they use their hands and face to find them. Later, the smell of the fluid seems to draw them to the breast like a tracking beacon. This biological sequence helps babies cue into their natural latching instincts.

Optimal Milk Production Depends on an Optimal Latch

Your baby’s ability to get all the milk available is strongly dependent on how well he is attached to the breast. If he doesn’t latch effectively, he cannot remove milk well from the breast. Ideas about how to get baby to attach well to the breast have been evolving in recent years. The basic objective is to get the mother’s breast and nipple positioned deeply in the baby’s mouth At one time, it seemed that lactation counselors believed that there was only one right way to do this and that a mother must follow the “correct” procedure, like a recipe. Today, skilled counselors understand that there is no single correct way for a baby to latch to the breast. The only essential measures of a good latch are that mother and baby are comfortable and that milk transfers efficiently. Great books for understanding how baby can latch more effectively include Breastfeeding Made Simple by Nancy Mohrbacher, IBCLC, and Kathleen Kendall-Tack- ett, Ph.D., IBCLC, and The Latch by Jack New man, M.D., IBCLC, and Teresa Pitman.

Once baby latches, pay close attention to how it feels. It’s normal to feel some tenderness in the early days, but if it actually hurts, he is probably latched too shallowly. Encourage a deeper latch by changing your position or the way he comes to the breast. If the pain continues, something is wrong no matter how good the latch may look on the outside; seek help from a lactation consultant sooner rather than later.

If baby isn’t latching successfully by the end of the first six hours, keep him skin to skin to stimulate his feeding reflexes and begin expressing colostrum. Don’t use your pump quite vet, though; hand expression usually gets more out than a pump in the beginning (see the video newborns.stanford.edu/Breastfeeding/HandEx- pression.html). It also works well if your breast:s become uncomfortably full as the milk comes in because pumping can draw more fluid into your areolas, which causes swelling and makes latching difficult for your baby. Before pumps were invented, women throughout time have hand expressed very effectively. Try expressing a few drops of colostrum onto a plastic spoon for someone else to offer the baby while you express into a second spoon.

Is Frequent Nursing the First Three Days a Bad Sign?

During the first three days after birth, many babies will nurse quite voraciously until full milk production starts. Nursing sessions can feel like marathons and last up to several hours off and on, without any clear beginning or end. You may wonder if baby will ever come up for air! Rest assured that this doesn’t mean baby needs more than you are making right now. A newborn’s stomach is very small at birth and stretches out gradually over the first week as your milk comes in. An extra hungry baby simply helps to hasten the increase in milk volume, but at a pace that is healthy for him.

If you can’t express much colostrum in the first few days, it doesn’t mean that it isn’t there Swollen breast tissue caused by water retention after birth can make expressing colostrum or milk difficult the first few days, and hand expression is a skill that takes some practice. Colostrum, which can be golden or clear like saliva, 1S produced in very small quantities. Babies take on average about 1 to 3 teaspoons (5 to 15 milliliters) per feeding, but every drop is valuable.

Optimizing Milk Removal: Breast Massage and Compression

Once baby is latching well, maximizing drainage helps strengthen the signal to make more milk. One of the difficulties of low milk production is that milk ejection is often less effective when it has less volume to work with, so milk may not be completely drained by the baby or a pump. To get the most milk out, massage your breasts both before and during feeding (or pumping). One study looked at the effect of simultaneous massage with pumping and found 40 to 50 percent more milk was removed when pumping with massage than without it.

One popular variation of breast massage is called breast compression and uses external hand pressure to push out any residual milk. Hold your breast with your thumb on top and your fingers underneath (or vice versa), far back on the breast away from the areola. Compress the tissue between your fingers and thumb gently but firmly-it shouldn’t hurt or pinch ducts- and hold the compression. If you feel any firm or lumpy areas, focus your efforts there as they may contain pockets of milk. Baby usually will begin swallowing more rapidly, or you will see milk spraying into the pump flange. When baby’s swallows or the milk spray slows, release the pressure and rotate a little to another firm area, repeating the process.

Breast compression while pumping and breastfeeding can increase the amount of milk removed

Proximity and Frequency

Research shows that there is no medical reason for healthy mothers and babies to be separated which is why those central nurseries from our mothers days are slowly being phased out. Stay- ing in close proximity to your baby after birth stimulates him to feed more often and helps you to respond to his earliest hunger cues. So nurse, nurse, and nurse some more, at least eight times each twenty-four hours for as long as baby desires. Remember that frequent feedings in the early days are normal, and for mothers at risk of low milk production, they may be essential to calibrate the highest milk supply possible. They also help create greater storage capacity, which allows you to store more milk at one time for baby. In general, the best way to make more milk is to take more milk.

Worried About Becoming a “Human Pacifier”?

Letting baby nurse when he isn’t actively feeding or for comfort between feedings isn’t wrong. It won’t cause bad habits or an un healthy dependence on the breast. Pacifiers are artificial replacements for your breasts the original place of comfort. Babies nurse for many reasons besides hunger. There is great comfort when nursing at your breast, nuzzling close to your body, smelling your familiar smells, and being held in your loving arms. Decades of child development research have shown that a baby whose needs are met learns trust and security. Listen to your maternal instinct; nature gave it to you for a reason because it prompts you to give your baby what he needs to survive and thrive.

Avoid the visitor Syndrome

Those well-meaning relatives and friends arrive at your hospital room with great excitement, forgetting that you are just learning how to breastfeed. Some mothers formula because they’re uncomfortable nursing or pumping in front of others or asking them to leave. The visitor syndrome can continue at home as friends and family show up to see the new little one. Some mothers feel obligated to stay with their visitors, especially those from out of town. Well-meaning friends and relatives may ask to feed baby a bottle or suggest that the baby isn’t hungry yet, he just needs to be held… or given a pacifier or walked or burped.. any thine but put back to the breast, because it is surely too soon. By the time everyone leaves, you’re exhausted, baby’s frazzled, and breastfeeding is off to a slow start. Remember that nursing your baby is ultimately more important than your visitors’ feelings. Feel free to reclaim your motherhood by assertively asking for the time and space you need to concentrate on caring for your baby.

Express Milk After Breastfeeding

The first few weeks are an opportunity to maximize your milk-making potential by removing additional milk after or between as many feedings as you can. This will calibrate your production as high as possible. Once your milk comes n, a pump can assist you in this job. Although you may have purchased or received a consumer- grade pump before baby was born, they are designed for moms who have established milk supplies and are using them two to four times a day while at work or school. Hospital-grade pumps are heavier duty and best for maximizing milk removal at this critical time in building your milk production. 

Pumping for a few minutes after as many feedings as possible (unless baby is nursing really often and effectively) should continue for at least the first three weeks and then until you are sure your baby is getting enough milk. If the diaper count is low and baby needs supplementation, be sure to feed him any milk you express see BLOG 11 discusses pumping in more detail.

Don’t Skip Nighttime Feedings

Most mothers willingly feed their babies whenever necessary during the daytime but find themselves longing for an uninterrupted night’s sleep. At the same time, newborns often sleep longer during the daytime and eat more at night. The temptation may loom large to avoid night feedings or to have someone else feed the baby while you sleep. But here’s what you need to know: prolactin levels are higher at night when you sleep, and the prolactin surge in response to baby’s suckling is also greater than in the daytime.2 Milk flows more easily then because mother s sleepy and relaxed. This winning combination will go far in maximizing your milk production.

While it may seem that pumping during the daytime so someone else can give a bottle of pumped milk while you sleep is one way to have the best of both worlds, it can still cause your milk production to decrease because FIL builds up in the accumulating milk.

The first key to successful night nursing is to find a lying-down position (in a bed, not a reclining chair) that works for you and baby. While this comes easily for some mothers, it may take time and experimentation for others. Once this is accomplished the fortunate mothers who are able to doze right through feedings, especially when baby is a little older and can easily self-latch.

Second, take at least one or two naps during the daytime. They don’t have to be long, but close your eyes and let yourself drift off once baby is asleep. Flow with baby’s sleep pattern instead of resisting it; you will be surprised at how much this extra sleep can help. Even short naps cause prolactin to rise, once again giving you another hormonal boost. If you find it hard to nap because you have other young children or children who need care, this is the time to ask family and friends for help so you can get some rest.

Attitude is the final ingredient and plays the biggest role in how well rested mothers feel. Those who stress and resent nighttime feedings often wake up tired, grumpy, and irritable. Those who give themselves over to baby’s temporary night needs, however, and who see this a:s a passing stage or a gift to their baby often find that they feel rested and able to function. In fact, they may not even remember how many times baby actually fed the night before. Your attitude, naps, and an early bedtime really can make a world of difference in how rested you feel.

Putting It All Together: The Essential Elements

Getting your milk production off to the very best start hinges on frequent and thorough drainage of the breasts from birth onward. With an optimal latch, baby will do his part to the best of his ability. All you need do is follow his lead and allow him to breastfeed whenever he asks. Having realistic expectations of new motherhood and a plan to nurture yourself will also help you to cope and even flourish during this time Preparation and making baby your first priority will help you to maximize your milk-making potential now and eliminate the most common causes of low milk production.