Updated: Nov 29, 2022
Got milk questions? We’ve got answers!
Excerpted from “Interview with lactation consultant, Elayne Clubb, RN” READ THE FULL INTERVIEW PLUS MANY MORE FEEDING RELATED ARTICLES IN THE FEBRUARY 2015 ‘BREAST ISSUE EVER’.
How can you tell if your baby is getting enough milk/formula?
**I am addressing breastfeeding only. This is one of the most commonly asked questions by new mothers, especially with her first baby. Many new mothers do not have the confidence that they will have enough milk for their baby. I try to reassure them to trust in their body and be as informed as possible. If your baby is usually content, is alert, active, and meeting developmental milestones, he is probably getting enough to eat.
During the first 3-4 days of life, an infant usually loses 5-7% of his birth weight. By day 5 (after mother’s milk comes in), the average weight gain is 5-7 oz. per week, regaining birth weight by days 10-14.
A good way to tell if your baby is getting enough to eat is by counting his/her diapers. In our hospital, we give new parents a chart that encourages them to keep track of the baby’s diapers and has a reference for normal parameters. Newborn babies usually have 1 wet diaper for each day of life (on day 1, they should have 1 wet diaper, on day 2, 2 wet diapers, and so on—more is fine) until day 4, after which they should have 4-6 wet diapers or more. The urine should be clear to pale yellow. Newborn babies usually have 1 stool or more on day 1, 2 stools on day 2, and so on until day 4, after which time they should be having 4 or more per day. More stools per day are normal, but less or no stooling can signify that breastfeeding needs to be evaluated. The stool will change from tarry black at birth to yellowish and soft or loose by day 5. Many breastfed babies have many soft yellow stools in the early weeks, and this is a good sign that breastfeeding is going well. After 4-6 weeks of age, the baby usually changes to having only one stool per day, and some babies have even less. If a mother is worried that her baby is not getting enough to eat, she can consult with a Lactation Professional who can help her. We often help mothers in this way by checking the baby’s weight gain as well as observing a feeding.
When a baby is nursing well, the mother’s breast should be firmer before the feeding and softer after the feeding (this may change as the baby becomes older). One should also hear or see the baby swallowing during the feeding. To determine how much milk a baby gets during the feeding, we use a gram scale and weigh the baby before and after the feeding. If the baby is not getting enough to eat, the consultant can help the mother find the problem and plan a solution.
Can clothing or improperly fitted bras increase the occurrence of mastitis?
Yes. This can cause milk stasis which can be a causative factor in mastitis; however, the major causes of mastitis are stress, fatigue, anemia, cracked nipples, and weakened immunity. Anything that restricts the flow of milk or sometimes puts pressure on the duct can result in milk stasis, plugged ducts, and even mastitis. In addition to clothing or poorly fitting bras, the strap of a purse or diaper bag or even a sleeping position can also put pressure on the ducts. If a breast is consistently not emptied, it is also at greater risk for infection. Using a nipple shield, limiting feedings, poor latch, oversupply, and tongue tie can all result in a breast not emptying well. Mastitis is an infection in the breast tissue. There is no infection in the milk, so the milk is safe for the baby.
How much of a factor is water intake when it comes to successfully keeping up milk supply?
Although it is very good for a breastfeeding mother to drink water, a mother’s milk supply depends on stimulation and emptying of the breast, not the amount of water or any other liquid she drinks. The more often and efficiently a baby nurses, the more milk the mother makes.
To increase her milk supply, a mother needs only to nurse more often and/or more efficiently. Some mothers choose to use a breast pump to increase breast emptying, pumping after or in between feedings. Increasing skin contact with her baby (called skin-to-skin nursing) is another way a mother can increase her supply. A practice called “switch nursing,” where a mother switches from one breast to the other, repeating several times, can also increase supply. A Lactation Professional can help if a baby is unable to empty the breast efficiently, and she can teach the mother about herbs and medications that can also sometimes help.
One of the things I have often said to parents when they are frustrated and tired of working on breastfeeding is that usually, the things that are most valuable in our lives are the ones that we have had to work the hardest for.
ABOUT THE AUTHOR:
Elayne Clubb, RN, graduated with a Bachelor’s Degree in nursing from the University of Utah in 1968. She has since worked as a Registered Nurse in many disciplines, including bedside nursing, nursing management, education, and as a Physician’s Assistant. For the last 25 years, she has worked in Maternal-Child nursing, specializing as a Lactation Consultant. For much of that time, she was certified as an IBCLC (Internationally Board Certified Lactation Consultant). Over these years, I have taught classes for new parents, doctors, and other healthcare professionals. She has also written various policies and procedures for the hospital and many educational tools for new parents.