Caroline Deacon
Journalist and author based in Scotland, UK

In Print

Breastfeeding for beginners - chapter 3, extract

Chapter 3: How breastfeeding works

How your body produces milk to feed your baby.

While you’re breastfeeding, your body produces two hormones, oxytocin and prolactin.

Prolactin ensures that your body creates more milk to replace what your baby has just taken, so you’ll never run out. Prolactin levels are often higher at night and make you feel sleepy, so when you get up to feed your baby, your body makes sure you can get back to sleep easily.

When your body thinks that your baby needs to feed, oxytocin will make the muscles around your ducts contract, pushing milk down from high in your breast to where your baby can get it.  This is called the “let down reflex,” which you may be able to feel as a tingling sensation under your armpits; it might even be strong enough to feel painful. Some women are completely unaware of their let down reflex, but all women will “let down” milk. Even a baby who is not well positioned at the breast may get a reasonable amount of milk purely from what his mother “lets down” (although in the long run he will not get enough milk).

Once breastfeeding is established, your let down can be triggered even when your baby is not with you - perhaps by hearing another baby cry, or by thinking about your own baby. Your milk may gush or spurt out, so you might need to wear breastpads when you are out and about, or have a cloth ready for mopping up when you are feeding your baby.

Oxytocin also helps your womb contract during the days after the birth, so it can return to its pre-pregnancy size. Some women find these contractions painful – hence the term “afterpains”, especially for second or subsequent babies. If you find these strong, ask your midwife for some painkillers; the pain will only last for a few days.

This hormone oxytocin is also what makes you feel good when making love. Even when you are not pregnant or breastfeeding, your breasts are connected through your autonomic nervous system to your womb and clitoris, which is why some women can reach orgasm through nipple stimulation alone. When you make love, milk may spurt or run from your breasts as your oxytocin levels increase.

What is breastmilk?

From about twenty weeks of pregnancy until several days after your baby’s birth, your breasts produce a straw coloured milk called colostrum. Although the quantities that you will produce are tiny - usually no more than a teaspoon per feed – it will give your baby a real boost as he enters the world as it’s rich in antibodies. It also acts as a laxative to help your baby pass meconium - your baby’s first, black and sticky stools. Feeding your baby often in those early days will also help him avoid jaundice, because colostrum helps your baby expel bilirubin from his bowels.

After a few days of feeding, your colostrum will be replaced by mature breastmilk; this is often referred to as your milk “coming in.” From now on, at every feed, each breast will start with fore milk (the milk which comes in before), which is dilute and thirst quenching, gradually thickening into hind milk (the milk which follows behind), which is packed with calories.  So when your baby latches on, first he has a refreshing drink, then he gets down to a satisfying meal of hind milk, which helps him grow at an enormous rate. Therefore, if you limit your baby’s time at the breast, or swap sides too soon, he won’t get so much of the hindmilk he needs to grow, so he will be hungry again very quickly.

Human breastmilk – whether colostrum or mature breastmilk, will not look like the milk you buy to drink - not surprising as a baby calf is quite a different prospect from a 7lb human baby!  Some women worry that their milk looks too thin because they expect it to look like cow’s milk, but be assured that your milk is perfect for your baby.

Not only does your milk change during each feed, it also varies with circumstances.
Your breastmilk will taste of whatever you have been eating so your baby can used to your family’s diet. It also carries antibodies to combat whichever specific viruses you come into contact with that day. Your baby’s immune system is immature during his first year and he cannot fight infections as well as you can, so you pass your own antibodies to your baby through your breastmilk.

Of course unwanted substances may pass through your breastmilk too. So just as you did in pregnancy, you should consider what you are eating and drinking carefully, avoiding any unnecessary medication. See chapter seven – breastfeeding and your diet.

As your breasts prepare to step up supply, changing from low volume colostrum to higher volume mature breastmilk, they become engorged with blood, and you may feel uncomfortable, hot, and find it difficult to latch your baby as well as before. Often the accompanying changes in hormone levels will make you feel weepy  - “baby blues” as this time is known.  It will pass within twenty-four to forty-eight hours, never to return, but in the meantime, feeding your baby as often as possible helps it pass. See chapter ten for more on engorgement.

How do I make enough breastmilk?

It’s quite simple to make enough milk, let your baby decide when he needs to eat, and when he has had enough. Only he is capable of deciding how much he really needs. The more you feed, the higher your prolactin levels and therefore the more milk you will produce - you can’t run out. “Saving it up” for later will actually mean you will have less than you need. This system of producing more milk whenever your baby feeds, is often called “supply and demand” or baby-led feeding.

In the early days, when your body is trying to work out how much milk your baby is going to ask for, avoid giving your baby extra fluids as this will mean he has less room for milk. Jaundice, for instance, is best cured with breastmilk, rather than water or formula milk.

Your answered:

Does feeding my baby on demand mean that I am spoiling him?

If you think of it as baby-led feeding rather than demand feeding, it sounds better! If you think about it, you too work on “supply and demand”. When you are short of supplies, your tummy “demands” more - i.e. it tells you that you are hungry. When your baby is hungry, he will let you know (“demands”). Your breasts then get to know how much your baby needs and when, and will “supply” the amount of milk he needs.

So is it always my baby who decides when to feed?

   No - you and your will baby form a two-way feeding partnership. If your breasts feel full, then you need to feed, so you can “demand” that your baby feeds and he will usually oblige. If you skip a feed, or go too long between feeds, you may get engorged, so feed your baby when you need to relieve this feeling of being over full.  You don’t need to wait until he asks every time.

Case history: -

Abigail is mother to Amanda, Ben and Katie. “I have always thought breastfeeding is very convenient - hot milk on tap at the right moment! Amanda was a very slow feeder at the beginning, so breastfeeding used to take a long time, but she did improve. The other two were fine from the start. That is the thing - it does always get much better and easier as time goes on.”

Myth or Fact?

If your baby feeds for too long he will use up your milk

False. Your baby cannot use up your milk. But if you need to cut feeds short occasionally, you can do. Remember, breastfeeding is a two-way relationship.