Ask a lactation consultant: your breastfeeding questions answered

Many women think it will just “come naturally,” but breastfeeding can actually be really difficult. Especially when you’re just starting out — sleep deprived and overwhelmed. From worrying about your milk supply to wondering why your newborn baby is not eating often enough, breastfeeding can end up adding a whole new level of stress to parenting. We interviewed veteran lactation consultant (LC) Fara Patterson to help us figure out when to relax and when we should be concerned.

How can I tell if baby is getting enough milk?

Unlike with bottle feeding, it’s hard to tell how much milk a breastfed infant is drinking. Short of rigging up a baby scale to weigh them before and after a feed, there’s no real way to know what they’re taking in. But according to Patterson, there are other ways of figuring it out. “After your milk comes in, you should see milk at your baby’s mouth. You should see slow, deep gulping. And most importantly, your newborn’s pee and poop frequency will tell you.” Most women receive a chart when they leave the hospital that lets them know the number of diapers a newborn baby should produce on a daily basis. If you’re hitting that target, your baby is getting enough.

How can I tell if I have low supply?

Patterson gets this question a lot. “Mothers get concerned around cluster feeding in those early days. They start to think they don’t have enough milk because baby’s always there feeding, and that’s not always the case,” she says. Knowing how many diapers per day is normal for a newborn is key, but your baby’s demeanour is also an indication. “Is your baby comfortable and settled after a feed or are they waking up constantly and screaming? Is baby feeding for over an hour at a time but never seems content and full? Are they droopy and listless? If you’re seeing dark yellow pee and their poop colour doesn’t change, your newborn baby is not eating enough. Seeing your doctor within 72 hours is also crucial, because we put a lot of stock in what your baby’s weight is doing.” If none of these factors apply, and your baby is gaining weight, then they’re probably doing great.

What do I do if I have low supply?

Domperidone gets a lot of publicity as a “wonder drug” capable of fixing all your breastfeeding woes. But before you run to your doctor for a prescription, there are other options to try first says Patterson. “For breastfeeding problems caused by low milk supply, we’re probably going to start pumping. As your baby grows, it goes through growth spurts and starts going to your breasts really frequently. This forces your body to kick up milk production. Pumping after nursing is just like telling your body that there’s a growth spurt happening with that baby.

“As well, we’re going to look at your latch. If your baby isn’t latched deeply and positioned well, they won’t have a latch that can efficiently strip milk out of your breast and help your body understand that it has to refill. And if you only have a baby snacking on a small fraction of what’s available, then the body’s response to that is only to refill that small fraction.” Basically, breastmilk is produced on a supply-and-demand basis. The body replaces only what is removed. So you’ll want to figure out how to increase the demand in order to increase the supply.

I think my milk is taking too long to come in

Even before your baby is born, your breasts begin producing colostrum. When your milk comes in, three to five days after birth, it’s called lactogenesis II. While that can seem like a long time to go without milk, Patterson reassures her clients that “full-term babies come packing a lunch, which means that they have extra fat on them. Between that fat and colostrum, they’re getting by.” She does caution, however, that babies who are born early or small do sometimes need intervention. And all babies must be seen by a doctor or midwife within the first 72 hours of their birth for a weigh-in, a well-baby check, and medical guidance. If you’re worried about your child’s health before their first checkup, however, don’t wait. Concerns regarding a newborn are a priority and you should have no trouble getting a same day appointment. 

My baby is feeding “too much”

Patterson draws a distinction between the first few days of cluster feeding and prolonged back-to-back short feeds later on, which might signal that something is wrong. “Until about day three to five when baby is getting by on colostrum, they’re going to be at your breast stimulating. Mother nature wants them doing that to get you to make milk. It’s part of the process. It’s not easy and nobody likes it very much, but it’s natural. But if cluster feeding is still constant at day eight, you should speak with an LC.

“Cluster feeding also happens in and around growth spurts — it can come back. But then it’s a different creature, it’s not about getting your milk in anymore. Some babies are fussy at the end of the day and want to do back-to-back feedings to settle themselves. But if you’re coming to me at week two and saying your baby has never stopped cluster feeding, that’s probably an indicator that you’re in trouble.” It’s normal for the amount your baby eats to fluctuate over time. But big changes might be a signal that all is not right. When in doubt, trust your gut!

My newborn baby is not eating enough

“In the early days, you need to make sure you’re getting in eight to 10 feeds in 24 hours no matter what,” Patterson stresses. Even, she says, if that means waking baby up to nurse.

Reading baby’s hunger cues can sometimes be confusing, especially at first or if they were born prematurely. In these cases Patterson suggests reaching out for some support. “Sometimes early babies don’t cue you like a full-term baby does. If that’s the case, it’s a good idea to speak to an LC – they’ll teach you about what a 36 or 37 weeker is doing.” But if you suspect your newborn baby is not getting enough to eat, your first appointment needs to be with your physician, who may suggest that you supplement with formula, at least for a bit. Once your child has been assessed by a doctor, however, seeing an LC is a great second step. Especially because baby not eating enough can cause engorgement (if there isn’t a supply issue).  This can make your breasts quite hard, which can cause the baby to have problems latching on, and ultimately make the situation worse. If this happens, hand expel some milk before nursing until your breasts are somewhat less hard. Left unaddressed, engorgement can lead to blocked ducts and mastitis.

There are millions of things for new parents to worry about. When breastfeeding doesn’t come easily, wondering if your baby is getting what they need gets added to the list. While breastfeeding problems are overwhelming for new parents, lactation consultants have years of experience to draw on and speaking with one can be hugely beneficial. From pain to latching and supply issues, they’ve seen it all. If you have concerns, speaking to one can help put your mind at ease.