Antenatal Expressing

A common question I get asked by mums-to-be is "How will I know I have enough milk for my baby?"  In most circumstances, Lactogenesis II and III (milk coming in and ongoing production) happen seamlessly, but for a rare few - milk supply does not come in as it is meant to.

In these cases, antenatal preparation in the form of education, expressing and storage of breastmilk during the pregnancy (from 36 weeks) may of been beneficial for those women.  The recently published DAME study in the LANCET 2017, indicated a benefit to those women particularly with gestational diabetes, but also dairy/food intolerances, Polycystic Ovarian Syndrome (PCOS), maternal breast surgery, known cleft lip and/or palate and other conditions that may indicate the possibility of early feeding problems such as kidney or heart issues.  

Knowing what is right for you and when/how to express should be done under the guidance of an International Board Certified Lactation Consultant (IBCLC).  There are some instances where antenatal expressing is not recommended, therefore a thorough history and education should be part of your care.

Make an appointment today with Adelaide Lactation Consultants to discuss your breastfeeding plan.  Antenatal preparation is vital for long term breastfeeding success.  We offer antenatal breastfeeding education which will include information about expression and storage of breastmilk.


Low milk supply

                                                                                        Adelaide Lactation Consultants © 2017

Most mothers produce enough milk for their babies.  Your milk supply is considered low when there is not enough breast milk being produced to meet your baby’s growth needs.

Many mothers worry about their milk supply, especially in the early stages of breastfeeding.  In fact, women who have stopped breastfeeding will most commonly say it was because they ‘didn't have enough milk.’  However, most mothers do produce enough milk for their babies.  Often the reason for ceasing breastfeeding is lack of support or knowledge about what is considered normal and expectations surrounding breastfeeding.  The support of close family and friends is important to guarantee success.  Sometimes well meaning relatives make mums doubt their abilities unnecessarily. 

If the breast milk supply is genuinely low it is usually a temporary solution and can be improved with appropriate support from a Lactation Consultant.

There are some common reasons why women may think their milk supply is low:

My baby feeds often, sometimes every 2 hours

Babies naturally feed frequently (between 8-12 times in 24 hours), and in the early postnatal period babies can be very unsettled as they try to figure life out.

My breasts always feel soft

When your milk supply adjusts to your baby’s needs your breasts may not feel as full (generally this is 6-12 weeks after birth).  As long as your baby continues to feed well, your breasts will produce enough milk.

My baby has started to feed more frequently

Your baby may want to feed more frequently during ‘growth spurts’ or ‘wonder weeks,’ but this increase in feeds over a few days/week will increase your overall supply and meet baby’s requirements for growth.

My baby feeds for a short time

This is no cause for concern as long as your baby is happy and continues to grow.  After two or three months your baby becomes more efficient at feeding therefore will take less time at the breast.

Signs your baby is getting enough milk:

After the first week following birth, your baby should:

  • Wake and demand for feeds by themselves
  •  Have at least 6-8 soaked nappies (4-5 heavy disposables) in 24 hours
  •   Settled between most feeds
  • Pass soft yellow stools at least once per day

Your baby should be back to birth weight around 2 weeks of age and gaining approximately 150grams per week for the first 3 months of their life.  Growth can slow after this time.

Possible causes of low milk supply

  •  Your baby is not attaching well at the breast.  This may also cause nipple pain and damage.
  • Your baby does not feed often enough       
  • Your baby does not feed effectively at the breast
  • You have recently had mastitis or have been unwell
  • Baby may have an issue with their mouth/tongue e.g. thrush, tongue, lip ties
  • Your are taking oral contraceptive pills containing oestrogen
  • You have started using formula (for even one feed) as well as breastfeeding.
  • You have had breast surgery that is effecting your milk supply e.g. breast reduction/augmentation
  • You may have some medical conditions that can affect the amount of milk you produce (occurs in less than 5% of mothers) such as Poly Cystic Ovarian Syndrome, Thyroid disorders
  • You smoke
  • Some medications can effect supply including herbal and over the counter preparations

How to increase your milk supply

There are many ways to increase you milk supply.  This may take some time and it is important that you seek advice and support from an experienced lactation consultant who can guide and encourage you.

Talk to Adelaide Lactation Consultants & Midwifery about strategies to manage feeding and expressing while you are increasing your supply.  Often it can take about 1 hour to feed and express.  Then you and your baby can rest between feeds.  Your partner or support person can settle baby, while you express so you do not feel overwhelmed.

If I could tell a new mum a few simple things to remember.....

  1. You can legally refuse anything. Vaginal exams, induction, c-section. It's your right to refuse, ask for more information, ask for a compromise on your providers care..... negotiate a mutually agreeable solution.  The medical/midwifery team all have one common goal... to ensure a safe birth for you and a well baby.  Simple.
  2.  Birthing while laying on your back narrows the pelvic diameter, it also means you are pushing    uphill making it more difficult and thus lengthening labour.  Most women find this position can be more painful.    Try squatting, standing, onto all fours, kneeling, these positions all have gravity on their side.
  3. Labour is hard..... very hard.  Research has proven that drugs used in labour can slow labour down, increase the need for medical intervention and impact breastfeeding outcomes.  Try to adapt a positive mindset to ensure you can get through labour. Surround yourself with a birthing support network who are all on the same page.  Don't have your friend or sister there if they are going to push you to have an epidural (because they had one),  if you do not want one.  This will erode your willpower and make you second guess your choices/preferences.  Remember.... it is one day..... and it is hard work!
  4. The midwives are there to help you.  They will discuss your birth choices and negotiate with you accordingly.  You are the boss!  But do remember that midwives also work within a medical model of midwifery, where the doctor and hospital protocols are what govern decisions/choices.  If you are well researched and discuss with the medical team your wishes, a mutually agreeable care plan will be negotiated.
  5. Cutting the umbilical cord before it has ceased pulsating means your baby can lose up to 1/3 of their blood volume!  This is routine practice in most delivery suites, however discuss this with your midwife/obstetrician.  It can also be done at C-section.
  6. Skin to Skin following birth for at least one hour is very important.  Ringing/texting people can wait until after this special time.  You never get these precious minutes back again and some babies find their own way to the breast and attach themselves!
  7. Delay weighing and bathing the baby after birth.  The special sticky white vernix over most babies acts as a moisturiser and antibacterial.  Baby is used to smelling this fluid and it is familiar to them.  If baby is placed directly skin to skin following birth, the vernix is around the breast... again offering a familiar scent for baby.  Think Hansel and Grettel and the crumbs!
  8. Doctors, nurses and midwives often get minimal breastfeeding education.  There is very little, if any, in a medical degree.  Some hospitals are BFHI accredited and therefore all staff dealing with babies are to have 20hrs of breastfeeding education.   If you are not getting the answers you need to support you to breastfeed, such as tongue ties, thrush, weight gain, positioning and attachment issues, seek further advice or ask to make an appointment with a Lactation Consultant.    You know your baby and you know what is working and what isn't.  If you are experiencing a concern, always talk to a International Board Certified Lactation Consultant (IBCLC) or breastfeeding counsellor.
  9. If you do need a c-section, it does not mean you cannot have a natural birth next time.  Your obstetrician will discuss with you their recommendations for future pregnancies and what is safest for you.  A healthy mum and healthy baby should be what matters most.