By: Jordan Berns

In the haze of stress that probably accompanied you home from the hospital, there is one question that seems to stick out: “Is my baby getting enough milk?”

Over the span of 24 hours, babies that were carried for a full term can be nursed up to eight to twelve times for the first four weeks depending on milk supply and appetite. After that, they may be fed approximately seven to nine times per every 24 hours. Sometimes newborns will be so sleepy that they don’t wake up crying to be nursed and this can lead to them being underfed. A good indicator is their urine and bowel movements. Five days after birth, well-fed infants should urinate six to eight times a day and have three or more bowel movements a day (these should be seedlike and pale yellow).

It is also important to monitor your baby’s weight. It is very normal to see term babies experience a 7% decrease in body weight a few days after being born. They will regain this weight 1 to 2 weeks later. There is only cause for concern if babies loses 10% or more of their birth weight and don’t return to their starting weight. Household scales are not precise enough to weigh your baby; they must be weighed on a medical scale. Always weigh your baby both before and after a feed and always in the same outfit to ensure accurate readings.

Doctors usually recommend that mothers breast feed for at least six months. However, women often stop breastfeeding early, particularly with women from higher-income countries. This occurs because breast feeding can be really hard for both mother and baby. Having trouble is a common experience. Some women have a difficult time producing enough milk and some babies have a hard time feeding. Life style changes and lactation consultants can help you breastfeed with more ease.

What is the key to producing more milk?

One of the reasons mothers do not produce enough milk for their babies is a biological one. Some women are missing glandular tissue that produces milk. Occasionally these do not develop enough during pregnancy. Hormonal imbalances can also cause milk to not be released. There are several hormones at play during pregnancy and breast feeding (which explains changes in moods as well). During pregnancy, estrogen and progesterone develop the breasts, while prolactin, cortisol, and insulin produce milk. Milk leaves the nipple with the help of oxytocin. A hormonal imbalance, along with low thyroid hormones, Polycystic Ovary Syndrome (PCOS), and hyperandrogenism (an oversupply of male hormones) can result in interrupted milk production and flow. Mothers under stress have lower levels of oxytocin, so when their babies start to suckle, milk does not release correctly.

Some medications interfere with milk production. Antihistamines such as Benadryl, decongestants with pseudoephedrine like Sudafed, Allegra-D, and Zyrtec-D, birth control pills with estrogen, and fertility medications like clomiphene can all negatively affect a mother’s milk supply.

Good hydration is critical for milk production. Even though breast milk is full of nutritious vitamins, proteins, carbohydrates, and fats, breast milk is 90% water! Eating plenty of water rich foods like fruits and vegetables can help you stay hydrated. If you question as to whether you are well hydrated or not, check the shade of your urine. If it is dark yellow, you need to increase fluids gradually throughout the day until the color is more clear. Drinks with caffeine like soda, coffee, and tea will dehydrate you; avoid these if you can. Luckily, the same oxytocin that triggers milk flow will also make you thirsty; listen to your body for hydration clues!

Women often wonder if breast reductions or augmentations will impact their ability to breast feed. Ultimately, it really depends on the individual woman and her specific surgery. Women who have had breast reductions could have a difficult time breast feeding, and might want to have a chat with their surgeon to see how breast feeding will work for them. Women with breast augmentations usually do not face any impediments while breast feeding. 

Some babies have a difficult time nursing, but you can help them succeed!

There are a few other reasons why your baby might have a hard time nursing and gaining weight. Some babies have birth defects of the mouth that keep them from nursing, like tongue tie (ankyloglossia). Tongue tie is when a stocky piece of tissue connects the tongue to the bottom of the mouth, restricting its movement. Tongue tie makes the tongue look heart-shaped or like it has a notch in it. This may have an effect on your child as he or she grows. It could interfere with how they can talk, eat, and swallow. It can also lead to tooth decay because clearing food from the mouth becomes difficult. However, there is a simple surgery that fixes this minor problem. 

Babies can also have infant torticollis, which is essentially a twisted neck caused by tightened muscles on one side of their neck. Babies with infant torticollis can have a difficult time nursing because they cannot find a comfortable position to latch. This is actually fairly common; 3/100 babies have it. It can be treated by encouraging babies to turn their heads from side to side while doing tummy time.

Simple ways of supporting good milk flow are increasing the time mother and baby spend together, working on your latch positions, and not supplementing as much with formula. Even though you’re fixated on meeting your baby’s needs, don’t forget about your own! Self-care is just as critical as taking care of your little one. Breast feeding can be difficult at times, but with a good team of doctors, nurses, and lactation consultants, along with a supportive base at home, this task doesn’t need to be a daunting one.  

2 comments

  • Sheila, Thank you for taking the time to write this thoughtful comment. We’ve changed the wording to better reflect the message we want to convey to the lactating community and are working on being more mindful of language choice in the future. -K.B. from Lactation Lab

    Lactation Lab
  • I am a retired IBCLC and a La Leche League volunteer leader for over 30 years. I am very upset to see the second sentence of the second paragraph in the above article giving information to nurse a baby 7 to 9 times in 24 hours after four weeks. That is a recipe for disaster for many nursing parents. At five weeks babies (and moms) are just starting to get the hang of nursing. Many parents are working on increasing their supply and working out the issues with soreness, which is common in the first few weeks. And using the word “should” puts many parents in a place of following that direction. And that will result in a lower milk supply for parent and an unhappy baby not nursing as often as they need to. Perhaps removing the word :should" and replacing the sentence with “at about 3 months babies can sometimes go a bit longer between nursings.” Please don’t set mothers and nursing parents up for failure. Thank you for your time, Sheila Zagone, retired IBCLC, La Leche League Leader, Postpartum Doula.

    Sheila Zagone

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