Your body was made to nourish your baby. During pregnancy, your breasts prepare colostrum with the assumption that you will breastfeed your newborn. After birth, this early milk gradually evolves into mature breast milk. As this occurs, the decisions that you make influence the development of your future milk supply. In the first few weeks following birth, a breastfeeding mother can take concrete steps that will lead her toward a strong milk supply.
I recently had a home visit with Marla, who was concerned about her low milk supply. After meeting with her and her three-week-old son, Henry, I concluded that Marla’s milk supply was indeed low. The cause of her trouble was clear; Henry was being cared for by a live-in baby nurse. This nurse had been keeping Henry with her during the night and for long periods during the day. Although he periodically breastfed, he was often pacified with artificial nipples and supplemented with formula bottles.
Marla was young, healthy, and capable of breastfeeding. Unfortunately, frequent separation from her baby and missed breastfeeding opportunities inadvertently gave her body the message that she did not intend to breastfeed, and Marla’s initially strong milk flow slowed to a mere trickle.
With so many variables affecting a mother’s milk supply, most new mothers are unaware that many of these variables are under their control. Had Marla understood that separation, pacifiers, and bottle-feeding would have a negative impact on her milk supply, she might have decided to keep Henry with her and breastfeed him more frequently so that her milk supply could fully develop.
What Are the Signs that My Body Is Making Milk?
Colostrum is available to satisfy your newborn’s thirst and hunger immediately after birth. Small amounts of thick yellow colostrum are high in protein, minerals, and some vitamins. Interestingly, colostrum contains cholesterol. Learning to metabolize cholesterol as a newborn may help your baby’s body develop healthy cholesterol levels later in life. Although small in volume, these early feedings are rich in immunities that work to protect your newborn from illness. With each successive feeding, your early milk prepares your baby’s stomach and intestines for the arrival of your high-volume mature milk.
“When Will My Milk Come In?” Timing varies, but new mothers can expect their mature milk to “come in” three to five days after giving birth. You will know that your mature milk has arrived because your breasts will feel different, your milk will look different, and your baby will feed differently. As your early milk changes, so will your breasts. Your breasts will become bigger, heavier, and warm. Many mothers describe feeling hot or developing a transient low-grade fever when their mature milk arrives. This entire process is called primary engorgement.
Your newly full breasts will begin to leak, and your mature milk will have a different look from your colostrum. The color of your early milk will gradually shift from yellow to white. Compared to your early breast milk, your mature milk will be copious in volume and look watery. Even though the breast fullness of primary engorgement happens overnight, it is normal to take several days for the color of your milk to shift from bright yellow to creamy white.
Finally, you will know that your mature milk has arrived by the way your baby feeds. Compared to early breast milk, your mature breast milk is higher in volume and sweeter tasting. Like your colostrum, mature breast milk is full of living cells that work to protect your baby from illness. As your baby feeds from your newly full breast, you will hear frequent swallowing and gulping as your baby takes in larger volumes of breast milk. In response to this greater intake, your baby should have a greater output of wet diapers and bowel movements. Your baby’s increasing diaper count is a sure sign of a healthy milk supply.
What Is Normal Engorgement?
Just as the hormones of pregnancy signal your breasts to produce colostrum for your baby’s first meal, the shifting hormones brought on by childbirth lead to the experience of primary engorgement. This usually occurs three to five days after birth even if a mother doesn’t intend to breastfeed. How a mother contends with the onset of primary engorgement can affect her milk supply and her entire breastfeeding experience.
Tara, a second-grade teacher and new mother, handled this important phase in the development of her breastfeeding relationship just right. Tara taught up until her labor started on a Friday afternoon. Her labor quickly progressed and Carla was born early Saturday morning. Tara breastfed Carla in the delivery room and by Monday morning the new family was home. So far, Tara and Carla had sailed through their initial days as a breastfeeding couple. Suddenly, things changed. On Monday night, both of Tara’s breasts became very full. It seemed that from one hour to the next, Tara’s breasts grew bigger than she thought possible. Carla noticed the change and had difficulty attaching to the new shape of her mother’s breast. Instinctively, Tara massaged and softened her breasts to help Carla get a better attachment. Tara breastfed Carla often, and Tara could hear Carla swallow milk as she breastfed. When Carla detached after feeding, Tara was happy to see that there was breast milk in and around her daughter’s mouth.
Even with frequent feeding, Tara felt uncomfortably full. To further soften her breasts, Tara expressed a little bit of milk so that she was more comfortable. By the end of the first week following Carla’s birth, Tara’s breasts were full but soft. She frequently leaked breast milk and began wearing disposable nursing pads. By following her excellent intuition, Tara was able to navigate through this period of primary engorgement with her strong supply of mature breast milk intact. The uncomfortable swelling resolved and Carla was now able to easily feed from both breasts.
Tara’s experience of primary engorgement was normal, or physiologic. By breastfeeding Carla frequently, Tara prevented her breasts from becoming overly distended. However, even with frequent feeding, Tara experienced the sensation of uncomfortable fullness. Overabundance at this time is normal as your body learns to predict exactly how much milk your baby needs. As Tara experienced, your body will err on the side of too much milk as opposed to not enough. As expected, within a few days, Tara’s body self-regulated, and this period of engorgement passed.