How to check if the baby has enough milk and increase lactation?
One of the most common and painfully experienced problems that mom faces when breastfeeding a baby is a lack of milk. How to figure out if the baby has enough milk, and how to increase its quantity if necessary?
Julia Lopina Pediatrician, Smolensk
The experience of whether her baby has enough milk happens at least once with each young mother, especially in the first months after childbirth. Unfortunately, for many mothers, doubts about the sufficiency of milk result in the transfer of the baby to artificial feeding. Often, faced with the first difficulties, the woman makes a hasty conclusion about her hopeless "dumbness" (although the amount of breastmilk may be quite sufficient) and with the "support" of grandmothers or girlfriends, often without the experience of successful breastfeeding, begins to supplement the baby with a mixture or completely refuses to breastfeed. Most often this is due to a lack of knowledge about the mechanism of lactation and those criteria by which the mother can independently verify whether her milk is enough for her baby.
What you need to know about lactation
The main role in the mechanism of lactation is played by two hormones - prolactin and oxytocin. They begin to be produced by the pituitary gland immediately after childbirth.
Prolactin is the hormone responsible for the secretion of breast milk. On it depends the amount of milk from the mother: the more prolactin the pituitary gland produces, the more milk is in the mother's breast. Active development of prolactin is promoted by regular and complete emptying of the mammary gland and vigorous sucking of the breast by a hungry toddler. The more often and more actively the baby sucks the breast and empties it well, the more will be the release of prolactin and, accordingly, the more milk will be produced. This is how the "demand-supply" principle works, with the child receiving as much milk as he needs.
Most of the prolactin is produced in the night and the pre-morning hours, so it is very important to keep the night feeding to provide the baby with milk for the next day.
The second hormone that actively participates in the lactation process is oxytocin. This hormone promotes the release of milk from the chest. Under the influence of oxytocin, the muscle fibers located around the lobules of the mammary gland contract and squeeze the milk into the ducts towards the nipple. Reducing the production of oxytocin hinders the emptying of the breast, even if it contains milk. In this case, the child has to make significant efforts to get his food, so during feeding, he can behave restlessly and even get angry. When trying to express the milk in this case, the mother will be able to squeeze out only a few drops from the breast, remaining in full confidence that she has not enough milk. The amount of oxytocin produced depends on the emotional state of the mother. The more positive emotions and pleasure a woman receives, the more this hormone is produced. While stresses, disturbances and other negative emotions reduce the production of oxytocin, as in this case a large amount of the "anxiety hormone" of adrenaline, the worst "enemy" of oxytocin that blocks its production, is thrown into the bloodstream. That's why a comfortable and quiet environment around her and her baby is so important for a nursing woman.
Why "breast milk" ran away
Lactation is a very fluid process, influenced by many different factors (mum's health, frequency of feeding, severity of the sucking reflex in a child, etc.). Breast milk can not be produced "on schedule", and for certain reasons, its quantity may decrease. Inadequate milk production in a mother is called hypogalactia. Depending on the causes of its causes, primary and secondary hypogalactia are isolated.
Primary hypogalactia is a true inability to lactation, which occurs in only 3-8% of women. Usually it develops in mothers suffering from endocrine diseases (diabetes, diffuse toxic goiter, infantilism and others). With these diseases in the body of the mother is often observed underdevelopment of the mammary glands, as well as a violation of the processes of hormonal stimulation of lactation, as a result of which her mammary glands simply can not produce enough milk. It is rather difficult to treat this form of hypogalactia, in such cases hormonal preparations are prescribed.
Much more common secondary hypogalactia. Decreased milk production is mainly associated with improperly organized breastfeeding (irregular attachment to the breast, prolonged interruptions between feedings, incorrect breast capture), as well as physical and mental fatigue, lack of sleep, eating disorders, and diseases of the nursing mother. The causes of hypogalactia can also be complications of pregnancy, childbirth and the postpartum period, baby prematureness, taking certain medications and much more. Reduction of lactation can be caused by the unwillingness of the mother to feed the baby with a breast or her insecurity in her own powers and the mood for artificial feeding. In most cases, secondary hypogalactia is a temporary condition. If the cause, which caused a decrease in milk production, is correctly identified and eliminated, lactation is normalized within 3-10 days.
All of the above situations are true forms of hypogalactia, which nevertheless do not occur as often as false, or imaginary hypogalactia, when enough milk is produced in the nursing mother, but she is convinced that she does not have enough milk. Before you beat the alarm and run to the store for packing the mixture, mom needs to figure out if she really has little milk.
Does the baby have enough milk?
Quickly and reliably make sure that the baby has enough milk, you can, counting the number of his urination. Make a test for "wet diapers": to do this, calculate the number of urination of the baby in 24 hours, without using disposable diapers and each time changing the diaper when the baby pisses. The test is considered objective if the child is exclusively breastfed and is not dopaivayut water, children's teas and other liquids. If the baby has stained 6 or more diapers, and the urine is light, clear and odorless, it means that the amount of milk that it receives is enough for its normal development, and supplementation is not required in this situation. If urination is rare (less than 6 times a day), and urine is concentrated, with a sharp odor - this is a sign that the baby is starving and it is necessary to take active measures to restore lactation.
Another reliable criterion for assessing the adequacy of nutrition and the normal development of the child is the dynamics of weight gain. Although the child's growth occurs unevenly, in the first half of life, the baby should add at least 500-600 grams per month. If her mother is worried about the rate of her child's weight gain, it is more appropriate in such cases to weigh the baby once a week, while observing strictly defined conditions (weighing it is necessary in the morning before eating a completely naked baby without a diaper). According to WHO, weekly weight gain of 125 grams and above is an indication that the baby is getting enough nutrition. From the age of 5-6 months the child's growth rate decreases, and he can add 200-300 grams per month.
How to get breast milk?
Only after the mother, relying on reliable criteria, was convinced that her baby really needs more milk, she needs to take measures to stimulate lactation. In most cases, the "runaway" milk can be returned. The most important criterion for success in this case is the confidence of the mother in her own strength and the desire to breastfeed. Only confidence in the correctness of their actions and the mood for prolonged breastfeeding will help her show the necessary persistence and patience and resist the "benevolent" advice of relatives and girlfriends to feed the "hungry" baby with a mixture.
In order to increase lactation, it is necessary to solve two main tasks: first, to find and if possible eliminate the cause of the problem (for example, fatigue, lack of sleep, improper application of the baby to the breast, etc.) and, secondly, to adjust the hormonal mechanism "demand - supply", increasing the number of feedings ("requests") of the baby, in response to which the body of the mother will respond with an increase in the "supply" of milk.
* Stimulation of the breast. Given the determining role of hormones in the mechanism of lactation, the most important and effective way to increase milk production is to stimulate the breast by sucking the baby and completely emptying it. With a decrease in milk production, the mother should first of all take the following measures:
- increase the frequency of applying the baby to the breast: the more often the baby will suck the breast, the more likely to receive signals for the production of prolactin in the brain and, accordingly, will produce more milk. It is necessary to give the baby the opportunity to suck the breast for as long as he likes, the artificial restriction of sucking can lead to the baby not getting to the most nutritious "rear" milk and will not get enough fat and protein (hence, there may be bad weight gain). If the milk in one breast is small, you should offer the baby a second breast, but only after he completely emptied the first. In this case, the next feeding should be started from the breast that the baby sucked last;
- make sure that the baby is correctly attached to the breast: effective stimulation of the nipple and emptying of the breast occurs only when the child completely captures the areola. In addition, if the breast is not correctly seated, the child can swallow a large amount of air that can fill most of the stomach volume, while the amount of sucked-up milk will decrease;
- preserve night feeding: the maximum amount of prolactin is produced between 3 and 7 am. To ensure the production of sufficient quantities of milk on the next day, there must be at least two feedings in the night and pre-weaning period;
- to increase the time spent together with the baby: to stimulate the production of milk to the nursing mother, it is very useful to spend as much time as possible with your baby, to carry it on your hands, to hold it against you, it is very useful for lactation to have a joint sleep with the baby and direct contact "skin to skin."
* Psychological comfort. In the life of any mother, there are inevitably anxieties and worries. The main thing is that its short-term momentary unrest does not grow into a constant anxiety. Nervousness, a burden of responsibility, a fear of doing something wrong can cause chronic stress. In this state, a high level of the adrenaline hormone is constantly maintained in the blood of the nursing mother, which, as already noted, has a blocking effect on the production of oxytocin and thereby prevents the release of milk. In fact, milk in the breast can be produced enough, but if the mother is nervous or irritated, she can not "give" to his baby. To avoid such situations, nursing mothers need to learn to relax. Help in this can massage, a warm shower or a bath with aromatic oils (lavender, bergamot, roses), pleasant music and other ways to create a calm and comfortable environment around yourself and, of course, the most important antidepressant - infinitely loved and in need of mother's love and warmth little man.
* Complete rest and sleep. Typically, the woman sitting at home with the baby is loaded with the whole load of domestic work, which is already saying that a full 8-hour sleep of the nursing mother "only dreams." Nevertheless, lack of sleep and physical overload are one of the most frequent reasons for reducing the amount of milk in the chest. In order to adjust lactation, the mother needs to revise her daily routine and be sure to find in her busy schedule a place for daytime sleep and daily walks in the fresh air.
* Nutrition and drinking regime. Of course, for the full production of milk, the nursing mother needs additional energy, nutrients and fluids, while it is important that the nutrition and drinking regime are full, but not excessive. The caloric content of the ration of the nursing mother should be about 3200-3500 kcal / day. The optimal frequency of food intake is 5-6 times a day, it is better to have a snack 30-40 minutes before feeding. With a decrease in the production of milk for breastfeeding mothers, it is desirable to include products that contribute to the production of milk in their menu: carrots, leaf lettuce, parsley, dill, fennel, sunflower seeds, Adyghe cheese, cheese, sour cream, as well as lactogenic drinks: carrot juice, black currant juice in the absence of allergies in the baby).
A much greater importance for maintaining lactation at the proper level and stimulating the production of milk while reducing it has a drinking regime. The breastfeeding woman needs to drink at least 2 liters of liquid per day (this volume includes purified and mineral water without gases, compotes and fruit drinks, seasonal berries and fruit, tea, sour-milk products, soups, broths). Promotes better emptying of the breast warm drink for 20-30 minutes before feeding (this may be a weak green tea or just warm boiled water).
* Shower and massage. Quite effective ways to increase lactation are hot or contrast shower and breast massage. These procedures increase the flow of blood to the breast and improve the separation of milk.
The shower is best taken in the morning and evening after feeding, while directing the water streams to the chest, doing a light massage with the hand clockwise and from the periphery to the nipple, for 5-7 minutes for each breast.
To increase the flow of milk, you can do breast massage. To do this, grease your hands with olive or castor oil (it is believed that these oils have a stimulating effect on lactation), one palm to place under the chest, the other on the chest. Massage the mammary gland with light circular motions clockwise (2-3 minutes each), without squeezing the fingers of the chest and trying to ensure that the oil does not fall on the areola of the nipple, so as not to cause frustration in the stool of the child. Then the same easy stroking of the palms from the periphery to the center. Such massage can be performed several times a day.
More often than not, increasing the number of feedings, adjusting the regime of the day and feeding the mother in a few days yield positive results, and lactation is being adjusted. If the above measures within 7-10 days do not bring a tangible result, the nursing mother should discuss with the doctor the pharmacological and physiotherapeutic methods of increasing lactation.
What is a lactation crisis?
Already in the process of adjusted breastfeeding, a nursing mother may encounter a physiological phenomenon, such as a lactation crisis, when she suddenly, without obvious reasons, decreases the amount of milk. Usually this is due to a mismatch in the amount of milk the child needs. The fact is that the growth of the baby can occur not uniformly, but jumpwise, the most typical growth spikes in 3, 6 weeks, at 3, 4, 7 and 8 months. As the growth of crumbs increases and his appetite, in this situation, the breast simply does not have time to produce the required amount of milk. In this case, the baby can receive as much milk as before, but this amount is no longer enough for him. This situation is reversible. With an increase in the number of feedings and the absence of supplementary formula after a few days, my mother's breast will "adjust" and provide enough food for the baby.