How much is enough? Thoughts on milk-making and motherhood

“I don’t have enough milk.”

In my work as a birth doula and a peer counselor with the Nursing Mother’s Counsel, I probably hear that lament a few times a week. Often, the statement is more accurately “I’m afraid I don’t have enough milk.” Talking more with the mom usually reveals that the baby is doing just fine (gaining weight, having plenty of wet and dirty diapers) but the mom is nervous.

This is understandable. What instinct is more basic to a parent than making sure our babies have enough to eat? Unfortunately, though, sometimes other forces are at work that may sabotage a mom’s commitment to breastfeeding. There’s the concerned grandma who, hearing the baby cry, suggests that maybe a little formula would help the baby sleep. There’s the pediatrician who suggests supplementation for every baby’s whose weight even gets close to dipping below an acceptable level rather than risk the health of the very, very few babies whose moms truly can’t make enough milk. Then there are moms themselves, who, in moments of sleep-deprived hysteria, reach out for anything they believe will help them get through the night–even if it’s the bottle of formula they really wanted to avoid and that might actually undermine their breastfeeding efforts.

Get educated

So what can these moms do? The first step is to get educated, particularly regarding where your pediatrician falls on the spectrum of support for breastfeeding. Pediatricians are wonderful medical caregivers, but their expertise and passion may not be around breastfeeding and they may or may not understand how important it is to you. You can ask some probing questions and a pose a few what-ifs, like “Under what circumstances do you suggest supplementing with formula assuming I am committed to exclusive breastfeeding? What if my baby loses more than 10 percent of his/her body weight in the first few days? What if my baby is jaundiced?” If you can have this conversation before your baby is born, you’ll know what to expect and can line up the support you need to get you through the first (sometimes tough) couple of weeks and get things off to a good start.

Understand the basics

You also need to understand the basics of breastfeeding: how frequently to nurse, helpful tips for positioning the baby, what to do if the latch is painful or if breastfeeding isn’t working. A breastfeeding class is a great way to obtain this basic knowledge prenatally. (Many are offered locally; I teach one at Blossom Birth in Palo Alto and the Nursing Mothers Counsel offers them in Redwood Shores.)

Get to know your baby

Then there’s another whole realm of education that doesn’t come from asking questions or reading books. It’s the on-the-job education of getting to know your baby. I always get a kick out of telling prospective parents that “The average baby will eat between 8 and 12 times per 24 hours.” Then I ask, “Who has an average baby?” Nobody! Just as adults have a huge range of “normal” in terms of food intake and timing, babies do too. And nobody can tell you what’s normal for your baby except–your baby.

Diane Wiessinger’s web site gives some good basic information about the wide range of feeding behavior you can expect from a breastfeeding baby. And the blog “Secrets of Baby Behavior”, produced out of UC Davis, is a wealth of information that can help you understand your baby’s behavior generally and feeding cues/behavior in particular.

What if it doesn’t work?

Now, back to that first statement: “I don’t have enough milk.” Yes, there are some moms who don’t make enough milk. These are the tougher cases. Sometimes there is a clear explanation–breastfeeding got off to a difficult start; mom is not feeding frequently enough; mom and baby were separated initially; mom goes back to work and stress levels rise and sleep decreases just as the baby is going through a growth spurt.

These problems can all be addressed, but fixing them might be a lot harder and might require a lot more commitment than a mom is willing to make. This is when the truly hard work of parenting begins: the balancing act of figuring out what is really important to you and how to prioritize sometimes-competing principles and desires. Do you work to build up your milk supply at the expense of cuddling and spending time with your baby? (Though skin-to-skin contact itself can help build supply, sometimes moms need the further stimulation of frequent breastpumping.) Do you fight for a flexible schedule at work at the risk of losing your job?

Nobody can answer these questions except you and nobody should judge you for the decisions you make. One thing I do know for sure from working with hundreds of moms over the last 11 years, some of whom were able to breastfeed exclusively and some of whom were not or decided not to, is that none of them loved or cherished their babies any less or more because of how they were fed.

— Audrey

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