BREAST CHANGES IN PREGNANCY

During adolescence the breasts develop. They continue to develop in pregnancy. The breasts produce milk as early as 12 to 14 weeks of pregnancy. In the last months of pregnancy, colostrum is present in the breasts. Most mothers will notice some breast growth, change of colour, tenderness, and the appearance of noticeable veins in the breasts during pregnancy.

HORMONES MAKE AND DELIVER MILK

As the baby suckles at the breast, hormones are released in the mother’s brain. The mother’s brain communicates with the breast to make milk and deliver milk to the baby. These hormones are prolactin and oxytocin. Prolactin is released when the baby starts to suckle at the breast, causing the breast to make milk. As the baby continues to suckle oxytocin is released, allowing the breast to deliver the milk. During this process, the little muscles around the milk sacs contract and the milk ducts dilate, allowing the baby to receive large volumes of milk. This is called the MILK EJECTION REFLEX. There are a number of these throughout the feed. At this time, the baby drinks. There are times in the feed when the baby suckles and does not drink very much, and there are times when the baby drinks after the milk ejection reflex. It is important to watch your baby to see when he is suckling and when he is drinking. It is also important for the baby to suckle in a way that signals the brain to release the hormones. The baby should achieve and maintain a deep latch onto the breast and areola, not just the nipple. Mom will be more comfortable and the baby will receive more milk if the baby suckles on the areola.

THE SUCKLE DRIVES THE SYSTEM

The baby’s suckle drives the system. The suckle is what releases the hormones from the brain and communicates with the breast to make and deliver milk. For this reason, the suckle should be protected. It is recommended that soothers or pacifiers and bottles be avoided until breastfeeding has been established as the way the baby suckles on these is different and may impact the way the baby suckle at the breast.>

STAGES OF MILK PRODUCTION AND COMPOSITION

One of the amazing qualities of breast milk is that it is actually live and it changes its composition to meet the baby’s needs over time, including during each feed.

After the birth of the baby, the breast makes milk in stages. The first milk is called colostrum. The colostrum is in the breast at the baby’s birth. Colostrum is thick, yellow milk with high amounts of germ-fighting cells. The main function of colostrum is protection. Colostrum lines a baby’s stomach and protects against harmful bacteria. It promotes proper stomach function and health. It also has a laxative effect, which helps the baby pass his first few bowel movements, called meconium. Colostrum comes in small quantities that are suitable for a baby’s small stomach size.

Over the first week, breast milk transitions from colostrum to mature milk. The mature milk usually “comes in” around day 2 to 5 in response to hormonal changes at birth. The mature milk is high in fat, carbohydrates, and calories. It may take a couple of weeks for your milk to change from colostrum (yellowish) to mature milk (bluish). The volume of mature milk increases every day over the first few weeks, as does the baby’s stomach.

Click here for a chart on change in the first week:CHART

Once your mature milk comes in, it changes throughout the feed. The milk starts off as foremilk, which is watery and quenches the baby’s thirst. As the baby feeds, the fat content in the milk increases and this is called hindmilk. As the breast empties, the fat content in the milk becomes higher. This is why it is important for the baby to be able to feed on the breast as long as he needs to. This will help the baby get the fatty milk and help him stay satisfied between feeds and gain weight.

Once the mature milk has come in, the only way to make more milk is to remove it. Milk should be removed frequently and on baby’s cue. This process is often referred to as supply and demand. The more milk removed, the more milk the breast will make.

MILK SUPPLY

Most mothers can and will make enough milk for their baby including mothers with multiple babies.

The key to making enough milk:

Allow your baby to breastfeed when he shows hunger signs. Remember to offer both breasts for sufficient stimulation.
Make sure that your baby has a deep latch, and is not just suckling on the nipple.
Check your baby for signs of hydration, such as wet and dirty diapers. Your baby should feed effectively at least 8 times in 24 hours.
Place your baby skin-to-skin anytime and often.
Avoid using pacifiers or artificial nipples. Allow your baby to suck at the breast instead.
Breastfeed soon after birth, within the first hour.
Breastfeed anytime and often, throughout the day and at night.
Breastfeed your baby for as long as needed, until he is satisfied. Do not limit the time the baby feeds at the breast.

The key to increasing your milk supply:

Ensure your baby has an effective latch and see a lactation professional if needed.
Use additional methods of milk removal after breastfeeding, such as pumping and/or hand expression to increase milk removal.

Remember the more milk removed from the breast, the more milk the breast will make.

MILK SUPPLY VIDEO

Video provided by Peel Region of Public Health. Their website has many breastfeeding tutorials and resources which are available in seven different languages. Please contact your local health unit for more information on breastfeeding services and resources in your area.

THE BABY LATCHES, SUCKLES, AND DRINKS

BABY-LED LATCHING OR LAID BACK BREASTFEEDING

Baby-led latching is a natural and simple way for your baby to find your breast right after birth or any time you are breastfeeding. It is especially helpful when your baby is learning to breastfeed, when your baby is not breastfeeding well, or when your nipples are sore.

Here are some tips:

Sit comfortably with support, leaning back.
Hold your baby skin-to-skin on your upper chest and between your breasts, so that his tummy rests on your chest.
Your baby was born with a reflex that helps him find your nipple. It is called the “rooting” reflex. You will notice him turning his head or moving it up and down looking for your breast. This may look like bobbing or pecking.
Support your baby’s back and bottom with your arm and hand while he moves towards your breast.
Your baby will find your nipple. He may touch it with his hands first.
After a few tries, your baby will push his chin into your breast, reach up with an open mouth, and latch onto your breast.
Once your baby is latched, you can adjust your position to make sure you are both comfortable.

HELPING YOUR BABY LATCH ON WELL

Here are some tips:

Make sure you are comfortable and well supported.
Bring your baby in close – tummy-to-tummy.
The baby’s ears, shoulders, and hips should be in a straight line.
Line up the baby’s nose to your nipple.
The baby’s head should be slightly tilted back.
Support your baby’s shoulders and neck.
Bring the baby’s chin and lower lip to the breast.
The nose should not be touching the breast.
Wait for the baby to open his mouth wide then bring him on, directing your nipple to the back of his mouth.
While supporting the breast, ensure your fingers are placed far away from your areola.

Latching and Positioning:Please contact your local health unit for more information on breastfeeding services and resources.

SIGNS YOUR BABY IS BREASTFEEDING WELL

Breastfeeding is comfortable for you.
You hear swallowing.
Your baby feeds in bursts.
Your baby’s mouth is opened wide.
Your baby’s lips are turned outward.
Your baby has a deep latch and his ears move while he is suckling.
Your nipples are not damaged or sore.
Your baby’s wet and dirty diapers are appropriate for his age.

MOM AND BABY COME TOGETHER TO FEED

FREQUENCY OF FEEDS

Babies should feed at least 8 times in 24 hours.
The milk is easily digested and it is normal for a baby to want to feed frequently.
Breastfeeding through the night helps maintain your milk supply.
Many babies will cluster feed (feed very frequently over a period of time), often in the evenings.
In the first days and weeks you may be encouraged to ensure your baby is feeding every 2-3 hours or to feed sooner if your baby cues to feed.
Once your breastfeeding is established and your baby is drinking well and often, has plenty of wet and dirty diapers, and is gaining weight, watch your baby for feeding cues and he will let you know when it is time to eat.

SUPPLY AND DEMAND

To have a good milk supply – feed early after birth and often.
The baby controls the milk produced with the supply and demand system.
The more milk the baby removes, the more milk the breast will make.
The baby will feed until he is full and he will be calm and relaxed after feeds.
Allow the baby to breastfeed as long as he wants to on each breast, to get the hindmilk.
Each breast produces milk separately, so offer both at each feed to build a milk supply in each breast. You may offer each breast more than once.
Alternate the breast you start on so they each make similar amounts.
During growth spurts the baby will stimulate the breast with more frequent feeds and the breast will respond in a day or two by making more milk.

Click here to watch a video on milk supply:Please contact your local health unit for more information on breastfeeding services and resources.

BREAST SIZE / NIPPLE SHAPE / BREAST SURGERY

Breast Size

Large and small breasts can make adequate amounts of milk. Smaller breasts may store less breast milk and babies may feed more often.

Nipple Shape

Women’s nipples differ in shape and size. Since babies feed on the areola (the area around the nipple), most mothers can breastfeed regardless of their nipple shape or size.
If you have flat or inverted nipples, they can often be drawn out with suckling. Speak to a lactation professional in your area if you have concerns.

Breast Surgery

Some women who have had breast surgery may experience challenges. It depends on the type of surgery, how it was done, and the nerves affected. If you have had breast surgery, be sure to contact a lactation professional in your area who will help you with your particular situation.

RELACTATION AND INDUCED LACTATION

Women who either have stopped breastfeeding and wish to resume breastfeeding or who adopt, may have the opportunity to breastfeed their babies. These situations take time, work and commitment. The degree of success in establishing breastmilk supply varies between each mother and baby. Some mothers will not be able to make the full amount of breastmilk to meet their baby’s growth and developmental needs. For this reason it is important for women who choose to relactate or induce lactation to seek assistance and ongoing support from their health care provider and a lactation specialist to establish breastfeeding. Mothers and babies can enjoy the closeness that the breastfeeding relationship offers, even if unable to produce the full amount of breastmilk required by baby.