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COMMON CONCERNS - MOTHER

Milk Supply, Foremilk/Hindmilk Imbalance - What Causes This?, Engorgement, What does breastmilk look like

 It is very normal to worry if things are "normal" or not in regard to breastfeeding your baby. There are no silly or stupid questions - if it's important to you, or concerns you, then it's worth asking!

Below you will find a list of links and information on some of the common concerns moms may have. If you have a concern, and it's not listed here, please don't hesitate to call your breastfeeding support network for information, and/or visit some of the informational sites listed in BREASTFEEDING LINKS.

 

MILK SUPPLY

Very rarely is a mother not able to produce enough milk to nourish her baby. Unfortunately due to myths and misinformation, many mothers are led to believe that they cannot produce enough milk, and are told to supplement their infants with formula. This is OFTEN totally unnecessary. For almost ALL mothers, the more you nurse, the more milk you will have.

Often mothers efforts at breastfeeding are sabotaged in the first few days, even while at the hospital. Some mothers don't realize or believe that colostrum (the thick yellow fluid that the breasts first make) is enough nourishment for their newborns.  Because of this,  mothers often will give their babies supplemental feedings. 

Many may have heard a newborn baby's tummy is about the size of a golf ball, but actually a newborns tummy is much smaller!

As per the FAQ on Colostrum (wonderful visual in this article!) at the LaLeche League website:

"A 1 day old baby's stomach capacity is about 5-7 ml, or about the size of a marble. Interestingly, researchers have found that the day-old newborn's stomach does not stretch to hold more. Since the walls of the newborn's stomach stays firm, extra milk is most often expelled (spit up). Your colostrum is just the right amount for your baby's first feedings!

By day 3, the newborn's stomach capacity has grown to about 0.75-1 oz, or about the size of a "shooter" marble. Small, frequent feedings assure that your baby takes in all the milk he needs.

Around day 7, the newborn's stomach capacity is now about 1.5-2 oz, or about the size of a ping-pong ball. Continued frequent feeding will assure that your baby takes in all the milk he needs, and your milk production meets his demands."

Given this information, we can see that large amounts of food are not necessary in these early days. For the first few days after the birth, the colostrum provides wonderful immunities for the baby, sets up the baby's digestive system, and is delivered in just the right amount for such a tiny tummy!

Between two and six days, most mothers will find that their milk "comes in". Sometimes this is accompanied by engorgement. Mom's breasts may swell and latching may be a little difficult for a couple of days. Frequent nursing will help to resolve, or even prevent engorgement. Because Mom's body doesn't know how much milk baby needs, it just makes a LOT, resulting in a heaviness or fullness in the breasts. Around the second week this fullness often goes away. This is not because mom is losing her milk but because the body has learned to regulate it's production to the amount her baby needs.

What does breastmilk look like?

Breastmilk can be thin and watery looking, and may have a blue or yellow tint to it. It can even take on a hint of green, orange or other color if mother has been eating lots of green foods, or other colored foods, especially those with dye, such as green gatoraide. The color of the milk is usually not anything to be concerned about however it's always good to check with a breastfeeding professional to be sure.

It does not always look the same because breastmilk changes it's composition throughout the feedings, as well as throughout the day. As baby grows, breastmilk continues to change to meet the needs for optimal growth, at each stage of baby's development . This means that mom's breastmilk at four months is perfectly suited to the needs of her four month old baby, and at six months, perfectly suited for her six month old.

Expressed breastmilk will seperate when stored in refrigerator. This can be a real shock to anyone who is not aware that this is normal. Sometimes there is a thick layer of "cream" or fat on top, other times a thin layer. Sometimes the milk looks lumpy, or clumpy, and sometimes it can be nearly clear toward the bottom of the bottle. It can be very yellow, very "creamy", "thin and blue", "watery looking", greenish, or even take on a pink or red hue.

All of the above are completely normal occurances, and does not mean the milk is, or has spoiled. Spoiled milk has a distinct sour smell.

These pictures show an example of what breastmilk may look like. The picture of milk on top left is of colostrum and beneath that is mature milk.

Occasionally milk may take on a "pink" color. This is often a result of a broken capillary, or surface abrasion to the nipple. The pink color is a result of a small amount of blood, and it will not hurt the milk at all.

Note that sometimes the blood will settle at the bottom of the bottle. If it really bothers mom to offer milk with a bit of blood in it, she has the option of pouring off the top portion of milk once the blood has settled to the bottom. Rest assured that it won't affect baby or moms milk at all if she chooses not to.

Keep in mind that there is a wide variation of normal and that "how" the breastmilk looks doesn't reflect on its composition, especially regarding fat content.

Note the blood has settled at the bottom of the bottle in photo to the left.

When ready to offer to the baby, one needs only to remove from fridge and gently swirl the milk in a gentle "tornado-like" fashion to remix it. Warm water run over the sides of the bottle will help when the thicker parts stick to the sides of the bottle.


NOTE: Never shake breastmilk to mix! Shaking can damage the milk, and is not recommended!

For mothers with questions or concerns regarding milk supply, information can be found here:

http://www.kellymom.com/bf/supply/low-supply.html#supply

http://breastfeeding.hypermart.net/supply.html

http://www.parentsplace.com/expert/lactation/archive/0,,239814,00.html

 

WHAT CAUSES AN IMBALANCE IN FOREMILK AND HINDMILK?

Moms that have an overabundant milk supply, or nurse in very short sessions, will often experience what is commonly called an imbalance of foremilk and hindmilk. What this means is that the baby is not getting enough of the rich fatty milk. This can cause excessive gas, fussiness, and very green liquidy and highly acidic stools. Sometimes mom can hear the baby's tummy "gurgling", and the baby usually will have a diaper rash.

The baby will want to nurse quite often because he is uncomfortable. Nursing actually will help to ease baby's discomfort, at least for a little bit, because it helps to move the gas. Babies often will pass gas and have a bowel movement either during their nursing sessions or shortly thereafter. Unfortunately, in a short amount of time, the baby begins to feel uncomfortable again and the cycle then begins again.

To avoid or reduce the risk of an imbalance you should allow your baby to completely finish the first breast before offering the other. Avoid interrupting baby nursing on the first breast in order to switch breasts or "timed" sessions (i.e. "ten minutes per breast").

NOTE: There has been some confusion over foremilk and hindmilk and "when" one changes from one to the other. To help try to resolve some of the confusion here's one good description (thanks Kelly!) of how the breast works:

A woman's breast really only makes one type of milk, and it's what's normally called "hindmilk," nutrient and fat rich milk.

There is no sharp distinction between foremilk and hindmilk - it is a gradual change from the moment of the let-down (and there are several per feed, although most mothers only notice the first one).

Because the composition of the milk changes as the feeding progresses and because every baby varies in the amount of time it takes him to receive his fill of hindmilk, allowing the baby to feed for an unlimited amount of time on the first side is important.

In between feedings, milk collects in mom's breasts. Fat globules stick to the walls of the alveoli, high up in the breast, near where the milk is made. Between feeds (since the fat is stuck higher up), some lower-fat milk (foremilk) gradually moves down to fill the milk sinuses. This is where baby accesses the milk, and this is the milk that is available before letdown.

When the letdown reflex is triggered, the milk is 'squeezed' down the ducts so it becomes available to the baby to milk out. As the breast starts to empty, the fat globules start becoming dislodged and move down the ducts. So the further into the feed, the higher the fat content of the milk coming out the nipple, as more and more fat globules are forced out.


These pages have more information on the overabundant supply issue (foremilk/hindmilk).

www.breastfeed-essentials.com/toomuchmilk.html

http://www.lalecheleague.org/llleaderweb/LV/LVOctNov95p69.html

http://www.breastfeeding.asn.au/bfinfo/lactose.html


ENGORGEMENT

Engorgement is the swelling of the breasts with milk. Initial engorgement takes place between 2 and 5 days after the birth of the baby, in most cases. Engorgement can be reduced or even avoided by frequent nursing. Mothers who delay nursings, or introduce scheduled feedings early have an increased risk of engorgement.

Along with frequent nursing or pumping, many breastfeeding advocates suggest using cabbage leaves to reduce swelling when mother experiences moderate to severe engorgement. Actual research data is minimal but the published studies and anecdotal reports from mothers who’ve used it,  seem to support its value in reducing breast engorgement.

NOTE THAT CABBAGE IS NOT RECOMMENDED FOR ANYONE ALLERGIC TO SULFA OR CABBAGE. In addition, cabbage should not be used if the skin is broken, such as in the case of  cracked, bleeding or blistered nipples. You can place the cabbage around the breast without covering irritated skin.

 To use cabbage compresses for engorgement:

Wash a fresh head of green cabbage and place cabbage in refrigerator to chill. Just before use, crush the veins with a rolling pin or similar object or slice off the tops of the "veins" with a sharp knife, whatever makes the leaves shape to your breast most easily.

Drape one or two leaves over each breast, covering ALL of the engorged area. Leave on until they become wilted, about 20 to 30 minutes. Repeat three or four times within a 24 hour period, or until engorgement subsides. This will usually be within one to two days. If the engorgement is severe, compresses can be used as often as every 4 hours, but care should be taken as there is indication that cabbage leaves can work TOO well and end up reducing mother’s milk supply.

For the mother who is not breastfeeding, cabbage compresses can be used continuously to help dry up her milk. Discontinue immediately if skin becomes irritated.

 More links on cabbage cure:

http://www.parentsplace.com/expert/lactation/qas/0,,239802_106157,00.html

http://www.promom.org/bf_info/Problems.htm

 Info on how to resolve engorgement:

http://breastfeeding.hypermart.net/engorgement.html

http://www.parentsplace.com/expert/lactation/basics/qa/0,3459,6294,00.html

REMEMBER...

The better a mother takes care of herself the healthier she will be. Resting and avoiding unnecessary physical stress can help in quicker recovery after childbirth. Breastfeeding is nature's way of making sure mom takes it easy and gets plenty of rest. She is meant to do little else but rest and nurse her child. Housework and other things CAN wait in most cases. In our fast-paced society, we have forgotten that the early weeks are not only important in establishing baby's future, but mother's as well. If you know a nursing mother of a newborn, perhaps you can offer her some assistance in cooking, or laundry, or even light housework, especially during the very early days after the birth. This can go a long way in helping her feel that she can relax and concentrate on getting things off to a great start.

Sources for above information include, but are not limited to:

Breastfeeding Answer Book
Breastfeeding & Human Lactation
Milk, Money & Madness

Copyright © 2000 - 2006  Jim Yount

Send email to Paula Yount for any questions or comments about this site.

Disclaimer:  The pages contained herein are meant purely for informational purposes and every effort is made to provide accurate and up-to-date information. This information, however, is not meant to take the place of your doctor, nor should the information contained on this web site be considered specific medical advice with respect to any specific person and/or any specific condition. The author, therefore respectfully but specifically disclaims any liability, loss or risk - personal or otherwise - that is, or may be, incurred as a consequence, directly or indirectly, from use or application of any of the information provided on this web site.