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
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