Dear Nicola

I’m wondering if you can help? My baby is 4 weeks old and not back at birth weight. I’ve been feeding her non stop, sometimes I have to wake her up  and also  my breasts seem softer this week. Is that normal?

Kind regards

xxx

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I frequently get queries like this from mothers asking about their baby’s weight gain. They say they were advised to pump by a HCP but think that’s “bad” advice. Sometimes they ask online and get replies saying – never pump before 6 weeks. This advice is incorrect.

Why?

During the first few weeks of breastfeeding, the prolactin receptor cells on the milk cell are activated. A good way to imagine it, is  lots of mini light bulbs on a tree (definitely not a Christmas tree as it’s only April..).  Every time the baby feeds (the electrical current)  switches on more light bulbs. The more light bulbs that are switched on, the brighter the tree (more milk supply). If the electric current is not strong the brightness of the lights will be effected or some may not switch on at all… see where I’m going?   

giphy-downsized-large

www.giphy.com

My colleagues Diana West IBCLC and Lisa Marasco IBCLC of www.lowmilksupply.org explain, “In the next several weeks after birth, average (or baseline) prolactin levels decrease until they reach a lower plateau. At the same time, receptors for prolactin are multiplying. The development of prolactin receptors in the breast is believed to be related to early frequent suckling stimulation and milk removal: the more often baby breastfeeds in the first days and weeks after birth, the more receptors are developed.  Click here,

Thus, if the baby can’t feed well, or if the baby is weak because of tongue tie, prematurity, low milk supply.. the correct action is to pump . The pump replaces the work of the baby. Sometimes, a pump is better than a baby contrary to what a Facebook group poster  might say… This is a critical window in time –  building supply,  that is lost when the receptors are not activated. Prolactin only remains elevated for the first few weeks of lactation, building the very best supply in this time gives a robust milk supply.  Babies love lots of milk  as it means they don’t have to work as hard!  Yes, there is a lot more to breastfeeding than just building a milk supply…. Remember though, it’s the number one reason why mothers stop breastfeeding  –  perceived low  milk supply. In my opinion and experience,  educating and supporting a mother instead of dismissing her concerns makes a big difference.

If a mother has a strong supply, her baby is thriving and clearly growing rapidly, pumping in the early days might stimulate too much milk. This is a very different situation to slow weight gain and problems with supply.

We shouldn’t have strict “rules” around breastfeeding anymore than we should have strict rules around babies feeding routines.  If you are given advice to just feed your baby, yet your baby’s weight gain is slow, then get an IBCLC to do a full feeding assessment. The IBCLC should take a detailed history of birth, your medical history and breastfeeding history. Then assess a full feed (possibly doing a test weight to complete the picture) and write a plan. 

 

If you are a complete lactogeek (like me) and want to learn more about prolactin , these are two great links

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The Prolactin Molecule. 

The Complete Guide to Prolactin.. This is a great article because it links every statement  to a reference.

Research Paper about Prolactin Receptors    and more about them…. on kellymom 

 

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