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Breast Feeding

No breast milk

08/21/2000

Question:

I had my first child at the age of 29. There was a slight engorgement 3 days after delivery. I would like to breastfeed her but my milk supply wasn`t enough. She screamed during feeding as if she wasn`t getting enough. I didn`t give her any infant formula, believing that the more I let her suck, the more milk my body would produce.After one month, I gave infant formula. When I totally stopped breastfeeding, there was also a slight engorgement. About a year later, I gave birth to my second child. Even though my breast got bigger during pregnancy, there was no engorgement at all after childbirth. There was no milk (although I drank a lot of milk during pregnancy). I only started giving infant formula on the second day (but he already had the problem of regurgitation).When I totally stopped trying to breastfeed, there was no engorgement at all. Is there any suggestion on how to overcome this problem ?

Answer:

You ask a complicated question and the answer probably requires more information. It`s hard to know whether there is an actual problem without asking other questions. For instance, how often did your first newborn breastfeed in 24 hours and how long did a typical feeding last? What was her wet and dirty diaper count the first month? How was her weight gain-from her lowest weight, not birth weight? What do you mean when you say she "screamed during feeding"? When did the screaming begin, what was its pattern, and how long did it last?

You are correct in believing that the more a baby breastfeeds, the more milk your body should produce. When a baby breastfeeds/sucks effectively, it "tells" the breast to make more milk. The more a baby breastfeeds/removes milk (effectively), the more milk produced; the less a baby breastfeeds, the less produced. The key word is "effective." The most common cause of insufficient milk production is an insufficient amount of breastfeeding for a particular baby. Often it is due to trying to "schedule" breastfeedings or because a mother doesn`t understand normal feeding patterns for breastfed babies. Some mothers think their normal breastfed baby isn`t getting enough milk because of more frequent feedings.

A baby that is unable to remove milk effectively may be the second most common reason for insufficient milk production. Prematurity, the effect of labor and delivery medications and anesthetics, jaundice, infection, certain health conditions and variations in the structures in a baby`s mouth may all contribute to ineffective sucking. Suspect ineffective sucking if the newborn frequently (one or more): · Does not wake for 8+ feedings or wants 14+ in 24 hours · Keeps latching on and letting go of the breast · Can`t seem to latch on or pushes away · Falls asleep 2-5 minutes after latch-on or starting to suck · Feeds for more than 30-40 minutes without self-detaching at the first breast · Feeds for more than 45 minutes but doesn`t seem satisfied · Soaks fewer than 6 diapers in 24 hours by day 6-7 · Has fewer than 3 stools in 24 hours by 6-7 days after birth through the first 4-8 weeks) · Seems "gassy" and produces green, frothy stools after the first week · Seems to have difficulty feeding no matter what feeding method is tried. (* Any baby may demonstrate one or more of these signs occasionally.) When a baby breastfeeds ineffectively, the mother is more likely to develop sore, red, bruised, raw, blistered, or cracked nipples. Her nipples may appear creased, flattened, misshapen or white at the end of a feeding. She also may experience a plugged duct or mastitis due to poor milk removal.

In addition to baby "causes," there can be mother-related causes. A few women are born with an insufficient amount of milk-making tissue in their breasts, although that is unusual. Other maternal causes known to or suspected of contributing to milk insufficiency include: · Any prior breast/chest wall surgery, especially breast reduction · Thyroid conditions · Severe postpartum hemorrhage · Retained placenta fragments (prolonged bleeding or cramping after birth) · Current use of a hormonal contraceptive (birth control) method, especially if containing an estrogen · Pregnancy (new) · History of abuse or current postpartum depression or anxiety disorder · Current tobacco use There is some evidence that certain maternal conditions, such as diabetes of any type may create a delay in the time when milk "comes in"; however, such conditions do not appear to have any long-term effect on milk production.

As noted earlier, some mothers think they aren`t producing enough milk when they actually are producing plenty. The physical signs you noticed indicate you were producing milk. Not everyone experiences obvious engorgement, unless many hours pass between feedings. If you began giving infant formula on the second day after the birth of your second baby and if your baby received a significant amount of his daily intake from formula, you may not have produced as much milk as you were capable of producing so there was no engorgement.

If you are considering getting pregnant again and plan to breastfeed, you may want to contact a lactation consultant (IBCLC) now or early during your pregnancy to review your general health and previous breastfeeding histories to see if a possible cause and solution can be found.

References:

Lawrence, RA & Lawrence, RM (1999). Breastfeeding: A guide for the medical profession (5th ed.). St. Louis, MO: Mosby.

Riordan, J & Auerbach, KG (1999). Breastfeeding and human lactation (2nd ed.). Sudbury, MA: Jones & Bartlett.

For more information:

Go to the Breast Feeding health topic, where you can:

Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati