The most common reason women say they give up breastfeeding is because they don't think they have enough milk. And is it any wonder that a breastfeeding mother's confidence can be shattered when almost any variation in her baby's behaviour (as in sleeping and feeding patterns) will be explained away by unhelpful advice such as, "are you sure you have enough milk?"
While there are certain medical conditions that may create challenges to breast milk supply, such as PCOS, diabetes, thyroid disorders, low iron levels, high blood pressure and a condition called insufficient glandular tissue (red flags include a lack of breast development during puberty and pregnancy and/or tubular shaped breasts that are widely spaced), there are also a lot of 'booby traps' that have mothers reaching for the bottle when what they are experiencing is perfectly normal, or could be fixed quite simply with the right advice and support.
If you're having a hard time, you don't need to ditch your nursing bra just yet. Try to remember, whether you can exclusively breastfeed or not, every drop of mummy milk is liquid gold, and there is help available. Calling in an expert such as an IBCLC (International Board Certified Lactation Consultant) could make a world of difference to your confidence and your breastfeeding experience.
Meanwhile, let's bust some 'booby traps'.
My baby feeds all the time
Your newborn's stomach is the size of a marble, and after about 10 days it will only be the size of his tiny fist (or a ping pong ball if you don't yet have a baby and can't visualise this). As a result, he'll need frequent feeds: around 8 to 12 feeds in 24 hours.
In the early weeks your baby is also mastering the art of sucking, swallowing and breathing, so he needs lots of practice to become an efficient feeder. It's also worth understanding that women have different breast milk storage capacities, so although most women produce enough milk, a woman with a smaller storage capacity (this isn't necessarily related to breast size), will need to feed her baby more often than a woman with a larger storage capacity, whatever the age of the baby.
Tip: Watch your baby, not the clock. In the early weeks, there is still some breast development going on, and by feeding according to your baby's hunger cues, you are setting your breasts' capacity for milk production. This means that the more milk your baby removes, the more milk your breasts will be signaled to make and the higher you will 'set' your ongoing milk production.
But if you space out feeds (by implementing a feeding schedule) or you top your baby up with formula, he'll naturally eat less at the breast, and your breasts will respond by making less milk. If you do need to offer supplements (first rule is 'feed the baby'), expressing, as well as putting your baby to the breast, will help increase your supply.
My breasts feel soft
At first your breasts will feel hard and swollen as your milk comes in, but a lot of this swelling (engorgement) is extra blood circulation and tissue fluid as your body gets used to this new experience. As your baby and your breasts become synchronised so you are making the amount of milk your baby needs, your breasts will naturally soften and feel less swollen. As long as your baby is feeding effectively and you respond to his hunger signals, you'll usually make exactly the amount of milk your baby needs.
Tip: If your baby is only drinking breast milk and having at least one soft yellow bowel motion and 6 to 8 very wet cloth or 4 to 5 heavy, wet disposable nappies a day, he is getting enough milk (what comes out must be going in!).
My baby has suddenly started feeding more frequently
If your baby has had a sudden hunger burst, he may be having a growth spurt and a corresponding appetite increase. He may also be coming down with a bug and need an immune boost: the transfer of saliva from your baby's mouth to your breasts signals you to produce antibodies to any bugs your baby is exposed to, and he will receive these antibodies as he drinks your milk.
Tip: Take your baby to bed or relax on the couch with a stack of DVDs, and rest with your baby, snuggling skin to skin (this will boost your milk-making hormones) and allow him to feed whenever he shows hunger signals. This will help your body catch up with your baby's increased need to feed.
My baby only has short feeds
Although in the early days feeds seem to take forever, often at around 10 to 12 weeks, many babies seem to quite suddenly feed more quickly. As long as your baby is having wet nappies (see above) and gaining weight, he is most likely becoming an efficient feeder so he doesn't need to suck as long. However, if your baby seems to be having short feeds and isn't gaining weight steadily, ask yourself: "is he latching and sucking well, has he been checked for an issue such as tongue tie, is he distracted during feeds?"
Tip: Any time you are concerned about your baby's feeding patterns, get a professional, such as a lactation consultant, to observe a feed to make sure your baby is attaching, sucking and transferring milk effectively.
My baby grunts, squirms and seems frustrated when he feeds
Although some babies become impatient as they wait for the milk to start flowing, others can feel uncomfortable for various reasons. For example, your baby may be affected by tummy discomfort because as he starts sucking, this also starts peristalsis (food or wind moving around the gut), so he's struggling a bit to coordinate feeding and farting at the same time.
Tired babies or babies who have been crying (crying is a LATE hunger signal) will often squirm at the breast because they are having difficulty organising feeding behaviour. This often happens in the evening, leading mums to believe they don't have enough milk.
Tip: Observe your baby's feeding cues (rooting towards the breast, moving his hand to his mouth and making little noises) and respond quickly. If you have been giving your baby bottles, he may be developing a preference for the fast flow from a bottle, so if you do need to supplement, start and then finish at the breast so he associates a full tummy and comfort with mummy and breastfeeding.
My baby gulped down a full bottle of formula after a breastfeed
Sucking is an involuntary newborn reflex; it's particularly strong in babies under three months. This means that when you pop a bottle teat into your baby's mouth, it will automatically stimulate a sucking reflex. As the baby sucks, his mouth fills with milk, which he then has to swallow. The swallowing triggers the suck reflex again, so your baby keeps on sucking and swallowing. It looks as though he is 'hungrily' gulping the bottle of formula when, actually, he simply can't control his natural sucking reflex.
Of course after drinking a bottle of formula your baby will fall asleep for hours because he is 'full', and also because formula takes longer to digest than breast milk – so it's only natural that you will start to doubt your ability to produce enough breast milk.
Tip: It's never too late to get help. Watch your baby, not the clock, eat nutritious foods, drink to your thirst, surround yourself with supportive people, and seek help if you have any concerns about your milk supply. If anyone asks, "are you sure you have enough milk?" tell them, "my nurse/doctor/pediatrician says we are doing fine, thank you", then quickly change the subject.
Pinky McKay is an Internationally Certified Lactation Consultant (IBCLC) and best-selling baby-care author. She is the creator of Boobie Bikkies, all natural and organic cookies to boost your energy and support a healthy breast milk supply. Download Pinky's Free Ebook Making More Mummy Milk, Naturally at www.boobiebikkies.com.au