Chapter 4: Preparation While You Are Pregnant

      There are lots of things that we can do while you are still pregnant. We can prepare for boosting milk supply based on your medical history or put a tool or two in your hospital bag just in case. Breastfeeding is physical and hormonal, so there is a checklist you can go through while you’re pregnant to see if you have any precursors for low milk supply.

      #5 is an important question: Did you experience breast changes during pregnancy. Sometimes you need to ask her significant other to answer that one. I’m not talking Dolly Parton changes, just slight changes in your bra cup size. About 1.5% of women do not have enough mammary tissue to make milk, so we must consider this as a possibility.

      If you have any history of thyroid issues, diabetes, polycystic ovarian syndrome, or you had problems getting pregnant, these are all precursors for low milk supply. Don’t worry, we can work on synthetically boosting your prolactin after the baby is born, but just knowing this information will help. You can refer to the section titled “Increasing Your Milk Supply.”

       Look at Your Nipples

      When I work with a pregnant mom, I do a breast exam to see if I can find any potential issues with the latch. If the nipples are flat or retract upon compression, we can plan for the use of a nipple shield. We go into detail about nipple shields in a later chapter. To see if your nipples retract upon compression, simply squeeze your areola from both sides and see what your nipple does. If it stays in place, you are in good shape. If it retracts back into the boob, you will want to be prepared for a possible latch issue. Don’t worry, you found out before any issues began, so that is an excellent start!

       BASIC NIPPLE FLAT NIPPLE

      Chapter 5: The Crucial First 2 Weeks

      Why are the first 2 weeks so important when it comes to breastfeeding? In the first 2 weeks a lot is going to happen. Your baby’s going to lose weight, gain weight, you’ll go from having practically no milk, to having a lot of milk, and this is when you establish the prolactin receptor sites in your breasts.

      Just picture if 10 of us have cell phones and there are only four plugs, six of those cell phones are going to die. That’s exactly what happens with prolactin receptor sites; if they don’t get set up in the first 2 weeks they die. Your brain controls how much milk you make, so moms who do not put the baby on the breasts in the first 2 weeks, and do lots of formula supplementation without pumping, have a real hard time down the line boosting their milk supply.

      If you can give me (and your baby) 2 weeks of your life to establish your milk supply, get through the hardest stage, regain your baby’s birth weight, and push through any issues, you have a very good chance to be successful at breastfeeding for as long as you want to.

      Chapter 6: Establishing A Milk Supply

      Remember, the first 2 weeks of breastfeeding are the most important in establishing your milk supply, and insufficient milk removal is the number one cause of low milk production. Here are a few rules to live by if you want to have a great milk supply:

       Rule #1: Empty Out That Milk 8 Times a Day!

      Breastfeeding is demand and supply, so you have to get the milk out, in order to make more milk. If there are ANY problems in the beginning, including latch issues or engorgement, you should add in some pumping sessions so that a good supply can be established. Simply pump directly after a breastfeeding session.

       Rule #2: You will need to breastfeed or pump a minimum of 8 times every 24 hours for the first 6 months.

      Typically, a breastfed baby eats about 10 times a day, but 8 is the absolute minimum. I know this sounds overwhelming, but your baby will become very efficient at the breast and you will be breastfeeding about 30 – 45 minutes every 24 hours when your baby is 3 months old. A lot of babies will sleep long periods, but you will need to fit in those 8 pumping or breastfeeding sessions if you want your baby to thrive.

       Rule #3: Prolactin Regulates Your Milk Supply.

      If you have any of the listed precursors for low milk supply, you will want to consider boosting your prolactin before your prolactin goes back down to pre-pregnancy levels at 2 to 3 weeks postpartum.

      A lot of people will NOT tell you these breastfeeding rules because they are afraid you will get scared and not even try. I find if I tell my patients the truth, they are better prepared. Don’t worry, you won’t be breastfeeding 8 hours a day for the first 6 months, each day your baby gets bigger and stronger they also get more efficient. A 3-month-old baby could drink 5oz of breastmilk from the boob in 5 minutes. Trust me, I used to see it every day.

      Chapter 7: The First Stage of Lactation (Colostrum)

      Here some fun facts for you! The reason your breasts changed size during pregnancy is because you already have milk in your breasts, ready to go!

      Right now, you are currently in a phase called Lactogenesis Stage I. During this stage, you are making a highly concentrated breast milk called colostrum. The colostrum is full of antioxidants, antibodies, and white blood cells (to start the process of repairing your baby’s leaky gut). All babies are born with a leaky gut, like a porous rock, so that these important components of the milk can pass through the digestive system and get right into their bloodstream. Your baby is born from a very sterile environment into very non-sterile environment, especially if they’re born vaginally. The colostrum will protect your baby from our bacteria filled world, like giving them a big antibiotic shot.

      The bumps on your areolas have also grown in size, and your areolas are now bigger and darker. Your baby will only be able to see contrast, so that is why you now have a bullseye on your chest. Don’t worry; they won’t be like this forever. The bumps on your areolas are called Montgomery Glands. The almost undetectable fluid that is secreted serves as a lubricant, and smells like the amniotic fluid. So yes, your mom is right. Your baby can smell you and knows that you are there. They use their sense of smell to guide them to the breast.

      Newborns do not get a lot of volume in their first few days, and they are born with their intestines full of this black tar looking poop called Meconium. Because babies poop out this Meconium, even when they are only eating about 1 teaspoon per meal, all breastfed babies lose weight in the first 3 - 4 days. During the colostrum phase babies just do a lot of sucking. They typically do 10 - 12 bursts of sucking in a row... suck, suck, suck, suck, suck, suck, suck, suck, suck, suck, suck, pause... suck, suck, suck, suck, suck, suck, suck, suck, suck, suck, suck, pause… I’m getting really sleepy mommy... and I am asleep. This is very common, because the baby is using a ton of effort for not a lot of return. A baby needs calories for strength and endurance, so we like to keep the baby alert and feeding by “politely” annoying them. This little trick is called the milk pump.

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