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Breastfeeding and milk supply

Difficulties with breastfeeding are common, especially in the first week after birth. As a rule, the milk, which is present all the time, 'comes in' at any time from 24 hours after birth. It is common for the breasts to become engorged early on, but in some there is insufficient supply.

Engorged breasts

What is engorgement?

In some women, a few days after delivery the milk supply comes on so quickly that the breasts become swollen, hard and sore. This is called engorgement. There is an increased supply of blood and other fluids in the breast as well as milk.

What will you notice?

The breast and nipples may be so swollen that the baby is unable to latch on and suckle. The soreness makes it difficult for you to relax and enjoy your baby.

How are engorged breasts managed?

• Feed your baby on demand from day 1 until he or she has had enough.
• Finish the first breast completely; maybe use one side per feed rather than some from each breast. Offer the second breast if the baby appears hungry.
• Soften the breasts before feeds or expressing with a warm washer or shower, which will help get the milk flowing.
• Avoid giving the baby other fluids.
• Express a little milk before putting the baby to your breast (a must if the baby has trouble latching on) and express a little after feeding from the other side if it is too uncomfortable.
• Massage any breast lumps gently towards the nipple while feeding.
• Apply cold packs after feeding and cool washed cabbage leaves (left in the refrigerator) between feeds. Change the leaves every 2 hours.
• Wake your baby for a feed if your breasts are uncomfortable or if the baby is sleeping longer than 4 hours.
• Use a good, comfortable brassiere.
• Remove your bra completely before feeding.
• Take paracetamol regularly for severe discomfort.
• Remember that regular feeding is the best treatment for your engorged breasts. Follow your demand and your baby's demand. As your breasts are used in this way, they gradually become softer and comfortable.

Insufficient supply

This is sometimes a problem in mothers who tend to be under a lot of stress and find it hard to relax. A 'let down' reflex is necessary to get the milk supply going, and sometimes this reflex is slow. If there is insufficient supply, the baby tends to demand frequent feeds, may continually suck his or her hand and will be slow in gaining weight.

Remember that there is always some milk present in your breasts.

What should you do?

Try to practise relaxation techniques.

Put the baby to your breast as often as he or she demands, using the 'chest to chest, chin on breast' method.

Express after feeds, because the emptier the breasts, the more milk will be produced.

Make sure you get adequate rest, but if you feel tired go to your doctor for a checkup.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia