We’ve all heard a mother has a period of time after birth to regulate and establish her milk supply, but what does this even mean? Why does this happen and how much time do I have to figure it all out!?
Regulating your supply means synchronizing your body’s demand to make milk with the nutritional needs of your baby. Supply regulation is important so your body can make enough for your baby. Simple, yet, so many women struggle to meet the needs of their baby even with excessive pumping! It takes several weeks for a woman’s hormones to balance out after birth, but when it does, there is a loss of opportunity to enhance milk production if a baby’s input is not synchronized with milk output.
So let’s dive into the wonderful world of lactation physiology and see how it all works!
Prolactin is our key hormone that is used to produce milk. It’s often referred to as our “milk-making” hormone because it’s the hormone that activates milk production. The more prolactin we have, the more milk we can produce. After the delivery of the placenta, the pituitary gland releases a surge of prolactin based on a hormonal control system. This means hormones are the driving force to keep high prolactin levels. After a few days postpartum, the milk production transitions from a hormonal control system to a local control system (the breast). The breast keeps prolactin levels high by frequently removing milk.
But how does frequently remove milk encourage high levels of prolactin?
When prolactin levels are high after birth, it stimulates an increase in prolactin receptors to bind to the mammary alveoli. These are sacs inside the mammary glands where milk production and storage occurs. As prolactin attaches to these receptors, milk synthesis begins, and a signal is sent back to the pituitary gland to release more prolactin. There is a positive feedback loop that tells the body to continue producing milk.
As the alveoli expands from filling up because of infrequent milk removal, the receptors change shape inhibiting prolactin to bind. If prolactin can’t bind because the alveolar glands are expanded, milk synthesis does not occur. The message to make LESS prolactin gets sent back to the pituitary gland to prevent an oversupply. If infrequent milk removal occurs enough consecutive times, the body believes there is no baby to feed or an older baby who is not in need of much milk and begins decreasing prolactin levels.
Wow! So how does my baby have a full feed if I don’t have any stored up from constantly nursing/pumping? Won’t I have to feed more often?
No! Your body learns how to make an endless supply of milk DURING the feed with continuous let-downs.
Initially after birth, your body stores milk in the alveoli. This is the feeling of fullness. After a few weeks, your hormones have had time to level out and your breasts become more efficient at making the adequate milk baby needs while feeding, rather than storing it in the alveoli. It’s a common belief to think the breast is empty after a feed, but in reality, the breast never runs out if a baby is suckling. As a baby stimulates the nipple by suckling, prolactin is released from the pituitary gland. When prolactin reaches the alveolar glands, it attaches to the prolactin receptors and milk synthesis begins. Most of baby’s intake is not from stored milk, it is synthesized while milk removal is occurring. As long as there is nipple stimulation triggering prolactin release, there will always be another drop of milk. This means the feeling of “fullness” will decrease overtime and it is not an indication of low milk supply. It is simply your body’s incredible ability to know exactly how much your baby needs. In fact, “waiting longer for your breasts to fill up” only sends the wrong message to your brain to slow down the milk production.
The best and easiest way to ensure your milk removal is adequate is to simply let your baby be the guide and aim to avoid the feeling of breast fullness (in hopes to give your baby have a “fuller” feed). Having your baby nurse as frequently as possible is the simplest way to achieve this. The body is very smart and knows how to make EXACTLY what the baby needs. This is skewed if the baby is being fed artificial milk without the corresponding milk removal from the breast. It can also be skewed by an independent pumping schedule rather than being synchronized to baby’s feeding patterns.
Most babies will alert you when they are hungry and you can click the link on my homepage to be able to identify early hunger cues. For most babies this will look like sporadic feedings throughout the day. Some feeds will be shorter than others just as adults will have 3 meals a day plus a few snacks in between. Babies are even less structured and should be given the freedom to nurse at their own will. Each baby is already preprogrammed with their biological rhythm of feedings. Restricting this to achieve more weight gain, shorter nursing sessions, or longer stretches of sleep will only deter you from reaching these goals.
Note: If your baby is low birth weight, premature, or goes more than 2-3 hours between feedings, you may have to follow different guidelines for feedings to ensure baby is getting the necessary caloric intake.
Increasing prolactin levels after your milk supply has been regulated is possible but the body will have to rely on mainly local control rather than having the influence of hormonal control. This is why the first 6-8 weeks postpartum is the best and easiest time to set the tone of your breastfeeding journey. Baby’s needs will fluctuate as they grow, get sick, or begin teething and prolactin levels will increase and decrease according to the frequency of feeds. However, in general, your body will have adapted to baby’s feeding patterns and nutritional needs.
IMPORTANT NOTE: Prolactin levels fluctuate throughout a 24 hour period but they are highest at nighttime. If there is a surge in prolactin with no milk removal, the prolactin receptors cannot bind to prolactin for several hours. If this practice continues, there will be a decrease in milk production. Nighttime feeds are crucial for maintaining an adequate supply during the day.
How to regulate milk supply with a bottle-fed baby
Simply match the baby’s input with milk output. Every time a baby drinks from a bottle or open cup (preferred method to avoid nipple preference), whether it’s a full feed or a top up, milk removal from the breasts should occur as soon as possible – especially at night! Pumping on a different schedule can easily create an oversupply or lead the mother to remove less milk than what baby’s intake is.
Peace Of Motherhood 
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