A little bit on how our breasts work

A little bit on how our breasts work

Breasts, nipples and areola are different, and all women are different. Women with very small and very large breasts can breastfeed. Most women have similar breasts on the right and left, but some have dramatically different breasts. The range of normal is too extensive to ever describe fully.

From birth, the rudimentary glands are already in existence and many babies have some growth soon after birth. A few even produce milk in small amounts. This is a reaction to their changing hormones. The baby’s breast then remains dormant, until hormonal changes that lead to puberty start to change them.

A few women have little or no breast tissue and absolutely no milk. Rarer is the woman who, despite getting very full breasts, finds her milk does not flow. We don’t know if it is hormonal or from duct abnormality. Some women have had trauma or burns to their breasts which can prevent breastfeeding.

Breast augmentation usually does not interfere with feeding if babies are allowed to feed to their needs. Breast reduction surgery can mean lower supply, because of the removal of milk glands. Nipple surgery often, but not always, causes issues.

After conception, the breasts start getting ready for the birth of the baby. Many women find sensitive nipples and heavier breasts are the first sign of pregnancy. Most women’s breasts grow in pregnancy, but this is very variable. Breast growth in pregnancy is not a reliable indicator of future milk supply. Women still feeding another baby can continue to do so, throughout the pregnancy and beyond. Some feel that the reduced supply and breast discomfort make it time to wean.

Colostrum is the first milk. Some women will leak this rich fluid from the second trimester of pregnancy. It is very low in volume but is full of antibodies, proteins and laxatives. At birth, the baby learns to suck, swallow and breathe on the breast, with just small volumes of colostrum being produced so if they do gag or breathe in a few drops, it won’t be harmful. The laxative in colostrum helps get rid of a bowel full of meconium. The baby then has space for milk when the volume increases, around postpartum day three to six.

At the birth of the placenta, hormones change; prolactin levels are high and other pregnancy hormones are no longer there. Therefore, the milk ‘comes in’ whether the baby goes to the breast or not. How much milk depends on the mother’s genetics and how much the baby feeds. A few babies will need extra milk at this time and should be given it, however many don’t. Unnecessary or excessive top ups can affect feeding and the baby’s gut. How much extra milk the baby needs will change and usually decrease, as her mother’s milk increases.

The type of birth a mother has can increase the risk of not being able to breastfeed. With good support after her delivery and frequent feeding or expressing, most mothers can go on to breastfeed their babies, if that is their wish.

Breastmilk is made and stored in the alveoli cells of the breast. When the baby sucks, or sometimes when mother thinks about the baby, milk flows into the ducts and some may leak out. This is called a letdown. Some women do not feel it, many feel tingling and some feel pain. Some women even report sudden and fleeting depressive thoughts. Many women only feel their first, or strongest letdown. The hormonal system and the muscles around the nipple prevent milk from leaking all the time. Babies who are given close contact with their mothers and frequent, uncomplicated access to the breast will regulate supply. When mother and baby are not separated, mothers have far less engorgement, when their milk comes in. Engorgement is a signal to the breast to reduce milk supply, not the positive sign of abundant milk we used to believe. If the baby does not feed in the first few days, milk will come in, but less than if they feed regularly. With more frequent feeds this deficit can be over- come. Some women have gross oversupply and some not enough, usually from breast stimulation or lack thereof.

If the baby never feeds, the mother’s milk will dry up. Initially she will be very uncomfortable but this will ease. It happens when the mother does not breastfeed, for any reason.

This process of breast filling and emptying continues until a child is fully weaned. Any restrictions, day or night to feeding (including any other sucking such as dummies and bottles) can lead to less breastmilk. Twins and triplets feed more on each breast, so mother makes more milk. Expressing, if the baby can’t feed can help, but is often not as efficient as a healthy baby.

The volume of each breast is dependent on the use of the individual breast. Especially in the early days, it is suggested to feed from both breasts, but following the baby’s needs instead of the clock. Breasts are never completely empty and spending extra time at one breast for a few extra drops is often not as helpful as offering the other breast. Frequently switching breasts for a baby who is happy feeding will frustrate everyone. Swap when the baby is sleepy, slowing down or fussy. Babies tend not to suck constantly, rather, they stop and start.