Nutrition Through The Ages - Special Edition: Lactation

Updated: May 24, 2023

Just like all other mammals, humans are born biologically adapted to species specific milk as a complete source of nutrition. The act of breastfeeding is also a means for bonding, nurturing, and caring for a newborn.

Pregnancy Changes

A woman’s body undergoes many changes during pregnancy including the growth of her breasts and nipples. Within the breast, there is a growth and increase of the milk ducts. A pregnant woman’s breasts become tender due to pregnancy hormones. The areola becomes larger and darker in color making it easier for an infant to find the breast after delivery. Glands in the areola release an oil that smells like amniotic fluid to provide comfort and familiarity to teh baby. The removal of milk reflected in the infant’s appetite is what determines a mother’s milk yield, not the mother’s capacity to produce milk. A key to establishing a good milk supply is beginning breastfeeding within the first hour of life.

Stages of Milk Production

There are three stages of breast milk production.

Colostrum: The production of colostrum is the first stage and can occur as early as the 16th week of pregnancy, continuing until several days after the baby’s birth. Colostrum is yellowish or creamy in color and contains a high amount of protein, fat-soluble vitamins, minerals and immunoglobulins. Baby is protected from a variety of bacterial and viral illnesses by the passive immunity that colostrum provides.
Transitional Milk: Some time between days 3-5 after birth, the breasts begin to make transitional milk which contains high levels of fat, lactose, and water soluble vitamins. It is also higher in calories than colostrum.
Mature Milk: After about 2 weeks, mature milk is produced. This milk is 90% water, keeping the infant hydrated. The remaining 10% is composed of the carbohydrates, proteins, and fats necessary for both growth and energy.

Baby's Hunger & Fullness Cues

Infants communicate in a variety of ways to caregivers, signaling their hunger and fullness. Understanding your baby’s cues will help in your journey to successful feeding either at the breast or with a bottle.

Most babies will begin with very subtle signs such as fluttering eyelids, putting hands/fingers in or towards the mouth, and mouth movements like sticking out tongue or making sucking sounds.
An infant may get fidgety, moving a lot, tensing up hands/fists in a show of restlessness.
More obvious signs may be that of rooting toward your chest or arm, whimpering or squeaking.
The baby may signal their fullness by pulling away or unlatching from the breast, appearing sleepy, relaxing their body (especially hands/fists), and starting and stopping the feed often.

Offering the breast at the first signs of hunger will ensure a calmer infant who is more willing to latch at the breast and feed.

"How To" Breastfeed

Finding a comfortable position in which to breastfeed may include providing back support, using pillows to support your arms and baby, and supporting your feet with a stool or footrest.
Keeping the baby close to you with their hips flexed will eliminate the need for the baby to turn their head to reach your breast.
Your baby’s mouth and nose should be facing your nipple and body should be so close that they are touching you, tummy to tummy.
Supporting your breast will help it avoid pressing on their chin. Baby’s chin should touch your breast, then their nose.
Encourage them to open their mouth wide while pulling them close by supporting their back (rather than the back of the head) so that their chin touches your breast first.
If you are feeling pain, detach the baby gently and try again. An adjustment to the latch or positioning can help your baby be more comfortable. Breastfeeding may be “natural” but is a learned skill that requires patience, practice, and persistence.

In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn’t right with the baby’s latch, position, or suck. If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contacting a lactation consultant for help if you need further assistance to improve your sore nipples may be needed.

Is Baby Getting "Enough"?

Many breastfeeding mothers wonder how to tell if their baby is getting enough at the breast. Breasts don’t have ounce markers and not being able to see what goes in can make a parent nervous about knowing exactly how much the baby is getting. There are several key factors to ensuring the baby is getting enough at the breast.

The number of times an infant feeds at the breast is a good indicator to begin with. The first few weeks of your baby’s life your milk supply is being established. Milk supply is determined by the concept of supply and demand. It is therefore important for the baby to feed at the breast 8-12 times in a 24 hour period.

It is important to understand these feedings at the breast may not be evenly spaced. In the first few days after birth, the baby will need to nurse frequently, as often as every ½ hour.
Most newborns need 10-45 minutes to complete a feeding. Baby’s belly size is about the size of a marble at birth, holding a mere 1-2 tsp of fluid at a time.
By day 10, their belly can hold about 1-2 ounces at a time. This is why breastfeeding can take a lot of time and why babies must nurse often.

The body will make more milk as it is removed from the breast which is why ensuring baby empties your breast at each feed and you limit supplemental formula bottles during this time in order to give your baby an opportunity to establish its supply.

Diaper volume is another good indicator that your baby is receiving enough at the breast.

Baby will produce 1-2 diapers a day in the first few days of life.
Once your transitional milk comes in on days 3-5, you can expect an increase of 3-4 wet and 3-4 poop diapers per day.
By two weeks, your infant will be producing at least 6 wet and 3 yellow, seedy, runny dirty diapers per day.

The growth of the infant and their weight fluctuations are important to understand as well.

It is normal for infant’s to lose up to 7% of their birth weight after delivery due to loss of fluids administered to mother during delivery and natural loss of water retained by the infant while in utero.
By day 3 or 4, baby should begin to gain weight.
Typically, newborns gain 5-7 ounces (140-200 grams) per week and should be back up to birth weight by two weeks of age.

Noting the suck swallow pattern in your infant can also be helpful in determining a successful feed at the breast.

Baby will begin with quick sucks at the beginning of the feed which will stimulate the milk reflex letdown.
This will be followed by long, slow sucks with regular swallowing and a breath after every one to two sucks.
If you can identify this pattern, then you know the baby is breastfeeding successfully.

Also remember that crying after a feed does not always mean the baby is still hungry. It is important to rule out other possibilities like a soiled diaper, too hot/cold, or being over tired before offering a supplemental bottle as this may decrease milk production.

Nutrition

Breastfeeding mothers generally need more calories in their diet to meet their own nutritional needs as well as the infant. The number of extra calories needed depends on the mother’s age, body mass index, activity level and extent of breastfeeding (exclusive versus offering supplementation as well). Approximately 2000 to 2800 kcal per day are recommended for a healthy, well-nourished breastfeeding mother. Drinking to thirst and maintaining good hydration are also important in producing breast milk.

There are several vitamins and minerals that may also be supplemented during the breastfeeding years.

A mother’s need for iodine and choline increases during lactation. Iodine can be found in dairy products, eggs, seafood, or in iodized table salt. Choline can be found in dairy and protein food groups, such as eggs, meats, some seafood, beans, peas, and lentils.
Breast milk alone does not provide infants with an adequate amount of vitamin D. The Dietary Guidelines for Americans and American Academy of Pediatrics recommend breastfed and partially breastfed infants be supplemented with 400 IU per day of vitamin D beginning in the first few days of life.
Starting at 6 months of age infants require an external source of iron apart from breast milk. Most newborns have sufficient iron stored in their bodies for about the first 6 months of life depending on gestational age, maternal iron status, and timing of umbilical cord clamping. An infant’s iron needs can be met through the introduction of iron-rich foods, iron-fortified cereals, or iron supplement drops at 6 months.
Infants are born with very small amounts of vitamin K stored in their bodies. The American Academy of Pediatrics recommends that all newborns, whether breastfed or formula fed, receive a one-time intramuscular shot of vitamin K1 which is needed to form blood clots and to stop bleeding.

Why Breastfeed?

The decision to breastfeed is a personal one that is best achieved through education and support. There are many benefits to both infant and mother. Research shows babies who breastfeed:

have a decreased chance of allergies and dental caries.
benefit from proper jaw, teeth, and speech development.
are more protected against ear infections, respiratory ailments, type 2 diabetes, intestinal disorders, certain childhood cancers, colds, viruses, staph, strep and e. coli infections.
are at a lower risk for asthma, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS).

The American Academy of Pediatrics recommends mothers breastfeed exclusively for the first 6 months, gradually adding solids while continuing breastfeeding for at least the first year. Breastfeeding is encouraged for as long as mother and baby desire it.

Additionally, providing skin to skin contact to a newborn in the first month of life has many benefits to the infant and their caregivers. Besides the obvious bond it creates, it also helps regulate baby’s heart rate, maintain their body temperature and blood sugar. Stress hormones in mom are lowered, it helps mom make more milk, and helps the baby attach more easily to the breast.

Babies do not come with instructions, so it's important to know where to turn for help. Community resources and support is available from many organizations.

La Leche League International has chapters in every state and provides breastfeeding moms with mother to mother support that can prove invaluable to a new nursing mom.
The National Breastfeeding Help Line (800-994-9662) is available Monday-Friday from 9am-6pm EST. The help line offers breastfeeding peer counselors to help answer common breastfeeding questions. They also offer support in case more assistance from a doctor or lactation consultant may be warranted.
Arizona Department of Health Services' 24-Hour Breastfeeding Hotline (1-800-833-4642) provides 24 hours a day support for all breastfeeding questions and concerns.
The Women Infant and Children Program (WIC) provides assistance and support to low income families. For local WIC information visit https://www.signupwic.com/

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Author Bio

Jill Coscarelli is a Registered Dietitian Nutritionist (RDN) and International Board Certified Lactation Consultant (IBCLC). She lives in Chandler, AZ with her 16 and 19 year old daughters, dog and 3 cats. She has been working for the Maricopa County WIC Program since 2018, first as a Dietetic Technician Registered then as a RDN and IBCLC. She attended Arizona State University, obtained a degree in Nutrition and Dietetics in 2018, and later completing a Dietetic Internship with Maricopa County Department of Public Health in 2021. Jill loves to bake and explore cooking with new vegetarian meals for her girls; and, she also enjoys reading, taking the dog for long walks, and planning new adventures.

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