How Do Breasts Make Milk

GENERAL INFORMATION:

How do breasts make milk?

• Your breasts change during pregnancy to prepare for making milk. Your breasts contain milk glands and milk ducts that increase in number, causing your breasts to get larger. Milk is made in small sacs called milk glands or mammary glands. The milk glands are arranged side by side in small grape-like clusters. The milk gland clusters connect to milk ducts, which are pathways for milk to travel through before reaching your nipples. These small ducts join other ducts and form bigger ducts as they get closer to the nipple. Breast milk flows from the ducts into the sinus (collection area) behind the nipple. It then comes out through 15 to 20 small openings on your nipples.
  
  
• During the later part of your pregnancy, your breasts start to make and store colostrum. Colostrum (KO-lah-strum) is a yellow, creamy fluid made by the breasts before they start making milk. It contains protein, vitamins and minerals, and sugar, plus antibodies (substances that protect against infection). Your baby will receive colostrum during breastfeeding before your breasts start making milk. Your breasts will start making regular breast milk 2 to 4 days after your baby's birth. Colostrum may continue to be in your milk for up to two weeks after your baby is born. Your milk glands make milk continuously while you breastfeed and removing more milk increases how much you make. Milk is removed from your breast during feeding when your baby suckles it or by expression (milk removal by hand or pumping).

Why is breastfeeding important?

• Breastfeeding offers many good effects for both your baby and you. Your breast milk is available at no cost, requires no preparation, and is always clean, fresh, and at the right temperature. Human breast milk has the best combination of nutrients for your baby. Nutrients include all the protein, fat, sugar, vitamins, and minerals your baby needs for his body and brain to grow. Breastfeeding helps protect your baby from infections. It may also decrease your baby's risk of getting allergies and certain diseases. These diseases include sudden infant death syndrome (SIDS), asthma, diabetes (high blood sugar), lymphoma (lymph node cancer), and leukemia (blood cancer). Breastfeeding also strengthens the bond between you and your baby.
  
  
• Breastfeeding helps stop bleeding from your uterus (womb) right after giving birth. It also helps you lose the extra weight and fat you put on during pregnancy. Breastfeeding without giving any formula to your baby can delay the return of your menstrual cycles. It can help control or decrease the amount of sugar in your blood. Breastfeeding can help make your bones stronger and decreases your risk of getting osteoporosis. It also helps protect you against breast, ovarian, and uterine cancer. You may need to learn and practice breastfeeding methods so your baby gets all the milk that he needs.

What is milk let-down, and what can I do to make my milk let-down?

• Your breast milk stays in the milk glands until it is released into the milk ducts. The process of this release is called let-down. The "let-down reflex" at first is triggered when the nerves in your nipple and areola (dark circular area) feel your baby suckling. This reflex is also known as the "milk-ejection reflex." When your baby suckles milk from your breast, hormones (special substances) in your body are released. You may have a warm, tingling feeling in your breasts when this happens. When you get ready to feed your baby, milk may drip or spray from your nipples when your let-down happens. You may feel breast fullness 30 to 60 seconds after your baby is correctly attached to the breast. Multiple let-downs happen during every feeding.
  
  
• Your body responds with let-down more easily to your baby than when you use a pump or do hand expression. When pumping or expressing milk, you will need to trigger your milk let-down without your baby's sucking. Being relaxed, free from distractions, and in a place where you feel comfortable can help your milk let-down. Seeing pictures of your baby, or smelling and feeling his clothing may also help. You can also record and listen to his voice. Placing warm cloths on your breasts may also help. Ask your caregiver for more information about pumping and hand expression.

What conditions may cause problems with my milk let-down? If you are feeling tired, ill, or stressed, you may have problems with let-down. You may also have let-down problems if you have nipple soreness or pain in your breasts. You may get breast pain if you have breast engorgement (overly full breasts) or mastitis (breast infection). Surgical changes to your breasts or nipples can also interfere with let-down:

• Breast implants: Breast implants are small bags filled with saline (salt) water or silicone gel used to make your breasts look larger. They are placed behind the breast tissue and push it forward to help improve the shape of your breast. They can pinch milk ducts, block the flow of breast milk, and make your breasts swell. The surgery to place the implant may injure nerves in your breast and interfere with let-down. When you have implants, you may feel more pain when your breasts are full of milk or have pain while feeding. The pain may get very bad and may cause you to want to stop breastfeeding. Ask your caregiver for more information on breastfeeding and implants.
  
  
• Nipple piercings: Your nipples can become too sensitive when they have piercings. This may bring discomfort during breastfeeding and cause problems with milk let-down. When you remove nipple jewelry to breastfeed, milk may come out from both the piercing holes as well as the nipple during let-down. You may get scar tissue in your nipples from being pierced that can block the flow of milk. This may cause problems with milk let-down.

What can decrease my breast milk supply?

• Drinking too much alcohol or caffeine. Alcohol is found in beer, wine, liquor, such as vodka and whiskey, and other adult drinks. Tea, coffee, or sodas have caffeine in them.
  
  
• Getting pregnant soon after having a baby. Breastfeeding is not completely effective as a means of preventing pregnancy. You will need to use other methods of birth control, such as condoms. Ask your caregiver for more information on ways to avoid becoming pregnant again just after having a baby.
  
  
• Pressure on your breasts. Sleeping in a face down position may squeeze your breasts and block milk ducts. Wearing a bra that is too tight or a sling that press on your breasts can decrease milk supply.
  
  
• Smoking. Cigarette smoking can decrease the hormones that help your breasts make milk. It can also decrease or slow down milk flow from your breasts.
  
  
• Stress. This includes physical, mental, and emotional stress. Stress can decrease your milk let-down and the amount of milk you make. Decreased milk let-down for a long period can stop your breasts from making milk.
  
  
• Taking certain medicines. These include oral contraceptive pills that contain estrogen and over-the-counter (OTC) medicines, such as antihistamines. Antihistamines are medicines used for allergies. Ask your caregiver for information on other medicines which can decrease your milk supply.

What can I do to increase my breast milk?

• Decrease the amount of alcohol you drink. Do not drink more than one glass of wine, or 2 bottles or cans of beer in a day. Do not drink alcohol at least two hours before you breastfeed. Drinking alcohol close to a feeding can change the taste of milk and be passed on to your baby. Ask your caregiver for more information about alcohol use while you are breastfeeding.
  
  
• Decrease the amount of caffeine you drink.
  
  
• Drink enough liquids. Drink 1.8 Liters of liquid each day (close to 8 eight-ounce cups). Good liquids to drink are milk, water, and juices.
  
  
• Eat a variety of healthy foods from all the food groups every day. Choose foods that will give your body the extra nutrition it needs as you breastfeed. Dairy products, such as milk, yogurt, and cheese, and brown and white bread provide calcium. Red meat and fortified breakfast cereals provide iron. Eat a variety of fruits and vegetables, including dark green and orange vegetables, and legumes (dry beans). Eat the right amount of calories as advised by your caregiver. Ask your caregiver for information about breastfeeding and your diet.
  
  
• Feed your baby more at night and space out feedings during the day. This pattern of feedings may help your body make more breast milk. Ask your caregiver for more information on ways to increase your milk supply.

What problems can I have while breastfeeding my baby? You can have one or more of the following:

• Engorgement: Breast engorgement is a condition where your breasts are painful and very swollen from too much milk inside. Wearing tight-fitting clothes or under-wire bras can lead to breast engorgement. Ask caregivers for more information about breast engorgement and on ways on how to prevent it.
  
  
• Leaking breasts: Your breasts may leak when they are full of milk and not emptied often. You may notice milk coming from the small openings in your nipples. This is normal. It may be prevented by crossing your arms carefully over your chest and pressing your arms against your breasts. This mild pressure applied over your nipples works to stop the milk let-down. Wear nursing pads inside your bra to soak up the milk. Wear several layers of clothing, and avoid wearing solid colored shirts. Doing these things may make the leaking milk harder to see on your clothes.
  
  
• Nipple soreness: Sore nipples may happen during your first week of breastfeeding after giving birth. Not being in a comfortable position while breastfeeding can lead to the baby not being latched on to your breasts properly. This makes the baby suckle harder to get milk, leading to pain in your nipple. You may also have other signs or symptoms, such as redness or swelling. Ask caregivers for more information about nipple soreness and ways to prevent it.
  
  
• Plugged milk ducts: A plugged duct is a blocked milk duct. The blockage can decrease or stop the flow of your breast milk. It can make your milk build up inside your breast and cause it to swell. Plugged ducts can lead to mastitis (breast infections) or a breast abscess (area of infection in your breast). These infections may make you want or need to decrease how often you breastfeed your baby. Ask caregivers for more information about the treatment and ways to cope with plugged ducts.

Where can I go for support and more information? Ask for information about breastfeeding and make sure caregivers know that breastfeeding is important to you. Ask caregivers to help you find a breastfeeding class before your baby is born. Take a breastfeeding class, or join a group with other breastfeeding mothers. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Contact the following:

• La Leche League International
  1400 N. Meacham Rd
  Schaumburg, IL 60173-4808
  Phone: 1-847-519-7730
  Web Address: http://www.lalecheleague.org
  

• The National Women's Health Information Center
  Phone: 1-800-994-9662
  Web Address: http://www.4woman.gov
  

• Women, Infants and Children Program
  Food and Nutrition Services
  WIC Program
  Supplemental Food Programs Division
  Alexandria, VA 22302
  Phone: 1-703-305-2196
  Web Address: http://www.fns.usda.gov/wic
  

When should I call my caregiver? Call your caregiver if:

• Your baby is very sleepy or very irritable.
  
  
• Your baby refuses to breastfeed for more than 8 hours.
  
  
• You feel you are not making enough breast milk for your baby.
  
  
• You feel a lump or a hard area in your breast.
  
  
• Your breasts become hard, painful, or swollen, or you cannot get your milk to flow.
  
  
• Your breasts do not feel full before feedings and softer after breastfeeding.

CARE AGREEMENT:

You have the right to plan how you are going to feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. Ask your caregiver questions about breastfeeding. You can talk with him about the best way for you to feed your baby.

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