How much breastmilk does my baby need?
I love this question and get asked this so often - so here is the run down!
Breastmilk production after birth follows a 3-phase pattern . The “Initiation phase, Secretory Activation and Maintenance phase.” During each of these phases your body adjusts both the volume and nutritents contained in your breastmilk to meet your baby’s ever changing needs.
Here is a little breakdown of the science behind lactation (don’t worry - I’ll try keep this simple and interesting!)
Phase 1: Initiation – The first 24 hours after birth
In the first hour after birth the ongoing release of oxytocin (our ‘love’ and labour hormone) helps us to deliver our placenta which causes a decrease in our progesterone (another reproductive hormone I’m sure you’ve heard of!). This stimulates the ‘initiation phase’ of breastfeeding. To put it very simply - the delivery of the placenta signals to our body we no longer need to feed our baby ‘inside’ but we now need to feed them on the ‘outside’. So now our colostrum becomes more readily availiable and in larger quantities (you actually aready had colostrum from approx 16 weeks of pregnancy but may not have seen evidence of this, release during pregnancy is also controlled by varying progesterone levels).
If your baby is born healthy and well at term, is an average weight, and you dont have any pregnancy complications such as gestational diabetes - then your baby likely only needs a very small amount of colostrum! Their little stomach is a smooth muscle and can hold varying volumes of food, but as to visualize it easier - think the approximate size of a cherry. Comfortably holds 2-7ml.
If your baby is premature, small for gestational age, requires respiratory assistance at birth, history of gestational diabetes - these are just some of the reasons why your baby might have increased energy requirements, meaning, they may need more food (you can read more about gestational diabetes and complications after birth here).
Now, if we are breastfeeding, we obviously cannot see the ‘volume’ they drink. Which is actually what nature intends - your baby is supposed to help your body decide how much milk to make for them. But, I’m getting ahead of myself. For now - you’ve just met your brand new baby and hopefully breastfed them for the first time. Now try get some rest! They will very likely want to rest too, a lot, in this first 24hours.
Phase 2: Building (secretory activation) – 48 hours to 2 weeks of age
By 48-72 hours of age, your baby’s interest and need for food has grown - tripled, even. This is because breastmilk production works as a positive feedback loop often referred to as “supply and demand” = the more your baby demands to feed (and therefore stimulate the breast’s production) the more milk supply you will make! Lots of hormones at work here too, and together with the physiological changes your baby is experiencing each day - a lot of change is happening. This is why every day after birth looks so different in the first week!
To try visualize this change (I’m a visual learner, can you tell?!) your baby’s stomach may* now resemble the size of a walnut, (approx 22-27mls). This means their appetitie has just suddenly increased in a very short period of time. This causes an understanable change in baby behaviour often referred to as “night 2 syndrome” or “the all nighter”.
The “Night 2&3” is when your baby seemingly wants to feed constantly and it is normal.
And when I say constantly, I mean they might want to feed every hour, all night.
Its so important thart with these frequent feeds you baby is able to attach well and you do not experience any nipple damage! This process may cause your nipples to feel tender and sore, but there should be no damage occuring. You'r baby may lose up to 10% of their birth weight during this time and this is also normal.
Their frequent demand to feed encourages your milk to ‘come in’ – which essentially just means rapidly producing larger quantities of colostrum mixing now with mature breastmilk (we call this transitional milk until 2 weeks after birth).
The building phase can be delayed by many variables including complications at or after birth, interventions (both necessary and unnecessary), stress/anxiety, lack of support or education, so during this time its so important you have access to appropriate support and evidenced-based information to help you advocate and navigate these changes safely.
By 2 weeks, your baby will be back to their birth weight or more, you’ll be changing lots of wet nappies and they will be happily tolerating 80-150mls per feed (if you’re breastfeeding, you wont know how much of course and thats okay! their wet nappies will tell you they are hydrated.)
*A note on using cherries and walnuts to describe baby stomach ‘size’: It is important for me to mention that while I use these representations to describe your baby’s intake, they are only an approximate guide – babies will often demand (and tolerate) more or less colostrum/breastmilk. Much like us, their appetite and volume consumed varies feed by feed.
Phase 3: Maintenance – 4 weeks +
Now, because of the whole supply and demand situation, its understanable why many assume we will just keep increasing the volume of breastmilk we make every day, forever. Thankfully this is not the case because that might look like making, say, 40L of breastmilk a day by the time our baby is 12months old (!).
What actually happens is:
By the time you and your baby have reached the 4–6-week postpartum mark, if you are exclusively breastfeeding on your baby’s demand (so not timing their feeds or picking the volumes for them) your milk volume production will plateau, at your baby’s chosen volumes. If you’re interested in statistics, the average volume made/consumed is 750-800mls every 24hrs . The range is 560-1360mls, if all has gone well.
This is why it is so important that you feed baby on their demand, try avoid unnecessary top-ups and focus on the quality of your baby’s breastfeeds rather than the minutes they take. As your baby gets older and stronger they become more efficient on the breast and may feed less often.
…or the opposite may also be true, they may be a frequent snacker – this varies, depending on the baby and the milk volumes (capacity) your breast can make!
In summary:
When you exclusively breastfeed you may not ever know how many ‘mls’ your baby is drinking - but that is okay! There are other ways to know they are getting what they need including nappies/weight/growth and behaviour.
The best way you can support the establishment and maintainence of an adequate breastmilk supply is to exclusively breastfeed your baby on their demand and make sure they are attached and transferring milk at the breast effectively.
There are lots of changes to your hormones and your baby’s behaviour in the first 6 weeks. This can make it hard to feel reassured your baby is drinking enough. You need a good support network of family, friends and healthcare providers who are educated, compassionate and informed on how to help you safely navigate any periods of uncertainty.
If you are ever unsure or worried your baby might not be getting enough breastmilk, please see your GP, Child and Family Health Nurse/Midwife or Lactation Consultant.
References:
Boss, M., Gardner, H. and Hartmann, P., 2018. Normal Human Lactation: closing the gap. F1000Research, 7, p.801.
Debra, H., 2011. Complexities and subtleties in the measurement and reporting of breastfeeding practices. International Breastfeeding Journal, 6(1), p.5.
Ford, E., Underwood, M. and German, J., 2020. Helping Mom Help Baby: Nutrition-Based Support for the Mother-Infant Dyad During Lactation. Frontiers in Nutrition, 7.
Geddes, D. and Perrella, S., 2019. Breastfeeding and Human Lactation. Nutrients, 11(4), p.802. International journal of Nursing Didactics, 2016. Pregnant Women's Opinions About Breast Milk And Breastfeeding Myths. 6(5).
Kent, J., 2007. How Breastfeeding Works. Journal of Midwifery & Women's Health, 52(6), pp.564-570.
Pang, W. and Hartmann, P., 2007. Initiation of Human Lactation: Secretory Differentiation and Secretory Activation. Journal of Mammary Gland Biology and Neoplasia, 12(4), pp.211-221.
Watchmaker, B., Boyd, B. and Dugas, L., 2020. Newborn feeding recommendations and practices increase the risk of development of overweight and obesity. BMC Pediatrics, 20(1).
Watchmaker, B., Boyd, B., Dugas, L., Adam, K. and Decicco, E., 2021. Smaller Feeding Bottle Size in Newborns Reduces Overfeeding on First Day of Life which is a Risk Factor for Later Life Overweight and Obesity. Section on Obesity Program,.