Milk Flow
It's at the Heart of Breastfeeding
By Beverly Morgan, IBCLC
Based on the audiobook Reading Your Baby's Body Language by Beverly Morgan IBCLC
Written for MOBI Motherhood International
Based on the audiobook Reading Your Baby's Body Language by Beverly Morgan IBCLC
Written for MOBI Motherhood International
This article contains information crucial to all breastfeeding mothers. It includes ways to “watch the baby” that you may not have heard before. I foresee this information helping you to enjoy, marvel at, and respect your special little person even more.
It will be helpful if you read this article from beginning to end first to get an overview, and then return to the sections that seem to apply to your situation.
When people think about milk flow and breastfeeding at all, it is often in relation to a mother not having enough milk. Fast flow can be of concern, too. In this article, we will explore both.
If you have concerns about your milk flow, seek help. An IBCLC can help diagnose the problem, work out a management plan, and refer you to an appropriate therapist if necessary. Some babies, such as those with tongue and lip ties have shaky breastfeeding feeding skills that can cause extra challenges. They can benefit by additional support.
It will be helpful if you read this article from beginning to end first to get an overview, and then return to the sections that seem to apply to your situation.
When people think about milk flow and breastfeeding at all, it is often in relation to a mother not having enough milk. Fast flow can be of concern, too. In this article, we will explore both.
If you have concerns about your milk flow, seek help. An IBCLC can help diagnose the problem, work out a management plan, and refer you to an appropriate therapist if necessary. Some babies, such as those with tongue and lip ties have shaky breastfeeding feeding skills that can cause extra challenges. They can benefit by additional support.
A Word of Caution: If your newborn baby is fussing and fretful while feeding at the breast, or if he shows a lack of interest, or is falling asleep at the breast, look for help today.
A Baby Reacts to His Mother Milk Flow
A friend of mine, while nursing her verbal child, asked him why he was massaging her breast while he nursed. He popped off her breast to say, "Cause it makes the milk come faster."
Milk flow is at the heart of feeding and its impact is far reaching. As an IBCLC, I became aware that many mothers are not conscious of the interplay between milk flow and the baby. A baby’s response to his mother’s milk flow shapes his nursing behavior. Consequently, his feeding behavior also affects his mother’s milk flow.
If the baby is always struggling with a flow that is too fast for him to handle, or continually tugging at the nipple because the flow is too slow, this can be confusing or disturbing to the mother. The quality of the nursing relationship is affected by a mother’s milk flow and her baby’s reaction to it.
Milk flow is at the heart of feeding and its impact is far reaching. As an IBCLC, I became aware that many mothers are not conscious of the interplay between milk flow and the baby. A baby’s response to his mother’s milk flow shapes his nursing behavior. Consequently, his feeding behavior also affects his mother’s milk flow.
If the baby is always struggling with a flow that is too fast for him to handle, or continually tugging at the nipple because the flow is too slow, this can be confusing or disturbing to the mother. The quality of the nursing relationship is affected by a mother’s milk flow and her baby’s reaction to it.
Variable Flow Rate Throughout the Nursing Sessions
Throughout a nursing session the general trend in milk flow is from faster to slower. However, it is not a straight line decrease. Like the tide, there is an ebb and flow. Let me explain.
If you’ve done any pumping, you will have noticed that when you start there is a delay before the milk flows. Once the milk ejection begins, the milk flows faster. The milk might even spray, especially if your breasts were firm when you started. The flow will then be steady for a time, gradually decreasing, and temporarily stopping. If your baby keeps nursing, or if you continue pumping, you will have another milk ejection. The flow will rise again with the next “wave” of milk, but unlike the tide, the flow of milk does eventually stop. Each milk ejection is less forceful and has less volume than the one before. This means that a baby has faster flowing milk at the beginning of a session, when he has a strong appetite, and slower flowing milk at the end, when he is full and sucking more for comfort. Keeping this variable flow rate in mind, the baby’s behavior at the breast becomes a bit easier to read.
Reading your baby’s behavior cues
If you’ve done any pumping, you will have noticed that when you start there is a delay before the milk flows. Once the milk ejection begins, the milk flows faster. The milk might even spray, especially if your breasts were firm when you started. The flow will then be steady for a time, gradually decreasing, and temporarily stopping. If your baby keeps nursing, or if you continue pumping, you will have another milk ejection. The flow will rise again with the next “wave” of milk, but unlike the tide, the flow of milk does eventually stop. Each milk ejection is less forceful and has less volume than the one before. This means that a baby has faster flowing milk at the beginning of a session, when he has a strong appetite, and slower flowing milk at the end, when he is full and sucking more for comfort. Keeping this variable flow rate in mind, the baby’s behavior at the breast becomes a bit easier to read.
Reading your baby’s behavior cues
- If he pulls back and milk is flowing out of the breast, it may be that his swallow is temporarily challenged and he is trying to get breathing space.
- He may have learned from experience that the first letdown is too fast and strong for him to handle comfortably, so he pulls away and waits for it to pass.
- He may pull off the breast once the flow starts. He may have been nursing more for comfort; this extra milk was not what he wanted.
- If he pulls his head back and tugs on the nipple of the first breast in a feeding, and you can tell that that breast feels soft now, he will likely be happy to change to the second breast for a faster flow.
- If he tugs or fusses right from the start he may be impatient for the flow to start. He may want the other breast if he knows it is the faster flowing breast.
Variable Flow Rate from Breast to Breast
Milk flow varies from one breast to the other, and it changes throughout the nursing session and throughout the day. I consider this variable flow as nature’s way of providing different flow rates for different babies. Often, tuning in to which breast flows faster, and learning what the baby prefers, can add an extra level of enjoyment to breast nurturing.
When working with mothers, I share “Morgan’s Rule of Thumb for Milk Flow”: The firmer the breast, the faster the flow—the softer the breast, the slower the flow.
Bottle nipple manufacturers and people who bottle-feed a baby have also discovered how important milk flow is to a baby. There are a variety of flow rate nipples available and a mother may need to try many to find the one that flows best for her baby.
When working with mothers, I share “Morgan’s Rule of Thumb for Milk Flow”: The firmer the breast, the faster the flow—the softer the breast, the slower the flow.
Bottle nipple manufacturers and people who bottle-feed a baby have also discovered how important milk flow is to a baby. There are a variety of flow rate nipples available and a mother may need to try many to find the one that flows best for her baby.
Side Preference
Not all children have a side preference and there are reasons other than milk flow that can induce an infant to favor one side. For example, a baby may have a broken or cracked clavicle from birth. If so, he will prefer to nurse on the side that does not put pressure on his sore shoulder. If a baby seems distinctly uncomfortable on one side, a therapist may be in order. He may be happy to use both breasts once the restriction or pain that caused his preference is resolved.
For the sake of our discussion here on milk flow, we will assume that there is no underlying physical condition causing the side preference, and that the preference is due to the most obvious cause: the baby’s preference for a faster or slower milk flow.
For the sake of our discussion here on milk flow, we will assume that there is no underlying physical condition causing the side preference, and that the preference is due to the most obvious cause: the baby’s preference for a faster or slower milk flow.
Supply and Demand
Interestingly, the favored side can change from time to time, sometimes because the baby’s flow preference changes. A baby who was having trouble keeping up with a fast flow can now handle it better, and suddenly he prefers the faster flowing breast. A baby who likes a slow flow may nurse on the slower flowing breast more effectively, so that with time both the volume and flow rate increase in that breast. This baby may now switch his preference to the other breast that has become slower flowing in comparison.
Sometimes, the preference for one particular breast remains for the entire duration of the nursing relationship. This preference may be consistent from child to child, or may vary depending on the child. One possible reason for the preference could be that one breast produces the larger portion of milk, and the mother’s children respond to that with a preference.
The more often the baby chooses one breast, the more stimulation and milk removal that breasts experiences. This milk removal and stimulation induces that breast to produce more milk. Some mothers offset the baby’s preference for the faster flowing breast by pumping in addition to nursing on the slower-flowing breast for a time to increase its flow. If the flow rate is too fast for the baby on one side, making him reluctant to take that breast, mother might use a nipple shield on that breast to slow the flow. Strategies such as these can assure that there is demand to drive the supply on both breasts.
Sometimes, the preference for one particular breast remains for the entire duration of the nursing relationship. This preference may be consistent from child to child, or may vary depending on the child. One possible reason for the preference could be that one breast produces the larger portion of milk, and the mother’s children respond to that with a preference.
The more often the baby chooses one breast, the more stimulation and milk removal that breasts experiences. This milk removal and stimulation induces that breast to produce more milk. Some mothers offset the baby’s preference for the faster flowing breast by pumping in addition to nursing on the slower-flowing breast for a time to increase its flow. If the flow rate is too fast for the baby on one side, making him reluctant to take that breast, mother might use a nipple shield on that breast to slow the flow. Strategies such as these can assure that there is demand to drive the supply on both breasts.
Baby's Cues: Watch Those Little Hands
Let’s assume the baby is nursing effectively and is generally comfortable with the flow of milk from both breasts. Let’s also assume that mom has the milk he needs. Now look at his hands. Here are some things you might notice.
- Think of his fists and arms as a gas gauge. His arms are up and his hands are in fists when he needs a fill up. His arms are down and his hands open when he feels satisfied!
- Anticipating the nursing session, his hands are held in fists near his face
- They remain fisted during the pre-milk ejection and the first milk ejection phase
- As he's becoming satisfied and the milk flow slows to the post-ejection rate, his hands gradually uncurl and drop down from his face
- If he has gas or is startled out of his relaxed state, his hands may go part way up again. However, his hands will usually not go as far as his mouth and they will usually start to drop again more quickly then at the beginning of the feeding.
Tailored Breastfeeding
You have now been introduced to baby-watching, an important aspect of “Tailored Breastfeeding.” Tailored breastfeeding is not “off the rack” but specifically designed for each mom and baby. I coined the phrase “Tailored Breastfeeding” as a shorthand way of referring to a breastfeeding relationship that is interactive.
Rather than a specific set of rules such as “switch breasts after 15 minutes,” or “the baby must spend at least 20 minutes nursing,” Tailored Breastfeeding uses the baby’s behavior as cues to guide the breastfeeding dance. A mother uses her knowledge of how each of her babies reacts to her milk flow and makes feeding decisions that are “tailor made” to each of her babies. The rules then become less important than the immediate experience for the breastfeeding couplet.
Rather than a specific set of rules such as “switch breasts after 15 minutes,” or “the baby must spend at least 20 minutes nursing,” Tailored Breastfeeding uses the baby’s behavior as cues to guide the breastfeeding dance. A mother uses her knowledge of how each of her babies reacts to her milk flow and makes feeding decisions that are “tailor made” to each of her babies. The rules then become less important than the immediate experience for the breastfeeding couplet.
Fast Milk Flow
Slow Milk Flow
Importance of Recognizing Milk Flow Issues
If milk flow problems are not recognized and addressed, serious problems can develop for the mother and the baby.
- Ultimately, a mother’s milk supply can suffer, and if she does not realize that she is producing less milk, her baby may not get enough nourishment.
- A baby may fall asleep at the breasts in response to a too fast or too slow milk flow. This may be his way of coping.
- He may cry and fuss even before he is at the breast because he anticipates the difficulties to come. It is painful for the whole family and mother often feels rejected when a baby is going through breast refusal.
- His stamina at the breast is reduced when a baby does not gain weight well. Eventually, he may go on a breastfeeding strike.
- When a baby finds a way to feed less than he needs to grow, his reduced feeding can lead to his mother having a reduced milk supply.
Problem Resolution with "Tailored Breastfeeding"
Every nursing mother has times when her milk flow does not match her baby’s wants. A mother’s milk flow can change, and may be temporarily too fast or too slow. Perhaps a baby who can usually handle his mother’s milk flow now has a cold and the faster flow is troubling him. Perhaps his appetite is building and he wants more milk. It may also be that he was not feeling well, nursed more for comfort, and built his mother’s milk supply beyond what he wants.
If your baby nurses well some of the time, tugs at others, and he is gaining well without supplements, then the solution for you may be as straightforward as letting him decide when to change to the other breast. While “switch nursing” is a time-tested way of building a milk supply, this is switch nursing with a twist. Instead of insisting that the baby stay on the first breast for a given amount of time, or until he has completely drained the first breast, the mother follows the baby’s cues for switching. This is part of “Tailored Breastfeeding.”
Sometimes the baby’s appetite for fast flowing milk is greater than the fast flowing volume in the breast he is currently using. He will happily settle on the second breast even though he did not drain the first breast yet. He may want to move back to the breast with less milk as his tummy fills. He may move back and forth from one breast to another in each feeding. He may want to move from the first breast to the second even though the milk has not totally drained. Think again of Morgan’s Rule of Thumb for Milk Flow: The firmer the breast the faster the flow.
Generally, later in the day the milk flow is less copious than in the earlier hours of the day. A baby may want to move back and forth twice during late afternoon or early evening nursings, but only want one breast in the morning if his mother’s breasts are super full and fast flowing.
If your baby has drained both breasts and still tugs and wants more after you have let him switch back and forth twice, you can distract him by changing activities for at least 20 minutes. Mom can have a glass of water and a lactogenic snack. If he still wants to breastfeed, the delay and moms energy boost will have allowed for some breast fill-up time. He will be happy to have some faster-flowing milk and will be less likely to tug, but will settle down for some unwind time.
If your baby nurses well some of the time, tugs at others, and he is gaining well without supplements, then the solution for you may be as straightforward as letting him decide when to change to the other breast. While “switch nursing” is a time-tested way of building a milk supply, this is switch nursing with a twist. Instead of insisting that the baby stay on the first breast for a given amount of time, or until he has completely drained the first breast, the mother follows the baby’s cues for switching. This is part of “Tailored Breastfeeding.”
Sometimes the baby’s appetite for fast flowing milk is greater than the fast flowing volume in the breast he is currently using. He will happily settle on the second breast even though he did not drain the first breast yet. He may want to move back to the breast with less milk as his tummy fills. He may move back and forth from one breast to another in each feeding. He may want to move from the first breast to the second even though the milk has not totally drained. Think again of Morgan’s Rule of Thumb for Milk Flow: The firmer the breast the faster the flow.
Generally, later in the day the milk flow is less copious than in the earlier hours of the day. A baby may want to move back and forth twice during late afternoon or early evening nursings, but only want one breast in the morning if his mother’s breasts are super full and fast flowing.
If your baby has drained both breasts and still tugs and wants more after you have let him switch back and forth twice, you can distract him by changing activities for at least 20 minutes. Mom can have a glass of water and a lactogenic snack. If he still wants to breastfeed, the delay and moms energy boost will have allowed for some breast fill-up time. He will be happy to have some faster-flowing milk and will be less likely to tug, but will settle down for some unwind time.
A Mother Speaks
A mother, Demetra, wrote to me after we spent some time working through her nursing problems and sore nipples. "…I have learned from you to have a more open attitude about what may work and I am willing to troubleshoot until we find a more comfortable position. You have given me a greater appreciation of Lola’s communication skills."
Chronically Frustrated Babies May Refuse to Breastfeed
If the milk flow situation becomes chronically frustrating to the baby, he may refuse to breastfeed because he does not feel successful. Sometimes using special feeding devices such as the Lact-Aid® or the Supplemental Feeding System™ (SNS) ™ by Medela can help the baby feel successful while the underlying problems are addressed.
Recognizing the importance of milk flow to your baby and discovering his preferred milk flow can help you and you baby tailor the breastfeeding relationship. Tuning in to your baby’s body language as it relates to milk flow can help you discover new ways of communicating with your baby. What a great adventure that is!
Recognizing the importance of milk flow to your baby and discovering his preferred milk flow can help you and you baby tailor the breastfeeding relationship. Tuning in to your baby’s body language as it relates to milk flow can help you discover new ways of communicating with your baby. What a great adventure that is!