Hands holding a small knitted newborn hat near a window
Woman breastfeeding infant on sofa, tender embrace, blue cushion

How milk production works: supply and demand

  • Your breasts begin making colostrum during pregnancy.
  • After your baby is born and the placenta is delivered, changing hormones tell your breasts to begin making more milk.
  • During the first few days, frequent breastfeeding helps get milk production off to a strong start.
  • Breast milk is made through supply and demand. This means your breasts respond to how often and how well milk is removed.
  • When your baby breastfeeds, nerves in your breast send signals to your brain.
  • Your brain releases prolactin, a hormone that helps make milk.
  • Your brain also releases oxytocin, a hormone that helps milk flow. This is called the milk-ejection reflex or “let-down.”
  • Frequent and effective milk removal tells your breasts to continue making milk.
  • When milk is removed less often, your breasts may begin making less milk.
  • Follow your baby’s feeding cues and offer the breast often, especially during the early weeks.
  • If your baby receives a bottle and you want to maintain your milk supply, try to pump or hand express around the time of the missed breastfeeding.
  • Each breast responds separately. A baby who feeds more from one breast may cause that breast to make more milk.
  • Your breasts are always making milk and are never completely empty.
  • As milk production adjusts to your baby’s needs, your breasts may feel softer. Softer breasts do not necessarily mean that you have less milk.
  • Milk production is different for every parent. Ask a lactation professional or healthcare provider for help if you are concerned.

How hormones help make milk

 

Sketch: mother nursing baby with diagram of hypothalamus-pituitary releasing prolactin and oxytocin

 

When your baby sucks at the breast, nerves send a message to your brain. Your brain releases prolactin, which helps make milk, and oxytocin, which helps milk flow to your baby.

How milk removal guides supply

Medical illustration: breast cross-section showing purple lobules, yellow fat, and chest muscle

Milk is made in tiny sacs in the breast called alveoli. When milk is removed often and effectively, the alveoli receive a signal to keep making milk. When milk stays in the breast for longer periods, milk production begins to slow.

Following your baby's cues

  • Early cues: stirring, bringing hands to the mouth, opening the mouth, and rooting
  • Active cues: stretching, increased movement, and searching for the breast
  • Crying as a late hunger cue
  • Signs of fullness: slower sucking, releasing the breast, relaxed hands and body, or turning away
  • Offering the breast responsively rather than following a rigid schedule
  • Expecting at least 8–12 feeds in 24 hours during the early weeks, with periods of cluster feeding

Your baby's cries are their way of trying to tell you something. But figuring out what your baby needs when they're upset can be a challenge. All cries sound basically the same... but there is a way to figure out what they need. In this video you'll learn how to decode your baby's cries to understand what they need so you can soothe them as quickly as possible. This video was created by Emma Hubbard at www.brightestbeginning.com

Establishing and maintaining your milk supply

  • Hold your baby skin-to-skin and begin breastfeeding as soon as possible after birth.
  • Follow your baby’s feeding cues instead of waiting for a set feeding time.
  • During the first few weeks, most babies breastfeed 8–12 or more times in 24 hours.
  • At times, your baby may want to breastfeed many times close together. This is called cluster feeding. It is common, especially during the early weeks.
  • Breastfeed during the day and at night. Night feedings help support early milk production.
  • Make sure your baby has a deep latch and is swallowing milk.
  • Let your baby continue feeding while they are actively sucking and swallowing.
  • Offer the second breast, but let your baby decide whether they want it.
  • Keep your baby close so you can notice early feeding cues.
  • If you are separated from your baby or your baby cannot feed well, pump or hand express as often as your baby would normally breastfeed.
  • If your baby receives a bottle and you want to maintain your supply, try to express milk around the time of that feeding.
  • Avoid extra pumping to “empty” your breasts when it is not needed. This can cause your body to make too much milk.
  • Eat regularly, drink when you are thirsty, and rest when you can. No special food or drink is proven to create a full milk supply.
  • Ask for help early if breastfeeding is painful, your baby is not swallowing, diaper output is low, or you are worried about your baby’s weight.
YouTube thumbnail showing baby breastfeeding with caregiver and play button

Most lactating parents are able to provide their babies with all the milk they need. However, if a baby is not thriving as expected, this video shows the how a mother improves her milk supply and the baby’s feeding. Source: Global Health Media Project. 

What is hand expression?

 

  • Hand expression means using your hand to gently remove milk from your breast.
  • It is a simple skill that does not require a breast pump or other special equipment.
  • During the first days after birth, hand expression may work better than a pump for collecting small drops of colostrum.
  • Hand expression can help protect your milk supply if your baby is sleepy, has trouble latching, or cannot breastfeed.
  • It can also soften a very full breast and make it easier for your baby to latch.

Hand expression is free, and does not require any equipment. Watch this video to learn how to hand express. Source: First Droplets. 

How to hand express

  1. Begin by washing your hands and using a clean container to collect the milk.
  2. Place your thumb and fingers around the breast, about 1–2 inches behind the nipple.
  3. Gently press your fingers back toward your chest, compress them together, and then release.
  4. Repeat this motion in a steady rhythm. Avoid pulling or sliding your fingers across the skin.
  5. Move your fingers around the breast to remove milk from different areas.
  6. Hand expression should not hurt. Use gentle pressure and ask for help if it is painful.
  7. It may take practice, and seeing only a few drops of colostrum at first is normal.
Hands holding crocheted breast model, squeezing milk into glass jar

Did you know?

Expressing breast milk by hand is an important skill for lactating women to learn, especially in case of an emergency. Click on the link to learn the steps to hand express your milk. Source: Centers for Disease Control and Prevention (CDC).