Hírolvasó

“I’ve heard that milk production can drop when I get my period. Is that true? Does that mean I won’t have enough milk for my baby?” Concerns about milk production top the “worry list” for many new parents. [1] Among these worries is whether the return of the menses will affect milk production. But keep in mind that for the vast majority of parents, milk production is a hardy process. Until about 150 years ago, our species’ survival depended on it. Before the 1880s, there was no safe substitute for human milk, and many babies who were not nursed did not survive. If milk-making was so fragile and easily disrupted, the human race would not have thrived. For many parents, an effective antidote to these worries is the empowerment that comes with a basic understanding of milk-making dynamics and how their own actions affect milk production.

How Milk Production Works

After birth, many new families mistakenly believe that healthy milk production is either there or it’s not there. While some lactating parents are naturally bigger milk producers than others, the most influential factor in the volume of milk made is what parents (and babies) do or don’t do. And that’s a good thing. While not every challenge can be overcome, it can be reassuring to know that many strategies are available to both prevent and address milk-production issues.   

What dynamics are most important to know? “Drained glands make milk faster” is one critical dynamic. [2] The breasts consist in part of glands, where with stimulation milk is made. For the lion’s share of nursing parents, more milk removals per day, either by nursing or milk expression, is the key to healthy milk production. The more times each day the milk is removed and the more fully it’s removed, the faster milk is produced. That’s how parents of multiples produce enough milk for twins and triplets. (And they do!) We even have recorded cases of parents producing enough milk for quadruplets. [3] How do they do it? They nurse their babies around the clock whenever their little ones show feeding cues (rooting, hand-to-mouth, fussing). Very frequent nursing (or pumping) gives their body the signal to keep making milk faster.

The opposite is also true: “Full glands make milk slower.” When parents replace nursing or milk expression sessions with formula (or even expressed milk from their freezer stash), the milk that accumulates in their glands sends their body the signal to make milk slower. Many new parents are unaware that feeding formula without pumping can decrease their milk production. [4] Sadly, some families find that as they supplement with formula more and more and stimulate their glands less and less, milk production slows and more supplements are needed.   

It is also common during the early weeks for families unfamiliar with nursing norms to misinterpret their baby’s normal feeding behaviors. Because their baby wants to nurse again soon after feeding (nature’s way of stimulating faster milk production), they erroneously believe this is a sign they don’t have enough milk. Newborns often bunch their feeds together (“cluster nurse”) during some parts of the day. This does not mean milk production is low. (Whatever the baby’s behavior, the expected weight gain is proof positive of ample milk production.)

Nursing and Fertility

In addition to affecting rate of milk production, nursing frequency also affects fertility. Due to the hormones released when baby nurses, in general, more frequent nursing leads to longer periods of infertility after birth. But each person’s biochemistry is unique, so the effect of nursing on fertility varies from person to person.

What’s average? When parents exclusively nurse from birth, gradually introduce solid foods around 6 months, and continue night feeds, some estimate that on average return of the menses occurs at around 1 year. However, if the lactating parent is not directly nursing at all feeds (even if expressed milk is given), solids are introduced earlier than 6 months, or the baby does not nurse at night, earlier return of menses is likely. [5]

During the nearly 40 years I’ve helped nursing families, I’ve seen a range of experiences. Some exclusively nursing parents begin menstruating as early as 6 weeks after birth, while others (myself included) go as long as 2 years before their first post-birth period. When nursing intensity is similar, this variation in body response is due to individual differences in biochemistry. After 6 months, the more time that passes before the first period, the more likely it is that ovulation will occur before the menses begin. [6] This means, of course, that it is possible to become pregnant before the first period.

Dips in Milk Production During the Menstrual Cycle

Many parents do not experience slowed milk production during their menstrual cycle, so this is another example of individual differences. Keep in mind that sometimes the return of the menses is a symptom of fewer daily milk removals, which also causes a slowing of milk production. In other words, rather than the menses causing slowed milk production, nursing or pumping fewer times per day may be the root cause of both the period returning and slowed milk production.  

What are signs of a decrease in milk production? Definitely an unexpected slowing of the baby’s weight gain. Are there other signs? Yes, but these may have other causes. A baby who was happily going for hours between feeds may suddenly revert back to the feeding frenzies (cluster nursing) common in newborns. Baby may want to nurse again within a few minutes or even all evening. But other factors—such as teething pain and illness—may cause these behaviors, too. If the number of milk removals per day dropped within the last few weeks (is baby sleeping longer at night?), this may cause slowed milk production, too. The overlap of this behavior with the menstrual cycle is sometimes coincidental.

Boosting Milk Production

Should slowed milk production cause panic? No. It’s helpful to know that at an average nursing session, babies only take only about two thirds of the milk available in the gland. [2] Nursing longer, more often, or even continuously gives a baby access to lots more milk. (Nature builds in a milk reserve.) Just keep moving baby back and forth from side to side until he is done. Think of the glands as fountains continuously producing milk rather than a container that can be emptied. Responding to baby’s cues to feed more often or longer not only provides the baby with more milk; it also stimulates faster milk production, quickly returning it to its previous level. Most likely, within a couple of days, baby will return to his normal feeding pattern. Giving formula or previously pumped milk, on the other hand, does NOT send the body the signal to make milk faster. When in doubt, take baby for a weight check. With a healthy weight gain, ample milk production is a given. In this case, another cause is responsible for baby’s change in behavior.

What is it about the menstrual cycle that causes some parents to experience a small but temporary slowing of milk production? After ovulation, blood levels of estrogen and progesterone rise and calcium levels fall. [7] For some, higher estrogen levels are associated with decreased milk production, [8] but to have this effect,  estrogen levels usually need to be much higher than the levels measured after ovulation.   

For parents who experience a noticeable slowing of milk production related to their menstrual cycle, taking a calcium/magnesium supplement may help. U.S. lactation consultants Lisa Marasco and Diana West suggest this in their 2020 book for parents,  Making More Milk. [9] (Its comprehensive second edition describes what is currently known about every aspect of milk production.) Although at this writing we have no research on the impact of taking calcium/magnesium supplements on milk production during the menstrual cycle, some report good results. These authors suggest taking between 500 mg calcium/250 mg magnesium and 1000 mg calcium/500 mg magnesium starting 3 days before an expected period and continuing it for the first 3 days after bleeding begins. They say some see results within 24 hours. 

The key point to remember is that for most families, milk production is extremely resilient. By taking advantage of frequent nursing and/or milk expression, even if milk-making slows in the short term, baby can usually get the milk she needs by simply nursing longer and more often. With this extra stimulation, milk production usually quickly rebounds to previous levels.

References

1 Morrison, A.., Gentry, R., & Anderson, J. (2019). Mothers’ reasons for early breastfeeding cessation. MCN: American Journal of Maternal/Child Nursing, 44(6):325-330.

2 Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women’s Health, 52(6), 564-570.

3 Berlin, C. M. (2007). “Exclusive” breastfeeding of quadruplets. Breastfeeding Medicine, 2(2), 125-126.

4 DaMota, K., Banuelos, J., Goldbronn, J., et al. (2012). Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women. Journal of Human Lactation, 28(4), 476-482.

5 Labbok, M. H. (2015). Postpartum sexuality and the Lactational Amenorrhea Method for contraception. Clinical Obstetrics and Gynecology, 58(4), 915-927.

6 Lewis, P. R., Brown, J. B., Renfree, M. B., et al. (1991). The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time. Fertility and Sterility, 55(3), 529-536.

7 Dullo P, Vedi N. (2008). Changes in serum calcium, magnesium and inorganic phosphorus levels during different phases of the menstrual cycle. Journal of Human Reproductive Sciences, 1(2):77-80.

8 Oladapo, O. T., & Fawole, B. (2012). Treatments for suppression of lactation. Cochrane Database of Systematic Reviews(9), CD005937. doi:10.1002/14651858. CD005937.pub3.

9 Marasco, L., & West, D. (2020). Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production (2nd ed.). New York, NY: M

When a baby makes clicking sounds while nursing, parents often worry. Is this a sign of a major problem? Should they be concerned? No matter what the cause, if nursing is comfortable, baby is otherwise healthy and gaining weight normally, clicking may not be a problem.  

Common Reasons for Clicking

Most often, babies click at some feeds but not at others, which is not necessarily of concern. It may be a sign of a slightly shallow latch, which may cause baby to slip as she attempts to keep the nipple in her mouth. If clicking does not occur consistently, notice if it happens more often in one feeding position than another.  In this case, taking special care to ensure baby gets a deep latch may be enough to reduce clicking.

Does clicking always indicate broken suction? No. There are other reasons for clicking. A very fast milk flow, for example, may trigger clicking as baby quickly swallows large volumes of milk. (When this is the cause, you probably hear the clicking only at the beginning of a feed as your milk lets down and not as much near the end.) If the baby seems otherwise fine, this is not a cause for concern. If baby struggles with the milk flow, though, try feeding positions in which baby nurses tummy down (see photo), which gives baby more control over milk flow. 

Baby’s Palate, Throat, and Unsolved Mysteries

Aspects of a baby’s palate (roof of her mouth) may cause clicking. One example is the baby whose palate moves abnormally during feeds or is unusually high or has a bubble shape. Clicking during nursing may also happen in babies with a cleft—or opening—in their palate. Some clefts are not obvious, because they are located under a layer of skin (submucous clefts). Floppy skin in baby’s throat (specifically the larynx or pharynx) is another possible cause of clicking sounds during nursing.1 In this case, parents may hear clicking more often at inhale or exhale. If one of these anatomical issues is the cause, clicking would likely happen at most if not all nursing sessions. But changing feeding positions may reduce clicking.

Some parents never find the reason for the clicking. One mother told me her little girl always clicked, whether she was nursing or drinking from a cup. This mother simply attributed the clicking—which resolved after her daughter started kindergarten—to her being a “noisy eater.” 

Frequent Broken Suction and Clicking

If broken suction causes regular clicking during feeds, this may repeatedly interrupt nursing. In this case, the baby may latch on and off frequently during feeds and may have difficulty nursing contentedly. Every nursing session may feel like a struggle. Or the baby may have unusually long pauses and spend time sleeping during most feeds. 

Tongue-tie and Clicking

Tongue-tie (an oral variation that restricts tongue movements) is one of the many possible causes of clicking during nursing. In a tongue-tied baby, this sound may occur as the tongue snaps back with each suck. Keep in mind, though, that as one review article concluded,2 at most only about half of babies identified as tongue-tied have nursing problems. In other words, if a clicking baby with a tongue-tie is gaining weight well, otherwise feeding normally, and the nursing parent is comfortable, this is not necessarily a problem and no action may be necessary.

Among the 50% of tongue-tied babies who do have difficulty nursing, tongue movements are so restricted by the membrane connecting the tongue to the floor of baby’s mouth (the lingual frenulum) that the baby may struggle to latch and stay latched. Other problems common in this situation include nipple pain, weight-gain issues, and constant nursing. Any baby who repeatedly breaks suction during nursing at most or all feeds should be checked for tongue-tie, because this may affect the baby’s ability to transfer milk. In one Brazilian prospective longitudinal study of 109 babies, 14 with nursing problems related to tongue-tie and 95 controls,3 the researchers reported that 64% of the tongue-tied babies with feeding problems made clicking sounds during nursing as compared with 14% of the control babies.  

Where to Seek Help

If your clicking baby also has nursing problems, such as slow weight gain, latching struggles, or you are in pain, it’s time to seek skilled lactation help. To find someone in your area, contact your birthing facility or your baby’s healthcare provider and ask for a recommendation. If your baby is doing well but you’re still feeling uneasy about the clicking, consider having baby checked by a pediatric ear-nose-and-throat doctor (ENT). ENTs are specialists trained to evaluate oral issues. In some areas, pediatric dentists have the training to evaluate issues like these.

Keep in mind that the most important thing is how your baby is doing. If she is healthy and gaining weight normally, regular clicking may simply be a sign of an oral variation and may not ultimately be a cause for concern. 

References

1 Genna, C. W. (2017). The influence of anatomic and structural issues on sucking skills. In C. W. Genna (Ed.), Supporting Sucking Skills in Breastfeeding Infants (3rd ed., pp. 209-267). Burlington, MA: Jones & Bartlett Learning. 

2 Power, R. F., & Murphy, J. F. (2015). Tongue-tie and frenotomy in infants with breastfeeding difficulties: Achieving a balance. Archives of Disease in Childhood, 100(5), 489-494. 

3 Martinelli, R. L., Marchesan, I. Q., Gusmao, R. J., et al. (2015). The effects of frenotomy on breastfeeding. Journal of Applied Oral Science, 23(2), 153-157.