“Do I have enough breast milk?” If you’re a breastfeeding mother, chances are good you’ve wondered this at least once. In fact, it’s one of the most common questions that breastfeeding moms ask, and one of the most constant worries. So it’s a very important question to know the answer to!
So how do I know whether my milk supply is adequate?
Even though we can’t measure breast milk intake precisely, there are other ways to make sure that baby is getting enough milk. In fact, can I tell you a secret? Measuring exactly how many millilitres of milk baby drinks is not particularly useful. There’s a wide variability in the volume of breast milk a baby needs to thrive, because each baby is different and each woman’s milk is different (even milk form the same woman at different times of the day can be very different!). Even when I work as a dietitian, and I prescribe specific volumes of expressed breast milk, I know my prescription is at best and educated guess – I monitor the exact same things I describe below and increase or decrease the volume of feeds based on that.
So what do I need to monitor, I hear you ask? Here goes:
Reliable signs that you have enough breast milk
1. Watch baby swallowing
This first sign is the simplest and perhaps the most important: can you see baby swallowing? If baby is breastfeeding and you can hear or see him swallowing (usually every 1-3 sucks), it means he’s getting milk. So right away you know there’s milk in the breast and baby’s getting it out effectively. This is especially reassuring in the first few days when you have only colostrum, or at any time when your breasts feel soft and empty.
2. Diaper output
The easiest thing to monitor at home is how many nappies baby has. The logic goes like this: what goes in must come out; so if there’s plenty coming out, it means there was plenty going in! By the time baby is about a week old, you only need to ask two things:
- Does baby have at least 3 poops the size of a R5 coin or larger every day? (this only works for the first 4-6 weeks; after that, poop can get a lot less, even as little as once in two weeks!)
- Does baby have at least 6 wet nappies a day? Now, modern disposable nappies can make this pretty tricky to judge, since they absorb a LOT of urine (I mean, some of those things can stay on for 8 hours and still feel dry!) If you can feel some squishy “gel” inside the nappy, it’s wet, even if the surface feels dry. Put two tablespoons of water on a dry nappy, let it absorb and feel how it feels, so that you have an idea of what you can count as wet. You can also count any dirty nappy as being wet. Urine should be very pale yellow or colourless. Your baby will continue to have at least 6 wet nappies a day until potty training, so it’s a useful thing to keep an eye on.
These two things are not absolutely 100% foolproof, but if you can answer yes to both questions, then baby is almost always getting enough milk. (Please note though that the diapers in the first week or so will look rather different – that’s a story for another post!)
3. Weight gain
The most reliable way to make sure your baby is getting enough milk is to make sure he’s gaining enough weight. But be careful! For weight measurements to be accurate, there are a few things to look out for:
- Baby must always be weighed naked. Always. Otherwise, how do you know how much of that weight is the baby and how much is the clothes? And please note, wearing a dry diaper is not naked. Some clinics are very lazy to undress babies, because it takes more time, but you should insist on it.
- You should only use a baby scale, and preferably an electronic one. My experience has taught me that most people do not use the mechanical (non-electronic) scales accurately enough to give you a meaningful reading.
- Only weights taken on the same set of scales can really be compared to each other. I’ve found as much as a kilogram (!!) difference between two scales on the same day! So always have baby weighed at the same place.
In terms of the amount of weight a baby should gain, there’s a lot of different guidelines out there. The most reliable ones (and the only one I would use) are the WHO growth charts (you can find them on the web here). These growth charts show the way a breastfed baby is supposed to grow. Most of the other charts are based on formula-fed babies and they are not appropriate for a breastfed baby (the chart in the South African Road to Health Booklet is based on the WHO chart, so that one is okay to use). If your baby is gaining weight so that her growth curve is running parallel to the curve on the chart (doesn’t matter whether she’s above or below it), all is well. If you want some more details on how to read a growth chart, check out this post.
Also remember that all babies lose some weight in the first few days of life – up to 10% of their birth weight. This is nothing to be concerned about, as long as baby is at least back up to birth weight by day 14.
And a final caveat: premature and low birth weight babies have their own way of growing. They often lose more weigh in the beginning and gain more slowly. You can’t judge a premie by a normal growth chart; they have their own special guidelines.
4. The bigger picture
This is where your mommy instincts come in. Just look at your baby: does she look healthy? Is she content at least some of the time? Is she alert, waking up for feeds on her own? Is she growing out of her clothes and getting creases at her wrists? Are her eyes shining and bright? Is she hitting her developmental milestones? If so, your baby is thriving, and you probably have nothing to worry about!
And that’s it!
That’s really all you need to monitor to know that your baby is getting enough milk. If baby is happy, healthy and growing and the diaper output is good, your milk supply is not a problem. It helps to keep this very, very firmly in your mind – because before long, someone will ask you something to make you doubt your milk supply! That’s why, in the this post, I explain all those “false alarms” that may make you doubt your milk supply, but that are actually not the right things to look at.