Increasing the Flow

In the early days and weeks newborns can sometimes seem very sleepy at the breast. They might latch and then very quickly relax and fall asleep again, suckling gently.

If this is happening most feeds within about 5 minutes then have a chat with your IBCLC or other breastfeeding professional to assess and decide whether your baby is getting enough milk.

Some babies are very reliant on a faster flow of milk to stimulate them to feed actively. When the milk flow is slower (very normal with colostrum!) they seem quite happy just to nibble away with very few swallows. In this situation we can help keep then active for longer and 'draining' the breast more effectively.

If you're not sure what the difference between a suck and a swallow looks like, have an explore of this playlist of videos which has some excellent examples.

Very simplistically: The lactating breast or chest contains hundreds of milk making alvioli connected by a network of very fine ducts to the nipple. Muscle-like fibres contract in response to the hormone oxytocin, squash the alvioli and propel the milk towards the nipple (the milk ejection reflex, or letdown). The milk-making cells around the edge of the alvioli are constantly dripping more milk into the central 'storage' area so you will never truely be 'empty' (you are a factory, not a warehouse!). Milk is made faster when the central area is less full and slows at it becomes 'full'

It isn't unusual, though, for the milk to flow more slowly after the initial 'milk ejection reflex' and this is where babies can sometimes seem to lose interest, become more passive and sometimes fall back to sleep.

Breast Compressions

One very useful set of tools in this situation are breast compressions. Breast compressions seem to increase the flow of the milk and can often stimulate a reluctant baby to feed more actively and efficiently. Better removal of milk will also help support or increase your supply.

  1. Watch your baby carefully and notice when their initial sucks turn to swallowing in response to your milk ejection reflex (some people can also feel a tingly sensation when this happens). You don't need to interfere at this point, your baby is doing a great job.

  2. When you see that they are doing many more sucks than swallows you can add in some breast compressions to help them. There are a number of ways to do this but you could start by using the flat of your hand towards the top of your breast or chest, far enough away that you don't disturb your baby's latch. Press firmly down and keep the pressure there while they are suckling. You should quickly see a response and them become more active.

  3. When your baby takes a pause you can release the pressure and move your hand to a different area if you would like (targeting the 'full' feeling areas can be helpful). Apply the pressure again when your baby starts to suck or when you feel that the pause may be going on too long.

  4. Some people prefer to apply the pressure with their hand in more of a c-shape (second image below), it is really personal preference and you can use a combination of both.

5. You can continue with the breast compressions until your your baby shows you they would like a slower flow to help them to sleep (they may seem more wriggly and unsettled when you increase the flow) or until the compressions stop making any difference

Switch Feeding

If the compressions have stopped making any difference but your baby still needs more milk you could try switch feeding where you change breasts numerous times during a feed. In this process the 'resting breast' will be collecting milk droplets in the storage areas which will result in a faster flow when you switch back to it. The bursts of faster flow when you switch can often encourage a newborn to be more active. Switch nursing is also extremely good for optimising milk supply - but should only be used when actually needed.

  1. Start nursing on breast A allowing your baby to elicit the milk ejection reflex (letdown). Once they are only swallowing ever 2/3sucks or more introduce breast compressions as above.

  2. Once the breast compressions stop being effective switch to breast B and repeat the process: let your baby try themselves; introduce breast compressions; then switch when they no longer work.

  3. You can switch breasts as many times as needed during a feed (6/8 times+ even).

Again, switch nursing should only be used in situations where it is needed and should be in consultation with your IBCLC or other breastfeeding professional. They will help you to carefully monitor your baby's wellbeing to ensure that they are getting all the milk they need.

Over time, as your supply increases or your baby becomes more active, you will find that the number of times you need to switch naturally gradually reduces and you also need breast compressions less often. If that isn't the case then do seek further support.

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