When does breast milk come in?
There were many surprises in the first few days after I gave birth to my daughter Sophie—like the sheer volume of laundry generated by such a tiny person and the constant ache down in Ladyland—but nothing was more unexpected than the amount of time it took for my milk to come in. I’d read that it takes, on average, three to five days. But no one really told me what you’re supposed to do to feed and comfort your baby in the meantime. And friends had said, “Oh, you’ll know” when I asked them about the signs of milk production ramping up: from the weight of your breasts, the human firehose superpower you acquire, or feeling weepy or unusually emotional. (One friend told me she started crying inexplicably while watching The Price Is Right, and within hours—bam!—her boobs felt like basketballs.) But I kept waiting anxiously and nothing—or what felt like nothing—happened.
Turns out, this is fairly typical. For the first few days, newborns want to sleep a lot and can survive solely on teeny drops of colostrum, the yellowish fluid your breasts produce after the baby is born (and sometimes even in the last weeks of pregnancy). It’s often termed “liquid gold” for being so dense in nutrients and antibodies, despite being low in volume. Infants only need a few teaspoons (six to 13 millilitres) per feeding until your milk production begins.
The nurses in the hospital told me to feed every two hours, even if I didn’t think Sophie was getting anything, because the more she suckled, the faster colostrum would give way to milk. While this is great advice—it’s a supply-and-demand process—it was easily the most frustrating part of the newborn days for me. Little Sophie had a weak latch and struggled to get the mechanics down (blame my inverted nipples), which in turn meant the milk was slow to come. She was hungry (and angry!) and not gaining enough weight, and I was getting desperate.
Finally, on day four, at my sister-in-law’s urging, I visited Mount Sinai Hospital’s Breastfeeding Centre, in Toronto, and an amazing lactation consultant showed me how to hand-express milk properly. (Am I the only one who thought it involved the nipple?! It doesn’t. It’s more about the areola.) In each session, I got enough colostrum or milk to feed my wee Soph a few drops at a time, with a tiny medicine syringe. We worked on nursing, too, but at least this way I was able to keep her satisfied when things didn’t go well at the breast.
Lactation consultant Nancy Harmon, of Good Latch Breastfeeding Support Services in Halifax, says this was solid advice. “I recommend finger-feeding expressed milk, but the syringe wasn’t a bad idea,” she says. “With a few drops of milk placed on your finger, the baby will have to use her mouth in a similar way to nursing to get the milk. It’s more instinctive.” Harmon also agrees hand expression is an important skill for new mothers to master. “Pumping is fine, too, but not everyone has a pump. It can also be hard on tender nipples. Hand expression allows the mother to be as gentle as she needs to be.”
By the sixth day of Sophie’s life, we were finally in business. I could feel the fullness of my breasts, I could tell she was satiated, and eventually, we were able to stop the syringe feeding. For the duration of the time I nursed her, I had to use a nipple shield, but we persevered for seven months (until my milk supply couldn’t keep up with the demand and we had to supplement with formula).
How do I know if my newborn isn’t getting enough milk?
Even if a little one latches well from birth, some women may not make enough milk to nourish a growing newborn, says Harmon. Watch for signs of dehydration (a sunken soft spot on the skull, dry mouth and decrease in wet diapers are the chief indicators). Newborns should regain their birth weight within 10 to 14 days (after losing weight in the early days). If you’re at all concerned—or just want to be reassured—check in with your doctor or midwife, your baby’s paediatrician, a lactation consultant or a public health nurse.
If you truly have a diagnosable milk production issue, a doctor may prescribe a medication called domperidone, which boosts prolactin produced by the pituitary gland. There are also some home remedies that can boost your supply. While you’re waiting for the magic of milk to happen, don’t hesitate to accept help, and consider finding a local breastfeeding clinic or scheduling an in-home lactation consultant visit. Reach out to other moms, too—you don’t have to wait alone.
How to treat your sore nipples
If regular lanolin isn’t cutting it, ask your doctor about a prescription for Dr. Jack Newman’s All Purpose Nipple Ointment (a.k.a. APNO). The miracle recipe is 2 percent mupirocin ointment (15 grams), 0.1 percent betamethasone ointment (15 grams) and 2 percent miconazole powder.