Enabling women to breastfeed with confidence

While parents and health professionals should have confidence that exclusively breastfed infants are receiving sufficient breastmilk if they are showing steady growth, are generally alert and are producing wet and dirty nappies, this is not always the case. The most common reason cited by mothers for ceasing exclusive breastfeeding is a perception of insufficient milk supply. 

According to Jacqueline Kent, from the Hartmann Human Lactation Research Group at the University of Western Australia, this perception is based on the mother feeling that her infant is not satisfied after breastfeeds, her concern that her infant is not attached and sucking well during breastfeeding, and/or that her infant is feeding too often or too quickly. 

Recent data from Dr Kent’s research group indicate that more than half of all the mothers seeking assistance at the Breast Feeding Centre of Western Australia were concerned about the frequency of their infants’ breastfeeds, or about the time taken for each breastfeed, and almost half of these mothers seeking professional assistance were not confident about their milk supply. This loss of confidence can lead to them weaning from the breast early and unnecessarily. 

Speaking in London at Medela’s Breastfeeding and Lactation Symposium earlier this year, Dr Kent stated that these perceptions can either be validated or shown to be inaccurate by using objective measurements. 

“Objective measurements can help to confirm or refute a perception of insufficient milk supply, but when there is a perception of insufficient milk supply or oversupply, objective measurement of milk supply is rarely made. 

“Every other biological function we have, we measure. The doctor doesn’t just look at us and say, ‘I think you’re okay’. We measure. If we’re concerned about blood pressure, we measure the blood pressure and compare that to a reference range. If we are within the reference range, we are happy. If we’re not in the reference range, then we find out what is wrong and we do something about it,” she said.

Dr Kent believes that breastfeeding concerns should be approached in the same way as any other health concern in order to reassure mothers who lose confidence that their baby is getting enough milk. 

“The same should apply to breastfeeding parameters. So, for breastfeeding mothers: how often should they or do they feed their infants; how long does the infant spend feeding; how much milk is transferred each time; and how much milk is transferred for the whole day?”

According to Dr Kent, by answering these questions you will obtain an objective measure of the mother’s milk supply.

“An objective assessment of milk supply can be made when a mother measures her 24-hour milk profile. This involves the mother using accurate digital scales at home to weigh her fully-clothed infant before and after every breastfeed for a 24-26-hour period,” she said. 

To enter the data gathered, mothers taking part in Dr Kent’s research, use a smartphone link to a secure website. They choose whether it’s a breastfeed or an expression, indicate whether it was the left or right breast, and then enter the weight of the baby before and after the feed. 

Dr Kent explained that this requires minimal interference in the infant’s normal feeding and allows calculation of the frequency and duration of feeds, the amount of milk transferred during each breastfeed, and therefore the total milk intake over a day. 

While a comparison of individual data with a reference range could establish whether the breastfeeding parameters are within normal limits, the problem remains that there is currently no established reference range for these parameters. Dr Kent and her team used the 24-hour milk profile technique to gather data from 71 mothers who were exclusively breastfeeding healthy term infants one to six months old. 

“These data demonstrated very wide ranges among normal dyads, but further data are needed to create a well-established reference range. We now have data from 212 healthy, term breastfeeding dyads. The central 95% values are: six to 17 breastfeeds per day, six to 24 minutes per breastfeed, 32-131ml per breastfeed, and 528-1,116ml breast milk intake per day. 

If there is a transfer of less than 550ml a day, Dr Kent said this warranted the baby being checked for normal growth. 

“If there’s anything of concern, we’d try to get milk production to come up a little bit, whether the mom needs to pump a bit more to increase supply, whether she needs to introduce an extra feed, it might be too long between feeds. She might need to do something else to increase her milk, such as adjustment of the positioning and attachment, which can make the transfer more effective,” she said.

Dr Kent said that the message for health professionals is not to try to force every mother and baby to be average, but to allow them to be individuals. So while some babies will feed 12 times a day, or more, and some only six, the only thing that matters is that they get adequate milk for healthy growth.