The milk coming in
For some women, the milk coming in was not a memorable event. They experienced a smooth transition from the colostrum of the first breastfeed to their full milk supply, with little or no discomfort. Several of these women spoke of a night where the baby just fed constantly and then the milk seemed to be there the next day.
On the third night in hospital she had a special night of skin-to-skin contact with her baby and...
Just the, recognition that this is it, this is reality now'
'this is your baby'
'and this is us and'
'time without interruptions without other people, the quiet of the night.
I think that's because there had been two other girls in the ward, it's a four bed ward, there had been two other girls in the ward, and this, but this was the first night that it was just me and my baby, and it was lovely.
And the next day your milk came in?
The next day I went home and, and it seemed that, that my milk had come in, people had said, 'Oh you'll feel your milk coming in it tingles and your, your breasts grow really hard and it's sore' and this and that and, well maybe it was but I'd either didn't know what I was looking for or it wasn't sore or, there was just too many other things going on for me to notice.
So, it was just a natural progression for you in fact it wasn't a momentous event?
No not at all, it was only when he was feeding and I could see milk leaking down his mouth I was thinking, "Okay there's milk there now' [laughs].
Do you think this might be a consequence of having just fed for that whole night that it just all flowed through smoothly?
It could be but I'll never know will I?
Well you might with another [laughs].
Well [laughs] yeah, [mm-hm].
She fed her son frequently after her caesarean section and does not remember her milk coming in....
So you have no idea how many days after the'
No, it just, he just fed and fed and fed and he was fine so we were happy.
So you didn't notice a change from?
It wasn't dramatic?
Because he was, he was feeding so well.
How often do you think he was feeding at that stage?
About every two and a half hours, I was trying to write it down and they, you know they're so keen on knowing how long you were feeding for and at what times, and I think if I went back to it again I could forget that throw the piece of paper out the window you know? Go away I know what I'm doing [laughs] I'm a mother, I wouldn't do that now, no way, I did it with my daughter but that's because of the medical problems she had with a normal baby there's no way I'd do that now as long as they're growing properly, it's all you need to know.
On the other hand, many women spoke in dramatic terms of the changes to their body and the milk coming in. They talked about their breasts as a “different landscape”, baseballs, melons and balloons. Their breasts became larger, firmer, very warm and sore. One woman said,
“I can remember the feelings and … wondering what was happening and being very aware of my breasts at this time, and the fact that they seemed to have grown and they seemed to have taken on a life of their own and they were dictating what was happening rather than me … It took me a few days to learn that actually my daughter, was in control, not me or my breasts, it was my daughter who was sort of dictating what was happening there”.
A few women talked about having to learn to attach their baby all over again when their full milk came in.
She learned to attach her baby when she had colostrum but then they both had to learn again on...
How did you feel about the breastfeeding by the time you came out?
It's a funny stage those first few days because you can learn to breastfeed very well when it's just colostrum, and, the midwives and maternity care assistants were very practical and hands on in their help and they often would even put the nipple into the baby's mouth but that style of feeding doesn't necessarily work well when the milk comes in and I think the transition from colostrum to, to full milk is, is very difficult I struggled with it a bit with my first child.
What sort of things are you talking about?
I think the breasts become very full, very hard and quite painful and the babies have gone from learning to feed on a very soft, quite small breast to suddenly being faced with a rock melon and for them latching on is very difficult so the babies often kind of bounce back from the breast and the overflow of milk is unbelievable, so I did a lot of hand expressing, particularly with the twins because having two stimulating the breasts made the problem even worse, so my milk kept, came in but kept coming in for several days and I used hot towels to squeeze the milk out, poured masses of milk down the drain before I fed them for the first few days and I was quite pleased to manage that in hospital this time, I think coming home before the milk comes in is quite difficult, because you're left on your own trying to relearn how to feed the babies and I think you have to be even more careful about your technique once the milk comes in. It's a different ball game once you've got full milk, you just have to work that bit harder at, positioning them correctly and holding them still but we, we managed [laughs].
The first time she had engorgement she expressed and had an abundant milk supply, the second time...
Did you take any painkillers or anything for that pain?
Painkillers? I didn't no, I didn't because I didn't think to, once I'd got I realised I could express milk which I didn't, you know, everything else that's going on new baby once I realised I could express the problem, the problem was okay. And I again it was at the local birthing unit that I had baby number three very, very quickly I hasten to add, I think she was fifty minutes from start to finish and the mid, the midwife had just turned up just in time to break my waters for me so that she could be born which was quite scary. Completely different birth, a very intense, birth, very, very quick and very sudden, not relaxed at all after the baby was born she was kind of, it was sort of, it wasn't the same ambience, the lights in the room were bright and it just didn't feel as relaxed and as calm but she came up and she tried to breastfeed, but wasn't interested, I think completely shocked from the birth, and I decided to stay in hospital for a week because obviously having a one year old at home, and I knew that the engorgement process would happen again and how painful that was and I kind of wanted to wait in hospital for that all to be over and, in my mind I thought I was going to go home with the breastfeeding pattern all sorted and everything hunky dory, so I stayed, I did stay in for about a week and, I had help through the night on the, the dreaded night when the engorgement came in and they had me in baths and, trying to do anything but extract the milk so that I wouldn't get this whole excess flow of milk all the time which is what I'd been told had happened last time because I was extracting so much last time, that's why I was always in abundance so, so this time I tried not to express any milk which kind of, made the milk supply a lot less I think and, in a way it was easier when it used to spurt out 'cause [laughs] 'cause you knew it was always there, so, they were, they were a bit worried actually when I was in hospital because the baby really wasn't interested in feeding
Her baby fed frequently one night and then the milk came in. She had to take extra care with...
So the evening of day two, he just fed and fed?
Yeah, fed and fed and fed, yeah all that night literally felt like it, felt like all night but I don't think, I think it was probably started at, before he did we probably didn't go to bed early, which is classic in our house and we probably didn't go to bed till about eleven o'clock and then the excitement of being home, being back here and he probably then, when we were ready to go to sleep he was ready to feed and it just was, it literally felt like all night but it was great 'cause we didn't have to get up the next day [laughs] only having one at that point so.
Did that bring your milk in?
Do you know I can't remember [laughs] I think I can remember it, I remember the feeling, feeling very full and very hot, my breasts feeling very hot and full and, it probably was the night, that day or next day it could have been the day after though, it's difficult to remember [laughs] because it was a long time ago, but I, that is my, that is my experience with him was my, the only time I from all four of my breastfeeding experiences of being engorged, feeling full, I didn't feel that with the others.
So what did you do for it?
I just fed him yeah, just fed him, I don't, I didn't do any of the people talk about cabbage leaves and things. I didn't need to do any of that I just fed him and I knew as well that it's not just milk, it's all the other fluids and the lymph and it isn't just that your breasts are completely full of milk and that they've got this big cavernous [laughs] sack of milk so yeah I just remember feeding him. I vaguely remember having, being a bit more difficult to get him latched on because I was engorged, but not yeah not.
So you just had to take the extra care with the latch, you didn't have to do anything?
Yeah, no just making sure that being more careful and I remember having to, having to keep, you know, to putting him on and then taking him off and putting him on again to make sure he was right, then I remember one, I can't remember when it would be but I remember the one midwife helping me with positioning, no not with positioning helping me be, be comfortable 'cause I was sat on our sofa and it's quite high up and I was sat with my toes on tiptoe 'cause I hadn't, I hadn't got to the stage where I, you can just cross your legs and be really comfy and I was trying to sit up right so that I was in the right position to feed and she suggested I got some phone books [laughs] to put my feet up so that my feet were more comfy, that's the main tip I actually remember from a midwife. I don't, I didn't get well I don't think I needed any help from midwives really, I just managed it myself I was lucky.
She describes the difference between the pain of engorgement and the pain of sore nipples. She...
'breasts a lot of the time, so I don't know that she was feeding enough and emptying the breast, I just seemed to be filled with milk a lot.
So that soreness of engorgement'
'was different from the soreness of the sore nipples?
Oh yes completely different, yes.
'describe the two different sorts of sensations?
It's going back so, it just seems like years and years and years ago. Yeah her actual feeding was like a cut sore, more than anything like you, you know, like you'd hurt yourself, you grazed yourself, yes it was definitely an eye-watering, one of those, a bit like an electric shock I was told it felt like sometimes when that, and it was very much like that it was sore, whereas the actual sore bust it was the whole side of your body, you just felt uncomfortable and, achy and you know it was horrible.
So you used cabbage leaves?
Yes cabbage leaves'
How did you use them, what did you do?
'the midwives told me [laughs].
Did they work?
Well the midwife, one of the midwives who I thought was a bit loopy actually, told me and I thought, 'Oh God here we go again, she's come up with something else' put them down my bra overnight and they'd, it's, it was like having a warm flannel, that idea as well, the milk starts leaking out and they kind of like take them down, take the pressure off, they were great, didn't smell very nice but it was [laughs] it did work, definitely.
How often did you change them? How often did you use them?
I don't, I think.
How long for?
It was like a leaf, a leaf each side, per evening if I was doing it and then change them.
So how was?
I suppose they lose, kind of only last so long I don't know.
And how long did you do this'
Probably only used it about four or five times, but it was when me bust was really, really sore and, like trying to get a baby to latch on to a really engorged breast is very hard [laughs] and.
Did you have any other tricks up your sleeves for getting a baby to latch onto an engorged breast?
Just warm flannels, I was told to or stand in the shower and let the warm water.
Or in the bath.
That made the milk flow?
That yes, yeah or lie in the bath, sometimes as
She had several ways to relieve engorgement, including feeding the baby, having a hot shower,...
Low milk supply
A number of women we talked with felt that they were not producing enough milk. For some it was a temporary problem, but in at least one case the pattern of low milk supply remained unchanged throughout the lactation period. Lizzie, a first time mum, experienced very low milk supply that remained unchanged despite all her efforts to increase it. Lizzie’s son was born tongue-tie but he latched well so she and the health visitor expected that once the tongue-tie was corrected, her milk supply would increase. But it didn’t.
He latched well but from the start she struggled to feed him because of low milk supply. Even correcting her baby’s tongue-tie didn’t help.-
And they sort of said, “Well, it will take its time. You’ll have this, the first—what is it called? “Colostrum”?
Yeah. “You’ll have that first bit coming through, which is a very different consistency to normal breastmilk. And it could take another two or three days for normal breastmilk to come through.” So you’re sort of going, “OK, well, I’ve just got to wait and see, really.” And because I struggled with breastfeeding, I stayed in hospital for two nights. And then they kind of had to sort of throw us out, but I was completely distressed because, you know, my baby was, wasn’t sleeping, it was constantly crying. But they’re going, “Well, it’s a baby, you know? It’s scared to be out in the world. It’s a baby.” And I was sort of going, “But I can’t see, you know, it doesn’t seem to be happening.” They were like, “But it will. It’ll happen. It’ll happen. It’ll happen.” And yeah, it was just sort of going, “Well, it, you know, OK. I’ll trust them, you know. They’re the experts.” And I can completely understand that actually, you know, for some women it does happen easily and it just didn’t work for me.
So again in the hospital we had to supplement it twice with some formula, because again he was just screaming and screaming and screaming. And [sighs] just you know, I was squeezing, squeezed like a, like, like squeezing, and nothing was coming out of them. So I was sort of going, “Well, you know, but,” and they go, “No, it will kick in. It will kick in.” And so we got home and you, again it, he would, you know, he was I was sitting for hours and hours on end with, with my baby sucking. And everyone kept on saying, he had a good latch on, you know? And it, but I was sort of going, “Well, I’m not sure he’s getting anything.” And he wasn’t sleeping because I guess he was never full.
And then the community midwife comes and visits you at home. And he was, again, crying because he was hungry, we’re assuming. And she sort of looked. She just went, “Oh, I think I’ve seen the problem.” And at that point, they noticed he had 100% tongue tie, so his tongue was attached from right down at, completely really, so that the, the tip of his tongue was attached to the back of his gum. So there was just no way he could’ve been doing that proper sucking movement. And again, the issue was that at that point within the NHS there was only one specialist in this area, and there was a six week waiting list. And we were sort of going, “Actually, we can’t wait.”
So fortunately there is a private practitioner who’s a midwife in one of the nearby hospitals, so we paid for her to come, quite a lot of money, paid for her to come that day to cut this tongue tie. And again, she said, you know, “Your, your nipples are a great shape.” You know, he, because when they cut it, they say put them immediately on the breast because it will sterilize and help it heal. And she was going, you know, “Your, you know, the latch is great.” You know, no worries. But, so, at that point, we thought, “Great, actually.” You know, it was his tongue tie. It was obviously the problem. He wasn’t sucking properly.
But it still continued to just not happen really. Like, they were -there was one awful, awful night where my husband and I were in bed and he was, like, milking my breast like a cow. Like, he was squeezing it, desperate to get the milk out of it to try and feed our baby. And it was just not coming out. So, you know, at that point I was, you know, but the, you know, every time I spoke to the health visitor, “Oh, it’ll, it’ll come, it’ll come. Just be patient. The more you breastfeed, the more milk that will come.” And it, yeah, it just didn’t.
Despite her efforts, Lizzie didn’t manage to increase her milk supply. This resulted in a breastfeeding experience that became increasingly stressful and exhausting for both mother and baby.
And at night, probably I was at night managed to get him to sleep for maybe an hour and a half probably. And then he’d want feeding and then I’d feed. I’d be breastfeeding him for sort of an hour and a half. So it was, it was, it was physically exhausting. And my husband was brilliantly supportive and he would sometimes, when I just needed that break, would, would take [son] into another room and sort of just try and just distract him and play with him. But he just wasn’t having any of it, you know? He was hungry and that’s what he wanted. And even sometimes it was sort of going, “Actually, even if the comfort of breastfeeding, even if there’s very little coming out, makes him feel a little bit better,” and again, if he fell asleep, so then sometimes he did fall asleep for me in bed and went sort of sit there awake, not daring to move because I was just like, “Oh, I’m going to have to breastfeed again if he wakes up.”
*Footnote 1: Cabbage leaves, kept cool and applied to the breast, are sometimes recommended as a home treatment for engorgement. Their effectiveness has not been scientifically proven.
Footnote 2: Women who are able to get their baby to attach well and breastfeed without restriction are less likely to have problems with engorgement. The importance of good attachment (skin contact) and effective milk removal (by any means if the breasts are over full) is the surest way to the establishment of satisfactory breastfeeding and an adequate milk supply.
Foonote 3: In many countries women who have low milk supply are prescribed domperidone as it increases prolactin levels, and is considered compatible with breastfeeding. (Hale TW. Medications and mothers’ milk. 15th edition. Hale Publishing 2012)
Last updated September 2015.