Effect of frequency of breastfeeding on milk production

Breastfeeding my daughter is now well established at 3 1/2 weeks and I am confident we can continue to reach the goal of 6 months exclusive breastfeeding.

I have not had any issues breastfeeding at all (after the nipple trauma cleared up two weeks ago!). The only problem I had, was the recommendation from a number of sources than I should be feeding every two hours or risk reducing my milk supply. This was a little stressful for me because my baby could not be woken up enough to feed properly every two hours. It worked like this when I tried: two hours after a feeding, I would try to rouse her for an hour, she would suckle half-heartedly for a few minutes then drop off to sleep again. I tried all the classic tricks like tickling her feet, changing her nappy, and even washing her face with a cold wash cloth (she screamed like I was trying to kill her for a minute, then went back to sleep). It was a pointless exercise. She was impossible to feed every two hours. I was concerned about my milk supply, however I was more concerned about the stress I was putting her under waking her and trying to get her to feed more frequently than she seemed to want. Also, after the first day she regained her birth weight and was almost one kilo above her birth weight at the 2-week visit. She clearly was getting enough milk! I resented the standard advice I was given that obviously wasn’t appropriate for my baby.

According to my nutrition textbook (Nutrition Through the Life Cycle, 4th edition, by Judith E Brown), the amount of milk removed over a 24-hour period determines milk production rather than the frequency of feedings. So perhaps this advice that women should breastfeed their infants frequently isn’t really based on scientific evidence.

I looked up some research that looked at milk synthesis rates and frequency of breastfeeding. Two papers showed that there was no difference in milk production 2 and 6 (Daly, 1996) or 7 hours (Lai, 2010) after a feed. The first hour presumably was related to how long it had been between feeding the infant and arriving in the research centre. This shows that as long as infants are fed within 6 hours, there is no effect on milk production. The research reported by Daly and associates using a technique that measures breast volume (1993) shows a relationship between breast emptying and milk synthesis rates, but not nursing frequency. And the research from Kent et al. that weighed infants before and after a feeding found that milk supply depended on the volume of milk available in each breast, whether one or both breasts are fed from, and the time of day, and not the frequency of feeding. Incidentally, my baby’s 6 feedings per day falls within the range in this study. The authors reassuringly concluded “Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother-infant dyad.” That’s the key, as long as there are no health issues, babies should be fed when they want and not according to a schedule.

References:

Daly SE, Kent JC, Owens RA, Hartmann PE. Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol. 1996 Sep;81(5):861-75.

Daly SE, Owens RA, Hartmann PE. The short-term synthesis and infant-regulated removal of milk in lactating women. Exp Physiol. 1993 Mar;78(2):209-20.
http://ep.physoc.org/content/78/2/209.long

Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006 Mar;117(3):e387-95. http://pediatrics.aappublications.org/cgi/content/full/117/3/e387

Lai CT, Hale TW, Simmer K, Hartmann PE. Measuring milk synthesis in breastfeeding mothers. Breastfeed Med. 2010 Jun;5(3):103-7.

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