“I’m always feeding – how can she not be getting enough”
“It must be me – I don’t have enough milk”
“I’ve been told there’s nothing wrong with the positioning”
Any of these sound familiar? Usually, poor weight gain has nothing to do with the fundamental potential of the maternal milk supply. That is, there is no underlying maternal cause for low milk supply in the majority of cases. So in these cases, there is usually a story to unpick. It’s often poor positioning and attachment, or sleepy babies, or ineffective feeding. But I’ve run into a number of babies with a subtle problem that I’ve fondly termed ‘let-down surfing’.
Let me explain. When babies begin to suckle at the breast (however ineffectively), because there is an emotional connection between the mother and her baby, because she loves her baby, and because she is receiving emotional, psychological and physical stimulation, she will experience a let down, caused by oxytocin – the love hormone that also causes milk to be ejected through the nipple. The baby does not have to suckle particularly effectively for this to happen, because it is a hormonal response, and the milk will passively drip, spray or trickle in to the baby’s mouth.
Let me first just explain a normal suckling pattern, so you know the difference between normal feeding and ineffective feeding. Ok – when babies first attach to the breast, they normally suckle quite fast (to stimulate the let down reflex). They then begin to have deep rhythmic suckles with audible swallows (which sound like little sighs, or a huh-uh sound). They will take little pauses in between bursts of suckling – normally these pauses last for a few seconds, followed by more active suckling. Occasionally if the mother has a subsequent let down, you may notice the baby drinking faster again, and milk may appear in the corners of the baby’s mouth, but then the deep rhythmic suckling will resume. Towards the end of the feed (don’t forget the feed may last anything from 5-40 minutes – it’s the pattern of feeding not the length that matters) the baby will begin to flutter suck. So in summary:
Fast suckling - Deep rhythmic suckling (with pauses) - Flutter suckling
In most cases, the baby is also effectively attached and begins to actively suckle, using deep, rhythmic jaw movements, effective tongue action and draws milk powerfully out of the breast. In this way, the baby will carry on drinking actively long after the let down has passed, it will just slow somewhat.
But some babies seem to suckle very ineffectively, and whilst they will passively swallow milk whilst their mother is having a let down, once the let down has passed, they resume their ineffective suckling pattern. Now, because a mother will experience several let down surges in one feed, the baby will appear to feed in infrequent bursts, but in reality what they are doing is falling asleep and waiting for another let down – ‘let down surfing’.
So why do babies do this? Well, there may be a number of reasons – including:
- Tongue tie
- Birth trauma
- Or sometimes the baby has been used to the fast flow from a bottle
- Understand the underlying cause 9particualrly if the baby is jaundiced or ill)
- Try breast compressions during inactive feeding to increase the milk flow and remind the baby to actively drink. Get a big handful of breast tissue and just squeeze and hold until you notice the baby actively moving their jaw again
- Try switch feeding – take the baby off and put them on the other breast as soon as they look sleepy. Keep repeating
- Remember to protect your milk supply. If babies are not feeding effectively, they can quickly signal your breasts to produce less milk, so make sure you pump after ineffective feeds to ensure your body continues to get the message that it needs to make plenty of milk
- If you are using a bottle, make sure you are practicing ‘paced bottle feeding’ to slow the flow of milk and reduce stress to the baby, as well as reminding the baby that they can’t just lie there and expect milk to passively flow into their mouths without actively suckling. Google ‘paced bottle feeding’ and you’ll get plenty of information on this!
- Get help! Keep asking until you find someone who can make a proper feeding assessment and come up with a plan to help you and your baby feed as a team!