Hormones and cuddles set the stage for milk production, but the order is placed for the long-term in the early hours after delivery with frequent removal of first milk, either by the baby or the mother. Milk out, more milk in. New research supports a low-tech, high-touch approach to help mothers make plenty of milk and know that their babies receive enough. The ancient maternal impulse to hold, touch and help her baby, to keep the connection, plays an important role in every birth story. Game-changing research, including our own at Stanford, rediscovered the immense value of simple hand techniques. And what happens in the very first hours matters the most for long-term success. Hand expression of small amounts of first milk onto a spoon, which can then be offered as a “dessert” after breastfeeding, sounds pretty simple, but research shows that frequent hand expression in the early hours boosts later production for weeks. Furthermore, frequent supplementation of the newborn with mother’s milk flattens the normal weight loss trajectory. With simple guideposts (weight, bilirubin, stool color, behavior) combined with personalized mother-baby information, we hope in the future to provide feeding and expression strategies to reduce and prevent problems.
You are looking at breastmilk under a microscope. Each drop is alive, and uniquely tailored for each baby.
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the science
High-Touch, Low-Tech Breastfeeding
A Problem Worth PreventingInadequate breastmilk intake is the number one reason breastfed newborns need re-hospitalization, most commonly for treatment of excessive weight loss and jaundice. Twenty percent of mothers give up breastfeeding in the first month, most commonly concerned about insufficient production and suboptimal intake. Over 1/3 of first-time mothers of late preterm babies (those delivered between 34-36+ weeks) stop in the first month for similar reasons. Learn more about prevention of health problems in the cutting edge research confirming the immense protection of first milk on the infant’s immune system and developing intestinal microbiome. Again, first milk matters most.
Inadequate breastmilk intake is the number one reason breastfed newborns need re-hospitalization, most commonly for treatment of excessive weight loss and jaundice. Twenty percent of mothers give up breastfeeding in the first month, most commonly concerned about insufficient production and suboptimal intake. Over 1/3 of first-time mothers of late preterm babies (those delivered between 34-36+ weeks) stop in the first month for similar reasons. Learn more about prevention of health problems in the cutting edge research confirming the immense protection of first milk on the infant’s immune system and developing intestinal microbiome. Again, first milk matters most.
First Hour Colostrum ExpressionImportance of first hour colostrum expression
Expressing first milk (colostrum) in hour one vs. hours 2-6 post-delivery decreased the time before production accelerates and increases by 130% at 6 weeks. The establishment of milk production is time-sensitive and dependent on very early, frequent, and effective colostrum removal for subsequent production. The DAME study supports the safety of hand expression in the last month of pregnancy. This article discusses the science behind using your hands in the first hour.
Importance of first hour colostrum expression
Expressing first milk (colostrum) in hour one vs. hours 2-6 post-delivery decreased the time before production accelerates and increases by 130% at 6 weeks. The establishment of milk production is time-sensitive and dependent on very early, frequent, and effective colostrum removal for subsequent production. The DAME study supports the safety of hand expression in the last month of pregnancy. This article discusses the science behind using your hands in the first hour.
Value of early hand expression Value of hand expression of colostrum on subsequent production potential and other favorable breastfeeding measures
In pump-dependent mothers, all else being equal, (demographics, pumping frequency-duration and type pump) the strongest determinant of production at 8 weeks was the frequency of hand expression used only in the first 3 days. Hand expression compared to pumping has been shown to have multiple other unexpected advantages: Mothers find it more comfortable and breastfeeding rates are higher at 2 months; colostrum volumes expressed are greater to or the same as pumped volumes when mothers are assigned to use hand expression of colostrum vs. an electric pump; and the fat content, essential to the myelination of neuronal tissue, is greater.
Value of hand expression of colostrum on subsequent production potential and other favorable breastfeeding measures
In pump-dependent mothers, all else being equal, (demographics, pumping frequency-duration and type pump) the strongest determinant of production at 8 weeks was the frequency of hand expression used only in the first 3 days. Hand expression compared to pumping has been shown to have multiple other unexpected advantages: Mothers find it more comfortable and breastfeeding rates are higher at 2 months; colostrum volumes expressed are greater to or the same as pumped volumes when mothers are assigned to use hand expression of colostrum vs. an electric pump; and the fat content, essential to the myelination of neuronal tissue, is greater.
Preventative Weight Loss MeasuresImportance of the early weight loss trajectory and how weight loss can be modified by supplementation with spoon fed colostrum
- By 6 hours, weight loss differentials for infants at risk for excessive weight loss are evident.
- By 24 hours, weight. loss ≥5% predicts eventual excessive weight loss.
- By 48 hours, 5% of vaginally born infants and >10% of cesarean born infants have lost ≥ 10% of weight, with nomograms predicting weight loss per hour of life to help determine which infants are at the extremes for expected weight loss.
- By discharge, weight loss correlates with maternal concerns for underproduction at 2 weeks, adding formula by 1 month, and stopping any breastfeeding <6 months.
- Infants liberally supplemented with spoon-fed colostrum lose less weight and begin gaining sooner. Excessive weight loss is rare.
Importance of the early weight loss trajectory and how weight loss can be modified by supplementation with spoon fed colostrum
- By 6 hours, weight loss differentials for infants at risk for excessive weight loss are evident.
- By 24 hours, weight. loss ≥5% predicts eventual excessive weight loss.
- By 48 hours, 5% of vaginally born infants and >10% of cesarean born infants have lost ≥ 10% of weight, with nomograms predicting weight loss per hour of life to help determine which infants are at the extremes for expected weight loss.
- By discharge, weight loss correlates with maternal concerns for underproduction at 2 weeks, adding formula by 1 month, and stopping any breastfeeding <6 months.
- Infants liberally supplemented with spoon-fed colostrum lose less weight and begin gaining sooner. Excessive weight loss is rare.