Whether the body is producing enough milk is a common concern of breastfeeding mothers. In today's society, when it comes to birth and breastfeeding, the medical and media culture has taught women not to trust their bodies. We have been taught to doubt about our own body's ability to do things we are absolutely built to do, like birth naturally and breastfeed without supplementation.

So before you begin actively trying to build your milk supply, really step back and figure out whether you actually *need* to increase your milk. Increasing your milk beyond the true needs of your baby can lead to problems like plugged ducts and mastitis, increased reflux and vomiting by the baby after feedings, overactive letdown, breast discomfort, increased leaking, dermatitis from excessive pumping and other complications. Sometimes it's best to just let your body really listen to your baby's needs and adjust on its own.

Here's some things you should know before trying to increase your milk supply or supplement breastfeeding with formula:

• Is my newborn getting enough? -- The most frequent concerns about supply are from mothers with newborns, and interventions in the breastfeeding process and supplementation are common. Sometimes this is necessary, but often not. Ironically, this is the time when milk supply is the most responsive to your baby, and with proper guidance, very little intervention may be needed other than nursing on-cue. But problems establishing breastfeeding may interfere with establishing a strong milk supply, or early supplementation may cause the need to increase supply to wean from formula use. See my article on "Is My Newborn Getting Enough?" (see the related links at the end of this article) which specifically discusses how to assess the answer to that important question.

• Fussiness and crying alone are not indicators that milk supply is low. There are endless reasons why babies cry and fuss, on and off the breast. Unless the baby is exhibiting other signs like stalled weight gain, dehydration (dry mouth, dull eyes, dry diapers, decreased stooling), don't assume that fussiness or crying means that your baby is unsatisfied with your milk. I've seen numerous mothers with 18 pound, two-month old, butterball babies anxious about milk supply. We often project what we are insecure about onto our baby's cries, and insecurities about or lack of exposure to breastfeeding can make us doubt our ability to sustain our babies even in the face of clear evidence they are thriving.

• Is it normal for weight gain to slow after the first couple months. When nursing becomes fully established and your baby begins to become active – looking around, swatting at toys, rolling over or starting to scoot, it is absolutely normal for weight gain to slow. If you have concerns about this, be sure to discuss them with a pediatrician who is knowledgeable about breastfeeding before assuming that you aren't providing adequate nutrition through breastfeeding. If your baby seems otherwise healthy and robust, but your doctor seems really obsessive about that growth curve in the chart (probably based on formula-fed babies who develop on a different, more artificial curve) and really quick to jump to formula supplementation, at least get a second opinion from a local La Leche League leader or another pediatrician if you can.

• It is normal for breasts to feel less full after the first few months. After the first 2-4 months, it is normal for breasts to stop spontaneously leaking, for forceful letdowns to slow and breasts to feel less full in between feedings. Many women stop breastfeeding or begin to obsess about supply at the 3 to 4 month mark when this phenomenon occurs. Babies also start to notice the outside world at this point and begin to become distracted during feedings. This is normal and alone doesn't mean that your baby is not getting enough or dissatisfied at the breast. It is also normal for a baby this age to "cluster-feed," which is a fussy part of the day, often in the early evening, where the baby is fussy and wants to be permanently attached to the breast, or nursing really frequently for 2 to 3 hours.

• It is normal for the duration or spacing of feedings to decrease after the first few months. For some women, early feedings can be 45-minute marathon sessions. Babies not only need this constant closeness during this time, but are also working to establish milk supply with the extended stimulation. As they grow and become more competent nursers, they become more efficient and your body becomes more responsive to their needs. What used to take 45 minutes can now be accomplished in 5 to 10! Note that some mothers never have the super-long feeds at the beginning but have efficient nursers right from the start and a bountiful supply even with less stimulation, so don't get worried if you have a newborn who is not marathon feeding. With any dramatic change in feeding pattern, it is certainly worth watching the baby for any signs of dehydration and discuss any concerns with a breastfeeding-knowledgeable pediatrician, but know that this does happen.

• It is normal for wet and dirty diapers to decrease as well after the first few months. While repeated dry diapers, especially in the presence of other signs of dehydration, are something you should immediately notice, know that it is normal for your baby to begin to need less changes as the months progress. This is especially true with disposable diapers – the heaviness of them can sometimes tell you more than whether they "seem wet." Dirty diapers also decrease. It is common (although not universal) at the beginning for a baby to poop after every feeding, so that can be even dozens of time a day! Eventually this may slow to a few times a day, or even a few times a week. At the extreme, a perfectly healthy breastfed baby can stool only once every two weeks, like my first daughter. This is definitely an area in which to consult a pediatrician, but make sure they understand the differences between breastfed and formula-fed babies in this area.

It is often overwhelming how the same observation can indicate a problem or can be completely within the range of normal for different babies. Add this to sleep deprivation and a healthy sense of distrust of one's own body, and you've got a recipe for major anxiety. Having a pediatrician who is knowledgeable about breastfeeding and that you trust can be key during this period, especially for first-time moms. But allowing yourself to accept the gift of a healthy, thriving baby, and learning to trust yourself and your body's ability to sustain that baby is also critical. Sometimes, active management to increase milk supply *is* necessary, but before you jump on the pump or pull out the formula, be sure you have a true understanding of your situation and whether this is necessary.



Disclaimer: All material on the BellaOnline.com Breastfeeding website is provided for educational purposes only and does not constitute medical advice. Although every effort is made to provide accurate and up-to-date information as of the date of publication, the author is neither a medical doctor, health practitioner, nor a Certified Lactation Consultant. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation. Information obtained from the Internet can never take the place of a personal consultation with a licensed health care provider, and neither the author nor BellaOnline.com assume any legal responsibility to update the information contained on this site or for any inaccurate or incorrect information contained on this site, and do not accept any responsibility for any decisions you may make as a result of the information contained on this site or in any referenced or linked materials written by others.