by Anne Smith, IBCLC

One of the biggest concerns that new mothers have is wondering if they will have enough milk for their babies. This concern is the most common reason for starting formula supplementation, and also for early weaning. We live in a society that puts a lot of emphasis on measuring everything, and many of us (and especially our mothers) were bottle-fed, so you knew exactly to the ounce how much milk the baby took in at each feeding.

You can be assured that nearly all mothers can produce an adequate milk supply for their infant. The human race would not have survived for millions of years if this was not the case. There is a very small percentage of women who just "don't have enough milk", but this is highly unusual, and is most often connected to some sort of medical problem, (for example, breast reduction surgery, maternal medications such as birth control pills, or maternal hypothyroidism). Many of these medical problems can be corrected.

Women have two breasts instead of one so that they can nurse twins. It stands to reason that the average mother with two breasts will be able to produce enough milk for one baby (at least).

Since breastmilk intake can't be measured without using sophisticated scientific equipment, it is important to know how to tell if your baby is getting enough. Here are some guidelines to help you assess your baby's milk intake:

• Your milk should "come in" 2-5 days after your baby is born. Your baby is born with extra fluid in his tissues, which is excreted during the first 48 hours after birth. This weight loss usually averages 7-8 ounces. His immature kidneys are not equipped to handle large amounts of fluid during this time. The small amount of colostrum (the sticky yellow fluid that comes out of the breast before the milk "comes in") is perfect for his newborn system to digest, and provides important antibodies. During the first 24 hours after birth, you usually produce about 37 ml of colostrum (30 ml is an ounce). The baby will get 7-14 ml at each feeding, 1⁄3 to 1⁄2 ounce each time you nurse.

Usually on the second or third day, your breasts will start to feel "different": warmer, fuller, and heavier. You will begin to produce transitional milk at this time -- a combination of colostrum and mature milk, which will look yellowish. If you don't feel these breast changes and your baby seems hungry after feedings, consult a health care professional and have your baby weighed.

• Your baby should latch on and suck rhythmically for 10-15 minutes on each breast. He may pause periodically, but should nurse vigorously for most of the feeding. He should seem satisfied after nursing, and will often fall asleep at the second breast. If he falls asleep and will not take the second breast, try to divide the sucking time between the two sides. If he is sleepy, he will get more milk by nursing for 5 minutes on both breasts rather than 10 minutes on one. You should hear him swallowing regularly while he is nursing.

• Your newborn should nurse at least eight times in 24 hours. Many newborns will nurse 10-12 times or more. This includes longer feedings as well as shorter snack nursings. Nursing every 1½ - 3 hours during the day, with one 4 hour stretch at night (if you're lucky!) works well for many nursing couples. Don't expect your baby to be on a 4 hour schedule -- the average newborn will not gain enough weight that way. You may need to wake your newborn up for feedings -- newborns will often not demand to be fed often enough, especially during the first week or two. (See article on "Waking Sleepy Babies" for more information).

• Once your milk is in, your breasts should feel fuller before feedings and softer after you nurse. You may see milk dripping or squirting from one breast while your baby is nursing on the other side. This is a sign that your milk is "letting down." Your body doesn't know that you're not nursing twins, so your milk will let down on both breasts at once. You may or may not feel a distinct sensation associated with the milk ejection, or let-down reflex. Some mothers feel a very strong physical sensation, sort of a tingling, tightening, or pins-and needles response as the milk begins to flow. Some mothers never notice a distinct sensation, and some don't feel it until they have been breastfeeding for several weeks.

• Keep track of your baby's wet diapers and bowel movements. Other than weight gain, these are probably the best indicators of how much milk your baby is taking in.

For the first couple of days after birth, your baby will pass dark, tarry meconium stools. This is the stool the baby has been storing since before birth. Within a day or two of your milk coming in, his stools will change in both color and consistency. These early transitional stools may be brownish or greenish, and will be loose and unformed (kind of a pea soup consistency). By the time your baby is 4 or 5 days old, he should be having "milk stools": Yellowish and seedy, sort of like a mixture of mustard and cottage cheese. He should have at least 2-5 substantial bowel movements in each 24 hour period, and may pass a stool every time he nurses during the first few weeks of life. If he is stooling less frequently, it may mean that he is not getting enough milk.