Various techniques can be applied to ensure that the mother and the baby have a healthy, codependent feeding relationship, benefiting both. Complications can also occur due to different reasons, such as poor latch of the baby, incorrect positioning while breastfeeding, insufficient or excessive milk supply, and the mental well-being of the mother.
What is breastfeeding and its benefits?
Breastfeeding is the process where the biological mother (someone identified as female at birth, who is the one birthing a child) provides food for her baby by producing milk in her breasts. Secretory glands located in the breasts produce milk, which is a food resource for the baby.
There are two ways in which this milk can be consumed by the infant:
- Direct Breastfeeding - The baby suckles directly from their mother’s breast
- Pumping - A device is used to extract milk from the breast, which is fed to the infant at a later time
Breastfeeding is vital for both the mother’s and the child's well-being.
Benefits for the mother include:1
- Lower chances of breast/ovarian cancer
- Reduced postpartum depression (depression after giving birth)
- Decreased chances of Diabetes, Cardiovascular diseases and higher blood pressure (hypertension)
Benefits for the baby:
- Reduced risk of atopic dermatitis/ eczema (dry, cracked and itchy skin) and intestinal gastroenteritis (inflammation of the digestive system characterised by nausea, diarrhoea and cramps)
- Higher IQ (intelligence quantum) when older
How long should I breastfeed my baby?
There are different opinions on how long a person should breastfeed their baby. The ideal time period is at least for the first six months, as some people decide to breastfeed for up to 24 months (2 years), which is the recommended duration by the World Health Organization (WHO).2 However, that is not always the case, as many women have halted breast milk production (insufficient milk supply) just weeks after giving birth. Other reasons for early cessation of breastfeeding include an inadequate latch and experiencing nipple and breast pain.
How is breast milk produced?
Milk production (lactogenesis) is a process that occurs in the alveolar units (lobules) located in the breasts. A range of hormones affects milk production and secretion. Some of the most important hormones for breastfeeding are prolactin and oxytocin. Prolactin, produced in higher quantities during pregnancy, is responsible for the amount of milk production. The process of milk extraction from the breasts is called milk ejection.3 It is recommended that women pump their milk out as frequently as possible, usually every 2-3 hours.
Breast milk is the perfect nutritional food for newborns, packed with essential vitamins, fats, and proteins and easy digestibility for the infant compared to formula food. Breast milk also contains antibodies from the mother, providing immunity against certain pathogens, such as viruses and bacteria, that the mother has encountered in her lifetime. Other helpful ingredients in breast milk include immunoglobulins (IgA), white blood cells, oligosaccharides, etc. This reduces the chances of the baby developing certain health conditions such as asthma, respiratory infections, obesity and diabetes.4
After giving birth (2-3 days), the first milk production by the mother can be observed, called colostrum. Although colostrum is not produced in large quantities for the first day (40-50mL), it is sufficient to meet the infant’s food requirements. Colostrum is richer in proteins, fat-soluble vitamins (e.g.vitamin A, K, E), and minerals than later milk produced at a later stage. The higher quantity of vitamin A gives colostrum a more yellowish appearance.5
Between the second and fourth day, a higher amount of milk is produced. Usually, when the baby is three days old, they consume approximately 300-400 mL, and on day 5, around 500- 800 mL. Later, between days 7 and 14, the produced milk is called transitional, and after 2 weeks, it is referred to as mature milk.
At the beginning of the lactation process, the milk is called foremilk, and it is blue-grey in colour due to its lower fat content. Towards the end of the feed, the milk is called hindmilk and is richer in fats, which contribute to its creamy white colour. The fat in breast milk contains polyunsaturated fatty acids ( e.g. docosahexaenoic acid-DHA and arachidonic acid- ARA), which cannot be found in any other milk. They are of vital importance for the correct neurological development of the baby.
Some of the hormones having the best-known role in breastfeeding and lactation are:
Prolactin secretion is required for the production of milk by the alveoli (parts of the breasts). During pregnancy, the amount of prolactin increases, resulting in the growth of mammary tissue where milk production takes place. Secretion of the milk, however, does not happen during pregnancy due to the presence of two hormones, progesterone and oestrogen, which inhibit prolactin. After giving birth, the amount of progesterone and oestrogen decreases, and prolactin action can take place, initiating milk production. Blood serum prolactin levels also increase when a baby is suckling, stimulating lactation.
Oxytocin, responsible for the “ejection reflex”, is synthesised more quickly than prolactin. It aids in milk flow during a feed, making it easily accessible for the baby. Oxytocin synthesis starts when a baby is suckling or when a mother is expecting a feed for the baby.
Furthermore, the oxytocin reflex can adapt to different feelings and sensations such as the smell or the sight of her baby, touching her baby, hearing her baby cry, or having loving thoughts towards the baby. That is one of the reasons why if the mother is feeling down, such as being depressed or in a great amount of pain, her milk production can cease. If adequate help is received at the correct time, lactation can resume. This reflex gives us a better understanding of why after delivery, the mom and the baby should be kept together and have skin-to-skin contact, forming an emotional bond.
After giving birth, oxytocin causes the mother's uterus to contract, reducing the amount of bleeding. This process can cause pain. It is important to understand the oxytocin reflex because it explains why the mother and baby should be kept together and why they should have skin-to-skin contact.Oxytocin makes a mother's uterus contract after delivery and helps to reduce bleeding. The contractions can cause severe uterine pain when a baby is suckling during the first few days
Another factor to be taken into account is a protein called feedback inhibitor of lactation (FIL), which can be found in breast milk. In some occasions, one breast could be synthesising milk while the other experiences halted breast milk production (e.g., the baby is only feeding from one breast). When the breast is full of milk because it is not being used for feeding the baby, the inhibitor protein accumulates inside the breast and halts cells from producing milk. If the milk is regularly extracted, the inhibitor protein is also removed, and lactation will continue.
As the required minimum period of an infant`s breastfeeding is 6 months, the frequency of a baby`s feeding cycles from both breasts needs to be as often as possible, during day and night. This process is called unrestricted feeding. The average daily milk intake for an infant depends on both the mother and the baby and can vary between 440-1220mL, usually being around 800 mL daily for the first six months.
What are leaking breasts?
Leaking breasts are a common condition affecting many breastfeeding individuals assigned female at birth. In many cases, excessive lactation leads to full, leaking breasts. Some common complications include breast pain, engorgement, and feeling pain during milk ejection. Leaking from the breasts can occur between feed cycles. Severe engorgement lasting for more than 1-2 weeks is also an indication of breast milk oversupply. Another consequence of incorrect breastfeeding technique, specifically nipple trauma, can result from a poor latch, leading to cracked and sore nipples. It’s also important to empty the breasts as fully as possible because incomplete milk ejection could lead to blocked ducts and mastitis (inflammation of the breast).6
How do you manage leaking breasts?
Some quick home remedy ways to deal with leaking breasts include:
- Use of a good nursing bra with large, well-absorbing bra pads
- Choose clothing with patterns suitable for camouflaging any leaks
- Always carry a spare bra and tissues, especially when you feel a let-down reflex (milk starting to come out of your breasts)
- Express milk when your breasts feel too full and engorged
Breastfeeding is a crucial process for both the baby and the mom. It is not only vital for their health and well-being but also for the emotional attachment formed between them. There are correct ways to apply different techniques, such as accurate positioning of the baby for an optimal latch and breastfeeding. The duration of breastfeeding varies from person to person, lasting as little as a few weeks or up to 24 months or more. Leaking breasts can result in discomfort and anxiety due to clothes staining in public. Some ways to prevent this are by using nursing bras with good and absorbent pads and considering the patterns and colours of clothing while dressing up to avoid visible staining, as well as expressing milk whenever breasts feel engorged.
What causes breast leakage during breastfeeding?
A spike and decrease in certain hormones trigger milk release as well as an overactive let-down reflux.
Is breast leakage normal?
Breast leakage is completely normal. Some women may experience it, and some may not. It is entirely up to the individual, as everyone is different. It also depends on the strength of the muscles surrounding your nipples and how well they work.
Are leaking breasts an indication of a health problem?
Continuous leakage after breastfeeding can be an indication of milk oversupply, whereas a decrease in leakage could be the result of undersupply. However, the experience of leaking breasts is personalised. If you ever feel concerned about leaky breasts, always contact your GP or a lactation consultant.
When does breast leakage stop?
Breast leakage usually stops within a couple of months after giving birth. Some individuals may never experience it, and others may have it until they stop breastfeeding.
- Westerfield KL, Koenig K, Oh R. Breastfeeding: Common Questions and Answers. Am Fam Physician. 2018; 98(6):368–73.
- Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews [Internet]. 2012 [cited 2023 Oct 18]; 2012(8). Available from: http://doi.wiley.com/10.1002/14651858.CD003517.pub2.
- Neville MC. Anatomy and Physiology of Lactation. Paediatric Clinics of North America. 2001 Feb 1;48(1):13-34. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0031395505702832.
- Pillay J, Davis TJ. Physiology, Lactation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499981/.
- Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals [Internet]. Geneva: World Health Organization; 2009 [cited 2023 Oct 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK148965/.
- Trimeloni L, Spencer J. Diagnosis and Management of Breast Milk Oversupply. The Journal of the American Board of Family Medicine [Internet]. 2016 [cited 2023 Oct 18]; 29(1):139–42. Available from: http://www.jabfm.org/cgi/doi/10.3122/jabfm.2016.01.150164.