Leading Lactation Insights - April 2023

Scientific Basis for Early Initiation of Milk Supply

Maria Lennon, MSN, CNM, IBCLC

Research has shown that early initiation of breastfeeding is crucial in establishing a plentiful milk supply.  Nurses and lactation consultants must strive to help mothers get their breastfeeding journeys off to the best possible start by initiating breastfeeding within the first hour after birth.

 Placing the infant skin-to-skin immediately after birth is the best practice to help the newborn transition to extrauterine life and encourage the first breastfeed. Physiologically, it makes sense. Once the placenta is delivered, the progesterone level drops dramatically, and the hormone, prolactin, is released from the anterior pituitary gland. Prolactin promotes ductal growth and induces milk synthesis. The infant’s suckling causes the release of oxytocin, which pushes milk forward into the ducts - the milk ejection reflex. Oxytocin, also known as the “love hormone,” enhances maternal-child bonding.

In some US hospitals, routine birth practices continue to involve separating infants from their mothers immediately after birth to be suctioned, weighed, placed on a warmer, diapered, and given injections and eye ointment. Separation for these infants is highly stressful; they release cortisol and other stress hormones and cry as if they are in despair.  For these infants, maternal-infant attachment is interrupted, which can lead to behavioral disorganization and make breastfeeding more difficult.

Immediate skin-to-skin contact provides thermal regulation for the infant, as the mother’s chest quickly adjusts to the newborn’s temperature. Thermography has shown that a mother’s chest will increase by a few degrees to warm an infant who is too cool or will cool an infant that is too warm. Immediate skin-to-skin care enhances cardio-respiratory stability (including oxygen saturation levels), helps stabilize blood glucose levels, and allows for colonization of the newborn to the mother’s normal flora helping prevent infection and promoting infant intestinal health.

How to best help mothers succeed in establishing their milk supplies? 

Lactation science tells us that early initiation and frequent milk removal are key. Appropriate management is critical for developing optimal milk production. In term infants, earlier initiation of breastfeeding is associated with earlier secretory activation (lactogenesis stage II), increased milk volume on Day 5, and extended duration of breastfeeding.

For mothers of Very Low Birth Weight (VLBW) infants, Parker’s research has shown that beginning milk expression within the first hour after birth significantly increases milk volume. Because milk volume during the first week after birth is positively associated with later milk production in mothers of VLBW infants, it’s crucial that hospitals incorporate expressing milk within the first hour into breastfeeding protocols and hospital practices. 

The first hours and days after birth are critical for a mother to effectively start building her milk supply. Immediate skin-to-skin care, breastfeeding within the first hour after birth, and feeding at least eight or more times in a 24-hour period are essential practices. If mothers and infants cannot be together due to prematurity or illness, initiating milk expression within the first hour with research-based initiation breast pump technology combined with hand expression is crucial for the best milk supply outcomes.

Resources:

Bergman, N. J., Linley, L. L., & Fawcus, S. R. (2004). Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatrica (Oslo, Norway: 1992), 93(6), 779– 785.

Parker LA, Sullivan S, Krueger C, Mueller M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeeding Medicine 2015 Mar; 10(2): 894-91. Doi:10.1089/bfm.2014.0089

WHO Immediate KMC Study Group, Immediate “kangaroo mother care” and survival of infants of low birth weight. N Engl J Med 2021; 384:2028-2038
 DOI: 10.1056/NEJMoa2026486