Pregnancy, childbirth and raising a newborn bring up a multitude of awkward moments for the new mother, especially when she has the unenviable task of listening to the advice of her husband’s grandmother discussing her own experiences with those events. This, however, was just the position my brother’s wife was in when she brought her new son to meet my grandmother a few days after his birth.

My grandmother sat in her wheelchair and held her arms open, waiting to be presented with the newborn. As soon as he settled into her arms, she began to talk. Amidst talk of embarrassing pregnancy moments and admonishing my sister-in-law for not letting the nurses “do their jobs” by taking the baby to the nursery after birth so she could rest, Granny burst into tears and began to bemoan her inability to nurse her sons. “I just couldn’t produce enough milk!” she wailed. “They would suck and suck, but nothing would happen!” I could see my sister-in-law start to squirm. “I had to make formula for them out of milk and corn syrup. Oh, how I wished I could nurse them!” Granny pulled the baby close to her apparently drier-than-the-desert breasts and continued to sob until my father mercifully pried the newborn from her arms and announced it was time for lunch. I watched the entire transaction with a sense of bewilderment. How could a woman not have enough milk to feed her baby four times in a row? Was Granny just a product of her generation, or was there really such a thing as zero lactation?

Unfortunately for some mothers, there is such a thing as poor lactation. It is very rare, and does not equate “no” lactation, but there are some instances in which mothers have difficulty producing enough milk to sustain the needs of their babies. On the other hand, there are many mothers who are under the impression that as soon as their baby is delivered their breasts should overflow with milk and they should have no trouble generating more than enough every day. The reality is that many women do not begin to produce actual milk until the third or fourth postpartum day. During those days the baby is sustained with pre-milk fluid called colostrum. Sometimes called “liquid gold,” colostrum is extremely nutrient-rich and prepares the baby for eating milk.

Actual lactation, that is the production of real milk, is stimulated by both birth and adequate suckling by a newborn. The human breast must have adequate, frequent suckling by a nursing infant in order to stimulate and support lactation. When a baby is not providing adequate suckling, hand expression or use of a pump can supplement nursing to continuously encourage the mother’s body to produce more milk. Many women will become frustrated at their apparent lack of lactation and begin to supplement their breastfeeding with formula feedings, which will satiate the baby for longer, therefore decreasing the sucking stimulation even further and further preventing the production of breast milk.

Lactation specialists recommend that mothers avoid supplementing nursing if at all possible. If a baby still seems hungry after nursing, it is likely a matter of a hearty appetite, not a lack of milk. It is critical to remember breastfed babies need to eat more often than formula-fed babies. Particularly in the first weeks of life breastfed babies may eat every half an hour. A mother who attempts to “schedule” her baby to eating only every three hours or so will likely have a hungry baby on their hands. This does not mean the mother has no milk, only that the baby needs to be fed more often. Mothers are encouraged to consult with a lactation specialist if they are concerned about the amount of milk they are producing.

Source: Toshihiro Aono. The Initiation of Human Lactation and Prolactin Response to Suckling. The Journal of Clinical Endocrinology and Metabolism, June 1 1977. Volume 44, Issue 6, pp 1101-1106.