Making More Milk: Breastfeeding, Supply and the Feedback Inhibitor of Lactation

By Danelle Day, PhD © 2013

A common concern among new nursing mothers is milk supply. And while it is the case that very rarely does a mother carry a baby to term without also producing the milk this baby needs to thrive post-birth, the worry, "Am I making enough for my baby...?" is ubiquitous.

To maintain a full supply of human milk (and not much is needed in the early weeks or months of babyhood) a mother must drain her breasts often to create a demand. As simple and non-complex as it sounds, that is the very basic, fundamental rule of milk production: increased demand = increased supply.

This basic component of milk production in mammals is termed the Feedback Inhibitor of Lactation (FIL). In Breastfeeding Management for the Clinician: Using the Evidence, Marsha Walker explains, "FIL is an active whey protein that inhibits milk secretion as alveoli become distended and milk is not removed. Its concentration increases with longer periods of milk accumulation, down regulating milk production in a chemical feedback loop."

Unfortunately, when we decrease the demand from the body for milk production by supplementing or putting baby on a time clock (not as much milk is needed to feed baby when s/he is being filled with something else, or when longer intervals pass between feeds) then supply follows the drop in demand and decreases as well. A supplementing mom, or a mother who has been told she should only feed her baby every x number of hours, quickly finds that her milk supply dwindles, and she becomes frustrated and/or sad that breastfeeding "just isn't working out" for her and her baby.

Because of the FIL principle, when products are marketed specifically to mothers who are already breastfeeding their babies, or those who plan to nurse and wish to succeed in doing so, it is an irresponsible and hurtful move to push such items on women already concerned about their babies' wellbeing and their milk supply. Instead, we would empower the next generation of nursing (and pumping) moms, and see more happy, healthy, well-fed babies by understanding and appreciating the FIL process, and encouraging mothers to always listen to their little ones and feed on cue. And in cases where we wish to increase or build milk supply, we must make moves to nurse (and/or pump with a hospital grade pump) completely to empty, at frequent intervals.

When women elect to birth and breastfeed their babies, the female body is a powerfully wonderful, working organism - one which overcomes all kinds of roadblocks along the way. Yet we must provide our bodies with the feedback they need to fulfill what they were designed to do; and in the case of breastfeeding and milk supply, it is all about demand.


Reference:

1) Walker M: Influence of the maternal anatomy and physiology on lactation. In Breastfeeding Management for the Clinician: Using the Evidence. Sudbury, Massachusetts: Jones and Bartlett Publishers; 2006:51-82.


Related Reading:

Breastfeeding Made Simple (book)

The Baby Bond (book with excellent research on breastfeeding, among other topics)

Your Baby's Signs of Hunger (article)

Lactation Cookies: Increasing Milk Supply (article)

Nursing Mother, Working Mother (book)

Balancing Breastfeeding (article)

Making More Milk (book)

The Politics of Breastfeeding: When Breasts are Bad for Business (book)

Formula For Disaster (film)

Using Formula Like 'Similac for Supplementation' Decreases Milk Supply (article)

Breastfeeding Advocacy and Formula Feeding Guilt (article)

Helpful Breastfeeding Books

Breastfeeding Resource Page

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12 Ways to Nurture Babies at Conception, Birth, and Beyond

By Dr. Darcia Narvaez

We foster human potential and optimal relationships from the beginning of life.

Prenatal and Perinatal Psychology (PPN)*

Understanding our earliest relationship experiences from the baby’s point of view and how these experiences set in motion life patterns have been the intense study of the field of prenatal and perinatal psychology (PPN) for over 40 years. The PPN field uses the baby’s point of view to focus on our earliest human experiences from preconception through baby’s first postnatal year, and its role in creating children who thrive and become resilient, loving adults.

Prenatal and Perinatal Psychology incorporates research and clinical experience from leading-edge fields such as epigenetics, biodynamic embryology, infant mental health, attachment, early trauma, developmental neurosciences, consciousness studies and other new sciences.

The Origins of PPN 12 Guiding Principles

In 1999, Marti Glenn and Wendy Anne McCarty co-created the first graduate-level PPN degree programs and opened the Santa Barbara Graduate Institute.  Leading-edge prenatal and perinatal psychology-oriented therapists collaborated in an academic community grant project (funded by the Bower Foundation) to create a set of principles that arose from decades of PPN findings and clinical experience. 

The 12 principles are offered as a beacon to help guide parenting practice, professional practice, theory and research. They support human potential and optimal relationships from the beginning of life, laying the foundation for a new movement in welcoming and caring for our babies. All of us have a part to play.

The 12 PPN Guiding Principles:

1. The Primary Period

The primary period for human development occurs from preconception through the first year of postnatal life. This is the time in which vital foundations are established at every level of being: physical, emotional, mental, spiritual and relational.

2. Forming the Core Blueprint

Experiences during this primary period form the blueprint of our core perceptions, belief structures, and ways of being in the world with others and ourselves. These foundational elements are implicit, observable in newborns, and initiate life-long ways of being. These core implicit patterns profoundly shape our being in life-enhancing or life-diminishing directions.

3. Continuum of Development

Human development is continuous from prenatal to postnatal life.  Postnatal patterns build upon earlier prenatal and birth experiences.

Optimal foundations for growth and resiliency, including brain development, emotional intelligence, and self-regulation are predicated upon optimal conditions during the pre-conception period, pregnancy, birth and the first year of life.

Optimal foundations of secure attachment and healthy relationships are predicated upon optimal relationships during the pre-conception period, during pregnancy, the birth experience and the first year of life.

4. Capacities and Capabilities

Human beings are conscious, sentient, aware, and possess a sense of Self even during this very early primary period.

We seek ever-increasing states of wholeness and growth through the expression of human life. This innate drive guides and infuses our human development.

From the beginning of life, babies perceive, communicate, and learn, in ways that include an integration of mind-to-mind, energetic, and physical-sensorial capacities and ways of being.

5. Relationship

Human development occurs within a relationship from the beginning. Human connections and the surrounding environment profoundly influence the quality and structure of every aspect of the baby’s development.

From the beginning of life, the baby experiences and internalizes what the mother experiences and feels. A father’s and/or partner’s relationship with a mother and baby are integral to optimizing primary foundations for a baby.

All relationships and encounters with a mother, baby, and father during this primary period affect the quality of life and the baby’s foundation. Supportive, loving, and healthy relationships are integral to optimizing primary foundations for a baby.

6. Innate Needs

The innate need for security, belonging, love and nurturing, feeling wanted, feeling valued, and being seen as the Self we are is present from the beginning of life. Meeting these needs and providing the right environment supports optimal development.

7. Communication

Babies are continually communicating and seeking connection. Relating and responding to a baby in ways that honor their multifaceted capacities for communication supports optimal development and wholeness.

8. Mother-Baby Interconnectedness

Respecting and optimizing the bond between a mother and baby and the mother-baby interconnectedness during pregnancy, birth, and infancy is of highest priority.

9. Bonding

Birth and bonding is a critical developmental process for the mother, baby, and father that form core patterns with life-long implications.

The best baby and mother outcomes occur when a mother feels empowered and supported and the natural process of birth is allowed to unfold with minimal intervention and no interruption in mother-baby connection and physical contact. If any separation of a baby from the mother occurs, continuity of the father’s contact and connection with the baby should be supported.

The baby responds and thrives best when the relationship with the mother is undisturbed, when the baby is communicated with directly, and when the process of birth supports the baby’s ability to orient and integrate the series of events.

10. Resolving and Healing

Resolving and healing past and current conflicts, stress, and issues that affect the quality of life for all family members is of highest priority. Doing so before pregnancy is best. When needed, for optimal outcomes, therapeutic support for the mother, baby, and father provided as early as possible during this vital primary period is recommended.

11. Underlying Patterns

When unresolved issues remain or less than optimal conditions and experiences occur during conception, pregnancy, birth and the first postnatal year, life-diminishing patterns often underlay [subsequent] health issues, stress behaviors, difficulty in self-regulation, attachment, learning, and other disorders over the life-span.

12.  Professional Support

These early diminishing patterns embed below the level of the conscious mind in the implicit memory system, subconscious, and somatic patterns. Professionals trained in primary psychology (prenatal and perinatal psychology) can identify these patterns and support babies, children, parents, and adults to heal and shift these primary patterns to more life-enhancing ones at any age. When parents resolve and heal their own unresolved issues from their child’s pregnancy and birth, their children benefit at any age.

The Association of Prenatal and Perinatal Psychology and Health (APPPAH) endorses the 12 Guiding Principles.

REFERENCES

This article comprises excerpts from the official 12 Guiding Principle brochure and position paper co-written by the authors:

McCarty, W.A., Glenn, M., et al. (2008, 2016, 2017). Nurturing Human Potential and Optimizing Relationships from the Beginning of Life: 12 Guiding Principles. [Brochure]. Natural Family Living–Right from the Start: Santa Barbara, CA.

McCarty, W. A. and Glenn, M. (2008). Investing in human potential from the beginning of life: Keystone to maximizing human capital (pp. 12-14). (White paper available at www.wondrousbeginnings.com)

For bibliography, please see:

https://birthpsychology.com/content/birth-psychology-bibliography-classics

https://birthpsychology.com/content/birth-psychology-bibliography-2000-2015

For more information and to obtain the position paper and official 12GP-PPN brochures: see here. Brochures are currently available in English, Spanish, Italian and German and can be shared freely. For other uses of the 12 Guiding Principles content, please contact Dr. McCarty.

*Primary Authors:

Wendy Anne McCarty, PhD, RN, HNB-BC, DCEP, was the Founding Chair and Core Faculty, Prenatal and Perinatal Psychology Program at Santa Barbara Graduate Institute and author of Welcoming Consciousness: Supporting Babies Wholeness from the Beginning of Life–An Integrated Model of Early Development. She currently is a global consultant/educator for professionals and families to optimize human potential from the beginning of life and repair of earliest life experiences at any age.  See: www.12guidingprinciples-ppn.com and www.wondrousbeginnings.com

Marti Glenn, PhD is the Clinical Director of Ryzio Institute, offering professional trainings and intensive retreats to help adults heal adverse childhood experiences and trauma. A pioneering psychotherapist and educator, she was the Founding President of Santa Barbara Graduate Institute, known for its graduate degrees in prenatal and perinatal psychology, somatic psychology and clinical psychology. In her clinical work and trainings, She is an international speaker and trainer, emphasizing the integration of the latest research in behavioral epigenetics, PolyvagalTheory and affective neuroscience with attachment, early development, and trauma.

Both authors are recipients of the APPPAH Thomas Verny Award for excellence in the field of prenatal and perinatal psychology and health.

Related Reading

More on what scholars say about early nurturing here.

How raising babies is different from raising children.

Related Reading by Dr. Narvaez at Peaceful Parenting: 

An 'On Demand' Life and the Basic Needs of Babies

Where Are All the Happy Babies?

The Dangers of Crying It Out

10 Things Everyone Should Know About Babies

Why Keep Babies Happy? A baby's cry is a late signal of discomfort

5 Things NOT to Do to Babies

12 Ways to Nurture Babies at Conception, Birth, and Beyond

Are you treating your child like a prisoner?

Are you or your child on a touch starvation diet?

Conspiracy Thinking: Understanding Attachment and Its Consequences

Psychology Today: Circumcision Series

Learn More from Narvaez:

The Evolved Nest Institute

Kindred Media

Neurobiology and the Development of Human Morality: Evolution, Culture, and Wisdom

💜 Peaceful Parenting Community

💙 Peaceful Parenting on Facebook

💗 Peaceful Parenting on Telegram

Darcia Narvaez, PhD

Darcia Narvaez is a Professor of Psychology Emerita at the University of Notre Dame. She is the founder of the public and professional educational outreach project The Evolved Nest Initiative whose nonprofit mission is to share her science research into developing appropriate baselines for lifelong human wellness by meeting the biological needs of infants. This baseline is imperative at this time as the United States ranks 41st out of 41 developed countries in public policies that support families.

In a 2020 analysis of top scientists, Narvaez emerged in the top 2% of scientists worldwide. Of the eight million scientists in the world, the analysis concerned those who had at least five articles published in scientific journals between 1996 and 2017-- over six million scientists. Individuals were ranked according to various criteria, including number of citations of their work.

Narvaez’s book, Neurobiology and the Development of Human Morality: Evolution, Culture and Wisdom, was chosen for the 2017 Expanded Reason Award from among more than 360 total entries from 170 universities and 30 countries. Narvaez received the prize, including a substantial monetary award, at the Pontifical Academy of Sciences in Vatican City on September 27, 2017. The book also received the William James Award from the American Psychological Association in 2015. 

Narvaez hosted interdisciplinary conferences at the University of Notre Dame regarding early experience and human development in 2010, 2012, and 2014. In 2016 she organized a conference on Sustainable Wisdom: Integrating Indigenous KnowHow for Global Flourishing. (Click on the links to see the full conferences in video on the Evolved Nest's YouTube Channel.)

She is the author or editor of numerous books and articles.

She is the president of the venerable American nonprofit, Kindred World, a contributing editor to Kindred, the first global eco-parenting magazine, an advisory board member of Attachment Parenting International and the Association for Pre- and Perinatal Psychology and Health, APPPAH. 

She is former executive editor of the Journal of Moral Education.

What Are the Benefits of Breastfeeding for Mom and Baby?

Have you been wondering about the benefits of breastfeeding and if breastfeeding may be for you? There is no pressure to decide until your baby arrives. However, the following benefits of breastfeeding for mom and baby may help you make a decision.

The Benefits for Your Baby

Feeding your baby exclusively with breastmilk for at least the first 6 months has positive long term effects lasting into adulthood. Breastmilk grows with the quickly progressing needs of your baby.

Lowering The Risk of Infection

Antibodies from the mother are passed to your baby via breastmilk. This helps when it comes to your baby fighting off bacteria and viruses that can lead to infection.

Obesity

There are bacteria found in the digestive tract of babies that are breastfed. This bacteria is proven to help prevent obesity.

Sudden Infant Death Syndrome

Sudden infant death syndrome affects 1 in every 1000 babies. Breast milk helps boosts brain development, encourages safer sleep and supports suck and swallow coordination. As a result, breastmilk means your baby is at lower risk of SIDS.

Cardiovascular Disease in Adulthood

Baby's that exclusively have a diet of breastmilk from birth to 6 months have lower cholesterol in adolescence, study's show. This leads to reduced chances of cardiovascular disease.

The Benefits of Breastfeeding for Moms

When contemplating breastfeeding, you typically only think about the benefits for your baby. However, there are many health benefits of breastfeeding for moms.

Ovarian and Breast Cancer

While breastfeeding, it is common to shed tissue. This shedding of tissue can remove any DNA cell damage that could be cancerous. What's more, it can also prevent ovulation, reducing the risk of ovarian cancer.

Osteoporosis

New bone is built at a quicker rate when osteocalcin levels are high. While breastfeeding, you lose less calcium in your urine, resulting in an increased level of osteocalcin production.

Cardiovascular Disease

It is unknown how breastfeeding leads to a decrease in the chance of developing cardiovascular disease. However, it's suspected that breastfeeding acts as a reset of the metabolism for the mother's body. Burning the stored fat is essential for the baby's growth.

Benefits of Extended Breast-Feeding

The benefits of breastfeeding for mom and baby can continue when extending the breastfeeding stage for over 2 years. These benefits can vary from reducing the risk of developing maternal diseases, high blood pressure and type two diabetes. For your baby, this can include encouraging brain development and protection from illness.

Common Concerns

A worry for moms can be not producing enough milk to provide for their baby. If this is the case for you it is recommended to start power pumping. As the action of power pumping imitates cluster feeding, it encourages your body to produce more milk.

The Benefits of Breastfeeding for Mom and Baby

Motherhood can be stressful; thankfully, breastfeeding produces the soothing hormone oxytocin. This, along with the listed benefits of breastfeeding for mom and baby featured in this article, is surely a reason to give it a go. 

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Thank you for nursing in public cards to encourage fellow moms at Etsy.

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The Phony Phimosis Diagnosis

By Jennifer Coias, M.D.

I'm writing this article because this is probably one of the most frequent misconceptions that I encounter. It seems that everyone knows of a child or man who 'had' to be circumcised due to a tight foreskin, also known as phimosis. When people hear these stories, most of them do not question the validity of the diagnosis and treatment and simply accept it as, "What had to be done". Could it really be that so many men were designed with such a flaw or is this really just an epidemic of misdiagnosis courtesy of widely foreskin-ignorant medical professionals?

In this article, I will give an overview of the development of the intact male and explain why the diagnosis of phimosis in children and teens is entirely phony. Additionally, I will outline what is true phimosis, its proper treatment, and why our doctors are so confused.

Development of the Prepuce ('foreskin' in males/'hood' in females):

During infancy the prepuce is tightly fused to the glans (head) of the penis. The tissue itself is fibrous and dense at this age, as it is composed of a whorl of muscle fibers. The opening of the prepuce acts like a sphincter and only releases to allow urine to pass. This design serves very important functions:

-It protects the developing penis from feces, bacteria and other harmful pathogens. This is especially important during the diaper-wearing years when a baby is continually exposed to his/her own feces (e-coli and other harmful bacteria/viruses).

-It protects the developing glans and keeps them from becoming desensitized and keratinized.

-It protects against urinary tract infections.

As a child grows, the foreskin will separate from the glans. This can take many years for some boys and for other boys, it seems to happen all at once. During or after the separation process, there may be some shedding of dead skin cells in the form of smegma (please note that women and girls also have smegma). This shedding of dead cells aids in separation since it helps the foreskin differentiate itself from the glans. There is no need to try to clean smegma from underneath a child's foreskin. It will slowly work itself out via the narrow opening. Once a child's foreskin is completely differentiated from the glans this is not an indication that retraction is possible.

Retraction is a separate function that is designed specifically for intercourse and masturbation. Retraction enables the foreskin to glide smoothly over the glans of the penis. This gliding stimulates nerve endings in both the foreskin and the glans. In order for retraction to occur, the foreskin must have separated from the glans and the opening of the foreskin must have widened to allow it to slip back over the glans. How does the foreskin opening widen? Throughout childhood and adolescence, there is a release of hormones. As hormone levels rise, the fiber-dense tissue of the prepuce is replaced with a more elastic tissue. A boy will begin to explore his genitals as he grows and as time passes, the elastic tissue will allow the opening of the foreskin to widen. This can happen at any age but it is not common in young boys. In fact, only 50% of boys are retractable by age ten. The other 50% usually become retractable between age ten and the completion of puberty.

So why all the fuss about retraction? Well, many parents fear that if a boy can not retract, he will get infections. This fear probably stems primarily from misinformation given to them by their doctors and their own fears about lack of hygiene. First, parents must know that there is absolutely no need to clean under a boy's foreskin. As mentioned above, the smegma produced by a boy is merely a shedding of dead skin cells. It is not harmful will not harbor bacteria. Trying to clean under a prepubescent boy's foreskin is the equivalent to trying to wash out a girl's vagina. It is entirely unnecessary and, in fact, harmful. Premature retraction introduces harmful pathogens, disturbs the natural flora, creates scar tissue, damages the intricate structures and can lead to long-term complications. Second, parents must know that retraction of the foreskin is not a necessary function in boyhood. Retraction is specifically designed for sexual relations. The only function a boy's penis needs to perform during childhood is urination. In other words, if a boy can urinate, then his penis is doing exactly what it needs to do.

The Phony Diagnosis:

When a doctor diagnoses a boy with phimosis it is because he/she does not understand the normal development of the prepuce. First, in order to diagnose this condition, the doctor would have had to either try to retract the foreskin or encourage the boy to try to retract his foreskin. This is a huge "no, no" for the reasons described above. Second, there is no expiration date on developing a retractable foreskin. Each boy is individual as to when the separation and widening processes have completed. Just as each girl will begin menstruation in her own time, each boy will experience retraction in his own time. Since hormones play an important role in changing the composition of the tissue of the prepuce, it is not abnormal if the process isn't complete until the finish of puberty. Once an adolescent's foreskin is retractable he can easily retract his foreskin in the shower, rinse with water, and replace his foreskin over the glans. Most men do this naturally during normal manipulation of their genitals while showering. In the case that a boy becomes retractable before puberty, there is no need for him to rinse under his foreskin, unless he so chooses. In the case that an adolescent is not retractable, there is still no need to worry about cleaning under the foreskin. Remember, it is not abnormal for retraction to take until the end of puberty.

True Phimosis:

True phimosis is when a post-pubescent man is unable to retract his foreskin or becomes unable to retract his foreskin and he feels discomfort during sexual activity. A small percentage of men (and women) have prepuces that never retract. This can be a normal variation, so long as it does not impede sexual activity. If it does impede sexual activity then a man should seek conservative treatment. 90% of men with this rare condition can correct the problem with the application of a steroidal cream and stretching exercises. The steroidal cream mimics the effects of puberty hormones and allows the skin to become more elastic. A man usually applies the cream several times a day and uses manual stretching exercises while he showers. Men should be wary of any doctor who recommends circumcision prior to trying a more conservative treatment.

Confused/Ignorant Doctors:

So why are most our nations doctors confused or ignorant as to the normal development of the prepuce? This question has a few answers. First, if we look at the AAP (American Academy of Pediatrics) recommendations, it wasn't until the 1990s that the AAP finally warned against the harms of forcible retraction and outlined the development of the foreskin in the intact boy. Prior to this AAP's warning, it was widely believed that parents needed to retract their intact sons for 'cleaning'. As you can imagine, this lead to many complications for intact boys and resulted in many otherwise unnecessary circumcisions. Second, there was a preliminary study of about 300 boys to determine the average age of the development of a retractable foreskin. This study concluded that most boys will become retractable by age three. This out-dated study set an expiration date in the minds of the medical professionals. A follow up study of thousands of boys concluded that, in fact, only 50% of boys are retractable by age ten. Many doctors, unaware of the most recent study, still operate under the misinformation of the preliminary study. Third, the development of the prepuce is not taught in medical schools. There is no discussion of how the prepuce is structured, how it changes throughout childhood and its protective and sensory functions. Essentially, the only thing medical students learn is how to amputate the foreskin. Some medical students may learn about the condition of phimosis but they are not informed that this only applies to adult men, as children's foreskins are designed to be tight. Fact is, the US medical profession has cut off so many foreskins over the past century that the doctors rarely if ever saw an intact boy and have lost the base of knowledge of diagnosis and treatment. Now, professionals are operating in a vacuum of information or even worse, in an environment of false information. As the nation's circumcision rates have fallen dramatically, intact boys everywhere are suffering the consequences of a widely foreskin-ignorant medical profession. Each year thousands of intact boys between ages two and up are circumcised unnecessarily at the hands of misinformed care providers. Educating parents, doctors and future doctors is an essential step to correcting this problem.

If you would like more information about this topic, please review the following resources.

AAP Guidelines For the Care and Development of the Intact Male

Development of a Retractable Foreskin in a Child/Adolescent

Avoiding Circumcision after the Neonatal Period

Dangers of Forcible Retraction

Protect Your Intact Son, Expert Medical Advice

Answers to Your Questions About Your Intact Son


Also by Jennifer Coias:
The Nuts and Bolts of HIV in the U.S.A. and Why Circumcision Won't Protect Men


Learn more:

Intact Care Resource Page

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