The importance of early and frequent milk removal

The quantity of milk expressed right after giving birth plays a crucial role in your future milk production levels. 

Studies on lactation post-premature delivery indicate that initiating milk expression within the first hour after birth, as opposed to waiting six hours, leads to a higher milk supply at six weeks postpartum.

If your infant has any risk factors that may affect their ability to feed efficiently initially, such as being born prematurely, being small for gestational age, unwell, jaundiced, sleepy, or separated from you, it is important to begin expressing milk early and frequently.

This will help ensure an ample milk supply to meet your infant’s current and future intake requirements.

Women with risk factors for low milk supply can help their milk production by expressing milk early and frequently after giving birth.

These risk factors may include:

- Previous history of low milk production

- Previous breast surgery

- Polycystic ovary syndrome (PCOS)

- Thyroid problems

- History of infertility

- High BMI

- Insufficient Glandular Tissue (Breast hypoplasia)

Mothers who have these risk factors may still be able to make a full or partial milk supply.

The extent of their milk production capacity may not be known until their milk supply is established.

Following your infant's initial feed and a brief period of sleep, healthy, full-term newborn infants will typically feed frequently throughout the day and night.

In the early weeks, most infants will feed at least 8-12 times within 24 hours. During these feeds, infants should be actively sucking and swallowing to transfer sufficient milk and stimulate milk production. If your infant is not feeding as frequently as this, it is very important to express your milk to achieve a full milk supply.

As milk accumulates in the breast, a protein called the "Feedback Inhibitor of Lactation" (FIL) begins to slow down milk production. When breasts are full, milk production slows and may eventually stop altogether. This is why we see well-drained breasts producing milk more efficiently.

It is essential not to wait until your breasts feel full before feeding or expressing. Delaying this process can lead to a decrease in milk production over time.

Recommendations to promote an adequate milk supply include immediate skin-to-skin contact and milk removal (through breastfeeding or expressing) within the first hour of birth, as well as frequent milk removal during the initial 24 hours after birth.

Research has shown that early initiation of lactation, particularly breastfeeding or expressing within the first hour of birth, can result in a higher rate of continued breastfeeding beyond six weeks for full-term infants with skin-to-skin contact between the mother and infant in the first hour after birth being linked to earlier successful breastfeeding and an increased likelihood of breastfeeding between 1 and 4 months postpartum.

The frequency of breastfeeding within the first 24 hours postpartum has a positive impact on milk production on days 3 and 5 after birth telling us the importance of knowing if milk production is adequate during early lactation.