As part of World Breastfeeding Month, we’re diving into key topics that come up frequently for new parents. In this post, Leanne O’Connor, a registered nurse, midwife, and lactation consultant (IBCLC), sheds light on the often-confusing subjects of cluster feeding and low milk supply. With her expert guidance, we hope to provide you with clarity on these important issues and offer tips for navigating them.
Cluster Feeding vs. Low Milk Supply Explained
Firstly, it helps to understand the basics of demand = supply. The more your baby breastfeeds or the more your breasts are emptied, the more milk is made. We know that a healthy term baby, as a newborn, will feed on demand very frequently until milk supply is established. This time can vary from a few days to a week, depending on how often and how well the breast is emptied.
Once that supply is established, for a short time, there can be too much milk. Then usually with easier access to more milk volume, and your baby’s tummy capacity becoming larger, the time between breastfeeds lengthens. If baby continues to breastfeed on demand, milk supply will regulate.
Cluster feeding
WHAT IT IS:
Cluster Feeding is when a baby wants to breastfeed frequently. This can be over several hours. It often happens in the late afternoon or evening but can be any part of the day or night. It can seem like the breasts feel “empty” and your baby is feeding, not settling, and then showing feeding cues again after a short time. This can feel exhausting. Rest assured that when breasts are emptier, production increases. The fat content of the milk is low when the breast is full and high when the breast is drained. The average 24-hour fat consumed by the infant is not related to the frequency or length of breastfeeds.
Breastfeeding this way is a completely normal. Babies do this to naturally continue to drive milk supply to meet their growing needs.
SIGNS OF CLUSTER FEEDING:
- Breastfeeding very frequently over a few hours somewhere in a 24-hr period
- Can occur at certain predictable times of day
- Mostly content & settled between feeds outside this time
- Gaining weight and growing well
- Adequate Output: > 5-6 heavy wet disposable nappies in 24hrs (after 5 days of age) Urine should be pale and odourless. In the 1st 6 weeks of life after milk transitions, bowel actions should be 2 or more soft loose mustard (sometimes green, brown, orange). After 6 weeks bowel actions can be variable.
- Can sometimes occur when:
- it is warm weather,
- if baby is unwell,
- or if there has been a recent healthy growth period (almost like they have put their order in for more milk please!)
WHAT TO DO:
- Feed on demand
- Stay hydrated
- Try to rest when you can
- Remember this is how your baby naturally increases your milk supply
- Topping up with large volumes regularly instead of allowing baby to cluster feed means less stimulation to the breast which can then decrease your milk supply
Low Milk Supply
WHAT IT IS:
This is when your body isn't producing enough milk to meet your baby's needs consistently.
WHY IT HAPPENS:
It can be due to many reasons some of which include:
- Not breastfeeding/emptying the breast frequently enough
- Poor attachment/expressing with ill-fitting equipment
- Topping up/supplementing early and often
- Conditions for Mum which can include large post-birth blood loss, hormonal imbalances, retained placenta, insufficient glandular tissue (IGT)
- Conditions for Baby which can include jaundice, prematurity, infection, oral restrictions
- Certain medications or birth control
SIGNS OF LOW MILK SUPPLY:
- Baby isn’t gaining adequate weight
- Baby seems persistently fussy or unsatisfied after feedings (not just at certain times).
- Fewer than 5-6 heavy wet nappies per day after day 5
- Short or very sleepy feeds that don’t seem effective (watch for signs of letdown, strong suck and swallowing sounds)
- Little breast fullness or changes during feeding (breasts should feel softer post feeds)
WHAT TO DO:
- See an IBCLC- this is a common issue that we provide support with.
- Ensure proper latch so that there is adequate stimulation and emptying of the breast.
- Breastfeed/express frequently - you may be advised to feed/express at least 3-hourly if your baby is not demanding before this time.
- Breastfeed/express at night when milk making hormones such as Prolactin are at their highest concentration.
- As well as Breastfeeding, express after feeds for extra stimulation of the breast
- If you are expressing after feeds or exclusively expressing it is essential for you to have the correct size flange/flange insert as this will empty the breasts more effectively. Poorly fitting equipment can decrease milk supply and cause damage to your nipples
- Rule out any medical causes with your IBCLC
- Medication (Domperidone) may be option - discuss this with your IBCLC
- Eat a healthy well-balanced diet and drink to thirst. Whilst breastfeeding can increase your thirst, there is no evidence to suggest that increasing mum’s fluids will increase supply.
- A breastfeeding plan such as “triple feeding” where there is a breastfeed, a top of breastmilk/formula and then expressing will require close monitoring including regular weigh ins for your baby on the same consistent set of scales for true accuracy.
- Increasing the number of feeds and ensuring your baby attaches correctly and draining off the breast well are fundamental to increasing supply
About Leanne
Leanne O’Connor is a Registered Nurse/Midwife of 25 years and an IBCLC since 2018. Her private practice is Care Lactation. Located in the Southwest Victorian regional town of Warrnambool, Leanne travels up to 100km supporting rural families.
Phone/virtual consults are also available. Leanne was inspired to become an IBCLC after experiencing feeding challenges with her own 3 children now aged 20, 17 & 14 years.
References
Brodribb, W. (2012) Breastfeeding Management in Australia, Australian Breastfeeding Association.
Lauwers J & Swisher A (2021) Counseling the Nursing Mother - A Lactation Consultant’s Guide, Jones & Bartlett Learning.