You will have to remove milk from your breasts on a regular basis if you are to provide enough of your milk for your high-risk baby. Many mothers find they develop a better plan for expressing milk from their breasts when they understand how breast milk is produced. Initially, hormones play a greater role, but milk removal has a greater effect on the amount produced after the first one or two weeks after delivery (postpartum).
After a baby's birth, the placenta is expelled, which signals a drop in the hormones that maintained the pregnancy. The sudden drop in these hormones allows the hormone prolactin to begin working. Prolactin "tells" the breasts it is time to begin producing large amounts of milk. A mother feels the result of prolactin when her milk "comes in" at around three to five days postpartum. Increased milk production usually occurs at this time even if a baby is born extremely preterm. However, frequent milk removal sometimes speeds up the process of establishing increased milk production. Occasionally, a mother experiences a delay in the production of large amounts of milk.
Ongoing, long-term milk production depends mostly on milk removal. The more often milk is removed, and the more completely it is removed, the more milk the breasts make. The opposite is also true. When milk is removed less often, or an insufficient amount is removed, the breasts get the signal to slow milk production and make less. Milk removal occurs when a baby effectively breastfeeds or through appropriate milk expression.
Effective breastfeeding requires effective sucking by the baby so that enough milk is transferred from the breast into the baby's mouth where it is swallowed. To suck effectively, a baby must latch deeply onto the breast and use the structures in his/her mouth to create intermittent (periodic) suction and compress the milk sinuses (enlarged area of milk ducts) lying beneath the areola (the area about 1 1/2 to 2 inches behind the nipple tip). Proper sucking signals the mother's body to release the hormone oxytocin. This results in greater transfer of milk with the milk-ejection reflex (MER), or milk "let down."
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Milk transfer also can be accomplished through milk expression techniques. Generally, the milk-ejection reflex is triggered during milk expression sessions, especially if frequent and regular sessions occur. These include the following:
- manual expression - a mother compresses the milk sinuses by hand to remove milk.
- breast pumps - remove milk by creating suction; a few also have features that compress milk sinuses to some degree.
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