possible to alter circadian rythm of milk production?

[@llli*juniper]

Hi! I am breastfeeding a 3 month old little girl, and I have enough milk. The issue is, I have much more milk late at night/early morning (my breast is often very full/engorged at 03 am and 09 am), while I am quite empty in the evening, when she is actually hungry and wants to cluster feed to "fill up" for the night. So, I hand express every morning to collect my night-milk (ca 100 ml), and I give it to her in a bottle the evening. This works ok, but it's a waste of time for me. I wonder whether there is a way to shift my higher milk production to the evening, to produce milk when she needs it, without the need to hand express and using bottles. Suggestions anyone? She feeds 6 times in the 24 hr, and sleeps well at night. The typical feeding shedule is: 09:00, 12:00, 15:00, 18:00, 21:00, 03:00. Thanks in advance.

[@llli*maddieb]

Hi juniper, welcome to the forum. Congratulations on your baby.

Many- probably most- mothers seem to have more milk production in the very late night and early morning and less in the late afternoon and evening. In other words this is the biological norm. I know of no way to change this, unless possibly (and theoretically) if you changed your entire schedule so you slept during the day and were awake overnight. I imagine this is not what you are wanting to do!

Because it is so common, it is assumed that this pattern serves a biological survival purpose- and in fact the milk is available exactly when baby needs it in the appropriate amounts. Probably the purpose is that this situation keeps baby close to mom and nursing at the most vulnerable times of the day...evening and nights. (Such a survival strategy would have developed over hundreds of thousands of years when humans were nomadic hunter-gatherers and presumably the babies who survived and thrived were the ones kept very close to mom at all times.) A baby who holds onto mom and nurses and nurses all evening is likely to be held by mom as mom falls asleep. A mom feeling full in the middle of the night would cause her to pull baby close to nurse.

Another possible cause may be more directly physical and to do with mom's body and milk production. The breast getting very empty is what tells the body to make more milk. When a baby cluster nurses in the evening, as is typical, baby is emptying the breast and stimulating the breast and telling the mom's body to make more milk! Then while mom rests at night and is not expending as much energy elsewhere, that is a time her body can use more energy to make more milk in response.

In any case, the low in the evening, full in the morning feeling is very common, in fact pretty much universal. In you case, I think there may be an exacerbating of any problems this normal pattern of production causes because baby nurses fairly infrequently overall and because 12 hours is a very long time for baby to not nurse.

Here is what I would suggest.

Even if baby is getting enough milk to gain normally now, most babies need to nurse more than 6 times in 24 hours and most moms need at least 8 expressions of milk per 24 hours to keep milk production in good shape for the entire time they plan to nurse baby. So your body may just be telling you to encourage baby to nurse more often overall. While some babies nurse very regularly just on their own, most do not. Feeding schedules that reduce overall nursing frequency has been shown to be harmful to mom's milk production and to breastfeeding longevity for other reasons as well.

Many 3 month olds nurse several times overnight and very few would go anything more than 6 or 7 hours without nursing. So maybe you could try things that might encourage more nursing in the night and early morning and get relief from the engorgement that way.

To start you might try taking away or decreasing any sleep lengthening techniques you are using. A top off bottle in the evening is a method to lengthen sleep and of course would tend to interrupt the normal eating pattern. Unless your baby needs more milk to gain normally than she can get at the breast nursing with normal frequency, she does not actually need that top off bottle. Other things that cause a baby to sleep longer than normal are pacifiers, swaddling and baby sleeping in a separate room from mom or away from the hustle and bustle of the household. So simply eliminating or reducing the bottle and those practices (if you use them) may encourage baby to nurse more overnight. If needed, in order to actively encourage a baby to nurse more overnight, sharing a sleep surface with baby or simply offering to nurse at night, rather than expressing, often works.

[@llli*juniper]

thanks a lot - I enjoyed particularly your "evolutionary" perspective on breastfeeding! However, there are some misunderstandings - I apologize for not being clear enough.

You write "12 hours is a very long time for baby to not nurse". I would agree, but this is not my case! There have never been 12 hours between nursing sessions!! Baby feeds more or less regularly every 3 hours during daytime, and every 4-6 in the night. In the evening she breastfeeds around 18:00 - often for quite a long time - and then again around 21:00. The problem is that in the last evening feed (at 21:00) my breast is often empty or not full enough, and therefore I have to give her also the milk that I hand expressed earlier in the morning (if not, she would cry for food). Then, we both go to sleep, and she eats again without any problems around 03:00, 09:00, 12:00, 15:00, 18:00.... until 21:00, when we enter in the same issues as the evening before.

Note that I don't use any "seep lengthening techniques" - baby always decides when she's hungry, day and night. I do not use pacifiers, and she sleeps in "babybay original" cot attached to our bed in the night, and naps in a crib in the living room in the day. The bottle I give her in the evening is not aimed at making her sleep longer in the night, but only at giving her what she wants/needs, as by evening time (21:00) my breast does not provide the milk she wants/needs (by that time often I have only 40-50 ml left). I should mention that I know quite precisely how much milk I produce/she drinks, as I often weigh her before and after feeding (this is to make sure that she gets enough milk, as in the first 2 months I did not have enough and often needed to supplement a bit with formula; now I don't need formula any longer).

This being said, do you still think that 6 feeds in 24 hrs (she gets ca 120-30 ml per feed) is too little? And that she should eat more often than every 6 hrs in the night?

In addition to breastfeeding her 6 times in 24hr, I am also hand expressing ca 100 ml around 10:00 in the morning, after she finishes eating - which I put in the fridge and give her later on, in the evening.

I hope my problem is clearer now.
Thanks again for your attention!

[@llli*maddieb]

You write "12 hours is a very long time for baby to not nurse". I would agree, but this is not my case! There have never been 12 hours between nursing sessions!!

Oh ok. got it, sorry.

This being said, do you still think that 6 feeds in 24 hrs (she gets ca 120-30 ml per feed) is too little?

Yes, in most cases that would be too little. Please understand I am not saying your baby is getting too little to eat overall. Assuming baby is gaining normally that means she is getting enough- right now, or up to this point. And in some cases that would continue to be true, because some moms have a very high breast "storage capacity" and in those cases baby gets a large meal whenever baby nurses and mom does not get very full between nursing sessions (the full feeling tells the body to reduce production.)

But it is still "better" overall if a baby nurses more often in almost every case...In fact cannot think of a reason it would not be. Here is why. A baby nursing more frequently prevents mom getting uncomfortably full, and promotes continued normal milk production longer term. Also the more a baby nurses for other reasons than food (nurses to sleep, nursing for comfort) the longer the breastfeeding relationship continues. When you hear about babies who stopped nursing against mom's wishes, especially when it happens before a year, in most cases those babies were nursing on the lower side of normal frequency before they started refusing to nurse.

To look at it another way, your 3 month old is "eating" 6 times a day. So where are you going to go from there? The average 3 year old also eats 5 or 6 times a day.

And that she should eat more often than every 6 hrs in the night?

I think ONE 6 hour sleep stretch or even a little longer with no nursing in 24 hours is fine for many babies, as long as their overall nursing frequency is enough. But I also think it would be perfectly normal for a 3 month old to need to eat more often and not yet take a 6 hour stretch. And of course some babies take those long stretches at some point and then later start waking and wanting to nurse more at night later on. But it is too individual to say what 'should" be happening in your case.

However since you have had issues with producing enough in the past, I do think it would be wise to encourage more overall nursing frequency if only for that reason. Overall means you could encourage more nursing frequency when you are awake!

I am not saying you should nurse 10 or 12 times a day, although many 3 month old babies will nurse that often and more and it is entirely normal. I am not putting a number on it because each situation is unique. Also it depends on what baby has to say about it. But perhaps baby would be willing to nurse more than 6 times if encouraged to do so, and if so, this is not going to hurt anything and may well help.

The bottle I give her in the evening is not aimed at making her sleep longer in the night, but only at giving her what she wants/needs, as by evening time (21:00) my breast does not provide the milk she wants/needs (by that time often I have only 40-50 ml left).

Yes, I realize the bottle is not meant to make her sleep longer- but the fact is it might, because that bottle changes her normal internal hunger cues. If you were to eat a midnight snack, you might not be as hungry at 6 am as you would if you did not. The same idea holds true for babies.

Many moms with a baby who wants to nurse a lot at night/evening and is fussy etc. assume they cannot meet baby's needs at that time and so think baby requires supplements (any meal, whether breastmilk or formula in a bottle is "supplemental" for a breastfed baby). But this is not how it works. There is no such thing as part time low milk production. Either a mom makes enough overall for her baby, or she does not. If she does, assuming baby nurses often enough, baby will get what baby needs at the breast just fine and there is no need for bottles or pumping. If she does not, not only will a baby need supplements but the problem of low milk production will need to be addressed, first and foremost, by increasing how often milk is removed from the breasts. And usually the easiest way to do that is to encourage baby to nurse more often.

And if you and baby can increase how often overall baby nurses, that evening bottle should not be needed at all. (If it even is, at this point.) You might even see an increase in your evening production if baby started nursing more often overall. But that does not mean you will not still have a baby who is fussy and needing lots of comforting at the breast or otherwise in the evening and at night. This is normal and common behavior.

You do not have to take my word for this stuff, it can get a little confusing and I may not be explaining it well. Kellymom.com has several excellent articles on milk production and how it works. For more about breast storage capacity you can look at Nancy Morhbacher's blog.

[@llli*juniper]

Thanks a lot, I get your point about the importance of feeding more frequently. I'll do my best!

This suggestion however brings me to mention another (big..?) issue: my little one actually feeds for at least an hour at a time! That is, at least 30 min per breast. Hence, you see that there is a limit to how much more frequently she could feed. Of course I'd like our nursing sessions to be shorter and more efficient.. but I don't know how to do that.

I thought that the reason is that I had a very slow let down. I never "leak", and when I hand express or pump (vigorously), it takes at least 30 min for me to produce ca 100 ml. However lately I'm not so sure any more about the slow let down hypothesis... actually, at times it seems that it is too fast - she pulls off and gets angry. So, I'm confused. Another hypothesis is that maybe she's laying to comfortably on the pillow, and therefore she takes it too easy and does not suck at "full speed"? I just got a ring-sling, to try to keep her more alert (i.e. a bit more uncomfortable) while eating - hoping to speed up the process. Let's see if that works.

Well... suggestions are welcome, again!
Thanks once more!