Dance of the hormones

Hormones bring messages to our breasts, through our blood-stream. They switch on our breasts to create milk; and build up milk supply. Learn how to start and keep milk flowing!

Some people think of hormones as something bad: intruders who move into our bodies and take control; strangers who make us grumpy before periods start each month, or while we’re pregnant, or around menopause. The reality is more complicated – our bodies rely on hormones every day to make all our systems work. When we tune in, we enjoy our bodies’ amazing powers. Living out of tune with our bodies can make us suffer.

Hormones are often called chemical messengers. Messages nowadays land with a beep in our mobile devices. The hormones of breastfeeding are those involved in love, friendship and affection. They play together like musicians and dancers.

Prolactin, the milk-making hormone

This is the music that plays quietly all through pregnancy: prolactin is in our blood but our breasts are not ready to receive it. The hormones in the placenta block milk production until the baby’s born. There’s a sensitive part on the outer edge of every milk-making cell called a prolactin receptor. It’s closed off while the placenta hormones are circulating in the mother’s blood stream. When the placenta is delivered, these receptors wake up, throw away their ear-plugs and listen to the music of prolactin; they welcome it through into the cell, where it starts up milk production.

After that, every time prolactin’s tune is heard in the pounding of the blood, those cells make milk. If they go a long time without hearing their favourite song, they close down, cover their ears, fall asleep – and even die off. They won’t awaken until the next pregnancy. The first two or three weeks are the crucial time for the cells to be activated and stay in production.

A mother needs to flood her body with prolactin day and night for the first couple of weeks of her baby’s life. Fortunately, her baby knows this too and comes ready to snuggle on mum’s chest and feed as often as possible, day and night. He’s understood the words of prolactin’s song: he knows that his wonderful mother can only release prolactin when she feels that warm soft skin next to hers, and especially when she feels her baby suckling at her breast.

The nerve endings in the skin of her chest, nipple and areola react to her baby’s touch; they send messages to her brain (pituitary gland) and the brain sends out prolactin through her blood-stream. When it reaches the breast, milk-making starts. It continues after the feed ends too, rising to a glorious crescendo about 90 minutes after the start of a feed, in preparation for the next feed.

Our milk-making response to prolactin is most effective at night (between midnight and 5am, roughly.) Perhaps our bodies can hear the music better when there aren’t too many other noises going on.

Oxytocin – the hormone of love

Here comes a chemical messenger, sashaying through your blood stream like a gorgeous belly-dancer, bringing warm and tender feelings: and causing muscle squeezes as she goes. In labour, oxytocin makes the womb contract, and it floods the mother’s body for an hour or so after the birth.

Inside the breast, muscles wrap around each of those tiny milk-making cells, and round every duct small and large. The wrapper muscle fibres react to oxytocin when it reaches them through the blood: they squeeze those little pools of milk out of the cells, into the ducts, down through the ducts, out through the nipple. Each little shimmy of oxytocin causes another squeeze. It doesn’t stay though, once the stimulation stops (unlike prolactin). With a little backward glance, she dances off – until the next time. Here’s a lovely photo of Belly-Dance Instructor Rachel Walker, photo by Sonia Florent.

You make oxytocin in your brain (the back part of your pituitary gland) in response to love and tenderness, and especially the soft feel of your baby’s skin against yours. The sensation of your baby suckling at your breast sends oxytocin swirling through your arteries and veins. To get the milk flowing freely, we need a baby working well at the breast, not causing any pain for the mother, and removing milk effectively.

The let-down reflex

We call the rush of oxytocin that squeezes milk through the breast the ‘let-down reflex’, or ‘milk ejection reflex’. Mothers don’t usually feel it in the first couple of weeks of breastfeeding, but when we do it can be felt as a tingle. Some women feel it strongly, others hardly at all.

You may find the milk starts to flow when you see your baby or smell his head or hear his little noises – this is oxytocin delivering milk in anticipation of the baby coming to the breast.

Often, you can see a let-down happening as the baby feeds: he sucks quick quick quick, swallow, quick quick quick – and then suck-swallow, suck-swallow, suck-swallow – pause. That suck-swallow is caused by a let-down reflex or pulse of oxytocin rushing through the breast and pushing milk out. If the baby’s well attached and not causing pain, he can provoke another let-down reflex during the same feed, and another, until his tummy’s full. (This is less obvious in the first day or two, when the early milk is still low-volume and the baby’s learning along with you.)

Oxytocin is also involved in love-making and orgasm, but that’s another story. Breastfeeding feels pleasant and relaxing for the mother – when it’s working well and she’s feeling confident about it, which may not be in the first few days! – but it’s not the same as the intensity of making love.

How partners can help

One side-effect of an oxytocin rush is mouth dryness. The person who brings the mother a drink as she sits down to feed supports this loving interaction in a simple but effective way.

Partner, you can sit down with your arm around the shoulders of the mother or feeding parent and gaze lovingly at the baby. This way, you take part in the feeding process by enabling the let-down reflex, helping relaxation for all.

How your baby can help

That soft skin… stroking and cuddling your baby will give you a rush of oxytocin. The smell of your baby’s head as you nuzzle…the beauty of his eyelashes, toenails, ears… these all trigger the hormones of breastfeeding. When you take time to get to know each other, you are allowing your baby to affect your hormones and build your breastfeeding experience.

The first hour after birth is a great time to snuggle your baby skin to skin. You’ll have lots of oxytocin circulating, making your early milk available for your baby. If he feeds well then, he’ll get a nice meal and then sleep for a few hours.

If you’re not able to feed him in that first hour,

you can hand-express colostrum (early milk) for him in the first two hours after the birth when it’s plentiful – you may get several mls (millilitres) for him. He can have this life-saving colostrum by tube if he’s not able to suckle yet. Asd soon as you can be together, you can re-create your skin-to-skin experience: baby in just a nappy, against your bare chest, with a blanket over both of you. The oxytocin may not be flowing so freely as right after birth, so you may need more relaxing and snuggling time to get it going.

How often does a baby need to feed in the beginning?

When you can feed your baby often during the first two weeks, day and night, you build up your milk-making cells, keep them switched on, and prepare them to stay active throughout the time you breastfeed your baby. ‘Often’ means more often than you – including every drink of water, cup of tea, snack or meal.

Your baby may request a feed by giving you cues, or he may be sleepy because of jaundice or illness. You may need to wake him to feed in the first week or ten days, until he’s more alert. Consult with your health care providers if your baby is poorly. Don’t hestitate to get help quick if your baby ever seems unresponsive.

If your baby is ill, or you are

If you can’t have your baby at the breast every couple of hours, you’ll need to give the same messages to your breasts to start making milk. You can hand-express your milk in the first few days, while you make colostrum, the early milk. As your milk becomes more plentiful (usually around day 3 after the birth, sometimes day 4 or 5, sometimes day 7), you can use a breast-pump to mimic the baby’s action at the breast.

If you’re too ill to express, maybe your partner or a staff member could do it for you? You’ll need to put this request in your birth plan if you’d like to be prepared for all possibilities! Both hand expression and pumping are good ways to get prolactin circulating in your blood-stream, if feeding at the breast is not yet possible. As soon as you can hold your baby and snuggle him skin-to-skin, your body will tune in to your baby even better.

If your baby is close by day and night, you’ll hear his snuffles as he starts wanting to feed, and you’ll be able to smell his individual scent. Your body will start producing prolactin and oxytocin even before you pick him up, reacting to the baby by preparing his milk, even if you’re sleepy.

What if it’s not working?

If your baby’s mouth action causes nipple pain:

oxytocin won’t flow so well. The muscles inside the breast won’t squeeze efficiently. Milk won’t flow out so well. Frustration.

Can we fix it?

If there’s pain when the baby latches on, something needs to change! Get some clues here and get help. It’s not supposed to hurt! First help didn’t work? Find more help! If somebody says: ‘The latch looks fine’ but you feel pain or discomfort, you can smile, thank them, and find somebody with more training. If you are in hospital in the UK, ask for the Infant Feeding Specialist Midwife. In the USA, ask for a Lactation Consultant IBCLC. Community helpers are often called the Infant Feeding Team. If these good people are not able to help, or not on duty when you need them, or it’s still hurting, it’s time to call the experts!

Feeling tense?

What new mum or parent isn’t! Tension and worry can block the flow of oxytocin:

adrenalin, the fight-flight-freeze hormone. If there’s danger, we shouldn’t sit down to feed a baby, we should run!

Here are some easy things you can do to tell your body everything’s ok:

You can close curtains, turn off bright lights
get warm, including your feet
have a drink handy
get your tv remote, phone, magazine, book, whatever you need to help you relax
make sure your feet are supported so you’re not perching on your toes
get some cushions or a rolled-up towel to support your elbows
have a cry if you feel like it. A cry is not a break-down.
If somebody you trust is around, ask for a back-rub, in between your shoulder-blades. Aah, just there.
Deep, slow breathing, with a sigh on the out-breath
Snuggle your baby on your chest and feel his soft head against your chin. Smell the back of his neck. Smooch his cheeks, Talk silly talk to him.

What if you’re adopting your baby?

Adoptive mothers can sometimes build up a milk supply by pumping, even if they have never had a baby themselves. It’s the prolactin that causes the milk-making glandular cells to grow, and it’s the suckling (or pumping) that makes the prolactin. So if you’ve missed out those vital first two weeks – maybe you can still build up a milk supply: it might not be a full supply but every drop you make for your baby is vital.

Or if you stopped breastfeeding in the early days and want to re-start?

Here’s some great information about relactation and induced lactation

Emergency situations

If you’re working with mothers and babies in emergency situations, information is available to support breastfeeding and re-lactation from the Emergency Nutrition Network (ENN).

What are the formula companies up to?

They want you to think your body is not competent, powerful and able to make milk. They want you to think that pain cannot be resolved and nobody can help you. The companies tell us the only answer is to stop breastfeeding …. Look out for their weasel words that undermine your confidence! Catch them at it, then they won’t get to you. We can help each other!