The Stages of Lactation
One of the first things I learned during my training to become an International Board Certified Lactation Consultant (IBCLC), was the stages of lactation.
As a lactation expert, it made sense to have to learn the ultra-clinical aspects of breast development, how milk composition changes throughout lactation, and the 'benefits' of human milk from various stages.
But why would YOU, a new parent, even need to consider the stages of breastmilk?
Here's a quick list that I've come up with:
For reassurance that the milk consistency and volume you're seeing is normal
To know what to expect during the first few weeks after delivery when things are rapidly changing
To understand the importance of human milk at every stage of lactation
To know what choices and when, such as feeding frequency, will influence milk supply and when it won't
To develop a plan if you plan on not breastfeeding or weaning in the first couple of weeks
This post aims to provide you with the bare minimum information you will need to know as you start your lactation and breastfeeding journey.
The topic of lactation is a topic I could go on about for days, but I will contain myself...
Stage 1: Colostrum Phase
Colostrum, aka super-concentrated breast milk, is made during the first stage of lactation.
Before your baby is born, your body has been hard at work producing colostrum and storing it in your mammary glands (breasts) for your baby's arrival.
You may have noticed leaking of colostrum throughout your pregnancy- usually a clear or yellowish thick, sticky fluid.
If you haven't noticed colostrum, don't worry! Leaking or not has no bearing on your ability to breastfeed, and rest assured, the odds are very high that your breasts are putting in the work!
Colostrum production is under Autocrine control, which means it's made whether or not milk is removed and is entirely hormone-driven. This automatic production will continue throughout the first couple of days after delivery until your milk begins to increase in volume (milk coming in).
Stage 2: "Demand-and-supply"
There are technically 2 stages of lactation that fall under the "Demand-and-Supply" phase. There is some overlap as it's a gradual switch from solely hormonal control to exclusively "demand-and supply" control.
If you were wondering, no, "demand and supply" is NOT the scientific names we use in the lactation industry. These two stages are considered Lactogenesis II and Galactopoesis (Lactogenesis III).
Lactogenesis II is the onset of copious milk production- so the switch from the low volume of colostrum to the increased volume of "regular" human milk. This change in volume (known informally in parenting circles as milk coming in) usually occurs around day three but may happen later.
Symptoms of “milk coming in”
The rapid increase in volume is usually preceded by the popping up of fun symptoms such as heavy and full feeling breasts, increased breast warmth, not fitting into any bra you own, and some breast discomfort.
The fullness typical of "milk coming in" is not necessarily due to the increase in volume- in fact, as mentioned, the symptoms often occur before a noticeable increase in milk volume. The wonderful and universally appreciated symptoms (sarcasm) are due to hormonal and physiological shifts that increase fluid between cells (interstitial fluid) in the breast.
If you're feeling super full even after feeding or expressing during this couple day phase, you can thank your interstitial fluid. Those who received IV fluids during their labor and delivery may have more severe fullness.
If your breasts feel as firm as your forehead, breast pain becomes severe, or you can no longer remove milk, contact an IBCLC immediately.
2. Galactopoiesis (Lactogenesis III) is the maintenance of milk production.
So while you may be in the Lact II stage during the first few weeks after delivery, by the time you've reached three months of your breastfeeding journey, you well in Lact II.
Confusing, I know! Here's the important thing to remember:
After the colostral phase, milk production is "Demand and supply."
This means that frequent and effective milk removal IS REQUIRED to maintain supply.
Too little stimulation and milk removal in the early days will prevent you from reaching your maximum production potential over the lifetime of lactation. If too little stimulation continues, it may lead to a decrease in milk supply.
The inverse is also true. Increasing stimulation or adding additional stimulation and milk removal will increase milk production.
If you have supply concerns, a simple first step fix attempt includes increasing stimulation and milk removal.
There are cases when parents may overstimulate their breasts, leading to massive, unwanted supplies. If you're breastfeeding on demand (as your baby cues) or expressing in place of a missed feed or due to poor transfer, the risk of "oversupply" is low.
Additionally, it's worth noting that oversupply is subjective- some parents have massive supplies and are perfectly happy as their goal is to donate. To them, this would be an optimal supply. Similarly, a parent feeding multiples would need double the "normal" production for one baby and would not consider their milk supply an oversupply.
It gets a bit complicated, but I digress...
During the duration of lactation, milk components change in ratio, so there are differences in milk composition based on the stage of lactation.
The topic is fascinating, so I may make a post in the future about it, but the important takeaway is that at every stage of lactation, human milk is amazing and has a significant impact on infant health.
Involution aka Drying up
There comes a day when human milk is no longer present, needed, or desired.
For some, this stage comes sooner than anticipated, while for others, this may occur intentionally soon after their baby arrives.
Here are things to remember about the stages so far:
Colostrum is present soon into the pregnancy and is available for your baby on the day they arrive. Your body will produce colostrum automatically for the first couple of days.
An increase in milk volume (aka your milk coming in) is automatic and will occur regardless of whether you breastfeed or not.
Not removing milk frequently during the first few weeks will lead to a decrease in supply and potentially complete involution.
If you desire to wean, once your milk volume increases, gradually reducing the frequency and completeness of milk removal will get you to your goal reasonably quickly.
Some parents who don't desire continued lactation will skip any milk removal altogether, which certainly will lead to drying up, but also may come with complications such as pain and mastitis.
For this reason, professionals suggest a gradual decrease in milk removal over the course of a couple of weeks to maintain optimal breast health.
If you notice your supply decreases despite frequent and effective milk removal or if you never see an increase in milk volume, there may be medical causes at play. Booking a visit to explore the possibilities and get you the appropriate care will be super helpful.