Initiation and Coming to Volume: What Powers Breastfeeding in Your Patients
Evi Dewhurst / July 2017
Breastfeeding: it should just work for your patients, right? This oldest infant feeding activity should be as simple as a twenty-first century gadget that functions right out of the box. Plug and play, as they say. Yet sometimes the experience is less than user friendly.
Strangely enough, however, breastfeeding does have the equivalent of a new gadget installation. Allow me to elaborate.
While the process can be amazingly complex, there are two primary postnatal events that act as sources of connected power for successful breastfeeding: initiation, and coming to volume (build milk volume). These two events are like 1) connecting a new gadget to internet Wi-Fi, and 2) syncing a gadget with its new app.
Understanding these basic power functions of breastfeeding can help you better understand your patients and their breastfeeding difficulties.
Just as the latest and greatest gadget emerges from its box with only a few instructions needed to begin, breastfeeding starts out the same. With breastfeeding, there are two clear instructions for its user (or clinician who is guiding the user).
Let’s look at instruction number one for breastfeeding: Initiation.
Breastfeeding initiation: Connecting to the Wi-Fi of the body
Initiation is similar to connecting the breast to the body’s internet. Right after birth, a mother’s body experiences an “extraordinarily complex series of hormonal, anatomical, and HM (human milk) compositional changes” that occur in the very first days. This series of events taps in to a mother’s lactation process and typically completes itself within 72 hours in healthy mothers with breastfeeding infants.
This cycle is known as secretory activation (also known as lactogenesis II). It is when milk comes in. Effective and efficient mammary gland stimulation is key to continued breastfeeding success.
User Warning: This is a one-time event with a 72-hour window that is critical to continued HM synthesis.
You read that correctly. Whereas connecting to internet Wi-Fi allows multiple password attempts, this is one Wi-Fi that doesn’t allow do-overs. Initiation only has one window of opportunity – and then it’s lost. At the very least it can impact milk volume. At worst it will delay copious milk production, which can lead to secondary failure of milk production.
If an infant must be separated from its mother, then proper stimulation is recommended (such as with a multi-user, evidence-based, double electric breast pump) within the first few hours after birth.
Let’s assume instruction number one has been completed, either through successful, healthy infant breastfeeding or other supportive methods. Congratulations! Now you’re ready for instruction number two in the breastfeeding patient care manual: coming to volume.
Coming to volume: Synching with the app of the body
Coming to volume is similar to that new gadget sharing information through its mobile app.
Coming to volume occurs between secretory activation (lactogenesis II) and achieving a “threshold HM volume of 500-600 mL/day.” In short, just as a flow of information and data emerges from your gadget’s app, so too does human milk after proper initiation and now coming to volume.
This process experiences the transition between endocrine and autocrine control of lactation. What does that mean? Stated simply, human milk must be properly removed from the breasts… or it won’t be replaced. It’s like that app storing previous data – if it’s never cleared, it will ultimately block flow of new information.
User Warning: Insufficient milk removal will prohibit milk replacement.
Sufficient milk removal will allow milk replacement to occur in adequate volumes over time. Insufficient milk removal will not. As a clinician working closely with mothers, watch for signs that proper milk removal is occurring. As with initiation, if this process is inhibited in any way, additional support measures such as a breast pump can be used in the interim or as long as necessary.
Help your patients connect their power
Spend time educating mothers on the initiation and coming to volume stages of lactation. Monitor them pre- and postnatally to identify issues early, and don’t wait to provide assistance as needed. As mentioned, time is of the essence.
- Lactation may be inhibited if proper stimulation does not occur shortly after birth
- Sufficient milk removal must occur or milk will not be replaced
While these few steps may seem easy, they are in fact a complex and intricate biological series of events easily comparable to the most advanced technology – technology that can be negatively impacted by improper use. Don’t delay these out of the box breastfeeding instructions for your patients.
After all, a mother’s connection is waiting.
Learn more about the Symphony PLUS Breast Pump, which helps initiate, build, and maintain breast milk.
- Meier PP, Patel AL, Hoban R, Engstrom JL. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology. J Perinatol. 2016; 36(7):493-499.