Do You Really Need to Express After Birth to Boost Milk Supply?

This is something I am hearing more and more – ‘the midwives in the hospital said I had to express, but there was no issue with baby feeding directly’.

The simple answer? No - you should not need to express to increase or maintain your supply if your baby is feeding effectively.

In fact, if expressing is needed in the early days, it often signals that baby isn’t feeding effectively yet and that extra support is needed to protect your breastmilk supply – both in the form of expressing and seeing a professional for support and guidance.

First, we need to understand what is normal to know if there really is an issue.

Breastfeeding is a continuation of pregnancy and birth – the hormones and the changes that come about during pregnancy include changes that make breastmilk production possible.

Colostrum production (the first milk) should start around 16 weeks gestation with the help of hormones growing breast tissue and starting production. 

Another issue I see often is parents being led to believe that their milk is not ‘in’ after birth, because there is not large quantity, like we would see in bottles on social media.  This is not true – colostrum is milk, and it ‘comes in’ during pregnancy.

But I digress…

During pregnancy a hormone produced by the placenta, progesterone, prevents large quantities of milk from being made.  This makes sense – growing a baby takes energy, making milk also takes energy – if there is no baby needing milk, why would the body go to the effort of doing both at the same time?  But something is needed to ‘bridge the gap’ between the placenta delivering nutrients to the baby 24/7, the baby being born, and the milk volume increasing.  This is what colostrum is for.

After the birth of the placenta progesterone levels drop dramatically and now the body can go to work making more milk.

The effects of this might only be seen 3 - 5 days after birth though. Colostrum should be enough to feed the baby for the first few days. Do not be tricked by social media posts or anything else that might make you think newborns need more than this. In the first 24hrs anything between 5 - 125mls TOTAL (not per feed) is normal. And if you are expressing in this time, keep in mind that what you can express might not be completely representative what you are actually producing.

Around this time blood flow increases in the breasts – this makes them feel hot and heavy.  It also puts fluid into the breasts.  This helps increase the milk production/volume.

Mature milk is basically watered down colostrum.

Within 1 hour after birth the baby should latch the breast and start feeding.  Then they should wake up and feed on demand roughly 8 - 12 times in 24hrs (the normal range can be 6 - 20 times).

There can of course be cases where baby is not latching or feeding well – in these cases expressing might be necessary to help increase and maintain milk production.

But if baby is latching and feeding well in the first 3-5 days there should be no need to express.

How do you know if baby is feeding well?

Ideally all midwives would know how to educate parents on these signs, but unfortunately there is a real lack of education and knowledge amongst midwives (and I say that with love as a proud midwife). 

In the first 48-72hrs it is very normal for babies to lose weight – up to 8% is generally considered normal and needs no intervention.  Between 8-10% may trigger some extra monitoring, and beyond 10% loss usually starts more intervention, usually with 'top ups'*.  But there are situations where this could actually be OK and does not indicate a feeding issue. 

This is where getting expert professional assistance early on could be crucial to saving your breastfeeding journey.

By day 5 baby should be gaining weight gain – at least 25g/day is considered sufficient.  If there is less this again should be a sign to seek professional advice (keeping in mind that midwives and child health nurses may not be experts in breastfeeding support).

Output is another good indication of input.  Passing of meconium (the first poo) should happen within a few hours after the first birth.  Colostrum acts as a laxative – the bowel has not worked moved much during pregnancy, taking in colostrum should ‘turn it on’ so to speak.  Bowel movements should happen a few times within the first 48 hours.  By the time the breasts start to feel engorged the black meconium should be turning a sort of sludgy green colour, and by day 5 or so stools should be the classic seedy mustard yellow colour associated with breastmilk feeding.

Passing urine can also be a sign of good intake.  In the first 24-48hrs urine production is most likely a continuation of amniotic fluid that was swallowed while they were still in the womb (fun fact, the unborn baby swallows amniotic fluid, urinates it out, then swallows it again continuously throughout pregnancy…).  Because colostrum does not contain a lot of water urine production may slow down in the next 24-48hrs (but should not stop completely).  By the time the milk volume has started to increase baby should be having at least 5 heavy wet nappies per day.

How do you tell if a nappy is ‘heavy wet’ – if you’re using disposables the nappy should feel heavy.  Do not just rely on the line that many of them have that changes colour – you need to actually feel that it is wet and heavy.  If using cloth nappes you should be able to actually see and feel how wet they are.

In most cases milk production is dictated by demand by about 10 or so days (prior to this hormones can drive supply and the body may just give you lots of milk or it may be more cautious).  If milk is being removed frequently and effectively by the baby – and they are having good weight gain and output – there should be no need to express.  And newborn babies should be able to demand what they need to grow appropriately.

If there is concern that baby is not feeding effectively enough though, then expressing can be a very useful tool.

But expressing on top of a baby feeding effectively could have the opposite effect and create an oversupply, which then can have consequences of its own.

*If anyone suggests that the baby needs ‘top ups’ – usually a quantity of milk given in a bottle after a breastfeed – then expressing should be done as often as these top ups are given.

Here is another stage where expert professional support should be sought – breastfeeding, expressing, and topping up (aka triple feeding) should never be a long-term plan.  It is useful to feed the baby and protect or optimise the mother’s milk production, but it does not fix any underlying issues.  And stopping triple feeding once started can require someone to really examine what is going on.

In most cases, your baby is the best guide to your supply. Watch their cues, trust your body, and seek expert support if things feel off. Expressing can be a powerful tool - but it’s not a requirement for every breastfeeding journey.  If someone suggests you express they should be able to explain why it is necessary - again, not just ‘to increase your supply’, but ‘baby is potentially not feeding as effectively as needed, with these signs…and therefore expressing is needed to protect your supply until you can seek expert advice to fix any underlying issues’.

And if you are told to express, using the settings properly and having good fitting flanges are a must - www.cherishedparenting.com.au/single-post/increasing-your-milk-production-with-a-breast-pump (even if you do not need to increase your supply, this article discusses how to use a pump effectively) and www.cherishedparenting.com.au/flange-sizing-guide

If you need help with expressing, stopping triple feeding, with latching, or understanding your newborn, I would love to help you. Please get in touch - www.cherishedparenting.com.au/services