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Ongoing, long-term milk production depends mostly on milk removal. The more often milk is removed and the more completely it is removed, the more milk the breasts make. The opposite is also true. When milk is removed less often or an insufficient amount is removed, the breasts get the signal to slow milk production and make less. Milk removal occurs when a baby effectively breastfeeds.
Effective breastfeeding requires effective sucking by the baby so that enough milk is transferred from the breast into the baby's mouth where it is swallowed. To suck effectively, a baby must latch deeply onto the breast and use the structures in his/her mouth to create intermittent (periodic) suction and also compress the milk ducts lying beneath the areola the area about 1-2 inches behind the nipple tip. Proper sucking signals the mother's body to release the hormone oxytocin, which results in a greater transfer of milk with the milk-ejection reflex (MER), or milk let-down.
If a baby is not breastfeeding effectively, increased milk removal or production can be accomplished through milk expression techniques. When using manual expression, a mother compresses the milk sinuses by hand to remove milk. Breast pumps remove milk by reducing resistance to milk flow out of the breast, and a few pumps have features that compress milk ducts to some degree.
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