Guide to Low Milk Supply

Sheena Tabbert RN IBCLC

Why are we so obsessed with milk supply?

When it comes to milk supply, our society often has a “more is better” mentality. The truth is, a freezer stash of milk is not a requirement.  It can be difficult to determine if you have a low supply, especially when hormones and anxieties are running high, sleep is running low, and you’re recovering both physically and mentally from your baby’s birth.

If you are worried about your milk supply, it is important to reach out for help as soon as possible.  An International Board-Certified Lactation Consultant (IBCLC) can help you determine the cause of low supply and provide strategies to help you meet your feeding goals.

Causes of Low Milk Supply

Many factors can contribute to low milk supply.  It can take some detective work to determine causes.

Hormonal or anatomical barriers such as breast surgery, diabetes, or thyroid issues may be responsible. If such factors are deemed to be the cause, milk supply can often be increased through various interventions, support, and sometimes, medications.

More commonly, infrequent and ineffective milk removal is responsible for low supply.  When your breasts are drained of milk, your brain gets a signal that it needs to fill them up again.   When more milk remains in your breasts after feeds, the signal to keep producing gets weaker.  This can lead to lower production over time.

Anything that prevents your baby from removing a maximum amount of milk will contribute to low supply.  Oral restrictions (aka “tongue-tie”) and prematurity are some examples. Even misinformation or lack of support can cause supply issues: strict feeding schedules, early sleep training, and persisting through painful latching are common culprits.

Mental health plays a crucial role in lactation.  Anxiety, pain, and fear can all interrupt the important hormonal cascades that are necessary for milk removal.  When milk removal is impacted by these factors, less milk will be produced, causing more stress.

How do you know if you have low supply?

Every breast has a different milk storage capacity, and every baby has a different stomach capacity.  Some people may need to feed 12-15 times per day to keep their baby satisfied and maintain production while others only need to feed 8 times per day. We must work with your body and your baby for an individualized feeding plan.

Signs of good milk production and intake include:

• Breastfeeds are comfortable with no pain or nipple damage
• Your baby actively feeds (sucks and swallows) when latched (the length of every feed will be different- sometimes they want a snack, and other times they want a full meal!)
• Your baby wakes for feeds and seems content and satisfied after each feed
• Your baby is gaining weight appropriately
• An adequate amount of wet and soiled diapers

Signs that your baby isn’t taking in enough milk:

• Feeds are consistently very long or very short in duration (for example, always under 10min or over 45min)
• Your baby remains very fussy after most feeds
• Your baby is not waking for feeds, and is very tired and sleepy at the breast
• Few wet or soiled diapers, urine is darker in color
• Slow weight gain, or weight loss

Pump up the Volume

If you have a low milk supply, the help of a trusted support person, IBCLC, midwife, postpartum doula, or pediatrician may help determine the cause and help you work through strategies to meet your goals.

If you already have an adequate supply, incorporating additional measures to further increase it can cause complications.  Painful engorgement, plugged ducts, and mastitis are just a few issues that can arise from boosting supply too much.

Keeping the above warning in mind, here are some strategies to help maximize milk removal during feeds:

• Make sure your baby is doing their part to remove milk! A comfortable latch and position are the best places to start. Do not persist through a painful feed. Your comfort is the most important factor!
• Spend as much skin-to-skin time with your baby as possible! This can actually can help boost the hormones necessary for milk removal!
• Incorporate movement into your baby’s day! It is so important for their overall development, and can actually improve overall feeding behaviors! Baby-wearing, tummy-time, and water therapy are some examples.
• Get your baby assessed for oral restrictions (tongue-tie). This can greatly impact the overall latch and your baby’s ability to remove milk.
• Offer both sides at every feed and allow your baby to nurse for as long as they want on each side. Switch sides when they stop sucking and swallowing, or fall asleep.
• Perform breast compressions during feeds or pumping sessions to help with milk emptying.
• Breastfeed frequently and on-demand. On average, you should be removing milk (feeding or pumping) 10-12 times in 24h. Watch your baby’s earliest feeding cues for signs they are ready to eat (crying is a late sign of hunger).  Some feeds will be 30min apart, while others will be 2 or more hours apart.
• Do not skip night feeds. The hormone prolactin has a big influence on milk production and it peaks at night.  Nighttime feeds or pumping sessions take full advantage of that hormone and gives your body the ultimate signal that you want it to keep making milk.
• Switch nursing: offer each side twice during each feed. This can work well for a sleepy baby: the act of switching sides often wakes them up long enough to latch.  It also gives each breast the milk-boosting impact of cluster feeding.
• Incorporating a breast pump can be an important tool to help boost milk supply. As a rule, any time your baby gets a bottle of organic formula or pumped milk, do a pumping session. This will drain milk from your breasts and signal your body that it needs to keep producing.

It is important to note:

• There is very little scientific data to support the milk-boosting claims of herbal supplements, lactation cookies, and shakes.You could eat a bag of cookies a day, but without frequent and effective milk removal, they will not boost production.  Always discuss herbal supplements with your doctor before starting.
• Prioritize your mental health. Support from a friend or family member may be all that is needed to improve your confidence, give reassurance and provide encouragement. Other times, though, professional help, counselling, medications, and supplementary feeding methods become necessary to improve the well-being of both parent and baby.

There are several ways in which you can work towards boosting your milk supply.  Your baby’s ability to latch and remove milk is necessary for continued production! Several other factors can influence milk production and it can take some detective work to figure out the cause of low supply.  The most important thing is to be patient with yourself, reach out for help, and protect your mental health.  Your baby needs a healthy parent in both mind and body!

 

References:

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Mohrbacher N and Kendall-Tackett K. Breastfeeding Made Simple. Seven Natural Laws for Nursing Mothers. 2 nd Ed. USA: New Harbinger Publications; 2010.

Mortel M and Mehta S. Systematic Review of the Efficacy of Herbal Galactogues. Journal of Human Lactation. 2013; 29(2): p. 154-162.

The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion. BREASTFEEDING MEDICINE. 2011; 6(1):p. 41-49.

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