Low Breastmilk Supply

A common reason for giving up breastfeeding is when mothers suspect that their milk supply is low. Sometimes mothers can mistakenly think that their supply is low as they lack confidence in their ability to provide breastmilk and can become worried when their babies seem unsettled.

Other times low milk supply can be a real problem. It is important to know that the more milk that is taken from your breasts the more milk you will make. Introducing other fluids, including infant formula, will decrease your milk supply. With the right information and support a low supply can usually be increased.

Is your supply really low?

Sometimes what you think might be a low supply can be due to a lack of confidence in your ability to provide milk or confusing normal infant behaviour as a supply problem.

These are some common times when many mothers mistakenly suspect that their supply is low:

• when the initial engorgement experienced in the early days goes away and the breasts start to feel soft again. This is normal as your body rebalances itself and is not an indication of low supply. The initial engorgement experienced after birth is often due to excess fluid and blood supply necessary to start milk production.
• When your baby seems fussy and is wanting more feeds. This is very common infant behaviour at 2-3 weeks and 6 weeks but can happen at any time. They used to be called “growth spurts” but research is showing that it may be due to developmental reasons.
• As your baby grows and becomes more efficient at feeding and can finish a feed often within minutes.
• In the later months when your breasts seem smaller.
• When your baby is older and you don’t feel your milk “letting down” any more.
• When the weather is hot and your baby is feeding more often due to thirst.
• When your baby is unsettled after breastfeeding when discomfort or illness may be the cause.
• When your baby has more than 10 wet and many dirty nappies each day and is continually unsettled or seems colicky. This situation is often interpreted as a low supply but it is usually due to having too much milk (which can be addressed).
• When a baby has gained well in the early weeks and suddenly changes to a slower gaining pattern or a large baby’s weight gain slows down. It is common to see a plateau in weight gain in breastfed babies around 4 months. The weight gain charts in most baby health record books are based primarily on bottle-fed babies who tend to be heavier than breastfed babies.

How to tell if your baby is getting enough milk

After day 3-5 when your milk supply has really started you will be able to tell if your baby is getting enough breastmilk using the following guide:

• 6-8 wet cloth nappies (4-5 heavy disposable nappies) in 24 hours. Urine should look clear.
• regular soft bowel motions that are usually a mustard colour. In the first week or so your baby may have a bowel motion at every nappy change, then it will decrease to two or more soft bowel motions a day. As babies get older they will have fewer dirty nappies that can vary from daily to once or twice a week. As long as the bowel motions are soft and unformed it is all normal. Babies who receive nothing but breastmilk rarely get constipated.
• baby’s arms and hands relax when feeding
• baby is alert, acts hungry at times, is fussy at certain times of the day and acts satisfied after feeds.
• your breasts become softer and lighter as you feed
• you hear your baby swallowing when feeding
• your baby gains weight and grows in length and head circumference.

How often do babies need to breastfeed?

• It is common for babies to breastfeed 8-12 times in 24 hours
• Some babies will feed every 3 hours day and night, other babies will cluster feed, every hour or less for 4-6 feeds then sleep for 4-6 hours.
• Some sleepy babies need to be woken for feeds - a general guide is to wake them at least every 3 hours during the day, and at least once during the night.
• Night feeds are important for making breastmilk as Prolactin (milk-making hormone) peaks at night. Some babies need night feeds longer than others.
• Babies will let you know they are hungry before crying by: sucking their fist, turning their head from side to side, rapid eye movements, soft cooing or sighing sounds. It is often easier to breastfeed a baby who is a little hungry than one who is very hungry. Crying is considered to the a late hunger cue so you might like to offer your baby a breastfeed when he/she shows the early hunger cues above.

Why your milk supply may be low

Sometimes mothers experience a real low supply due to the following possible causes:

Inadequate stimulation of the breasts due to too few feeds, shortened feeds or incorrect positioning. Your breasts need the stimulation of your baby removing milk. The more frequently milk is taken from the breasts, the more milk is made. A baby who is fed to a strict schedule may not stimulate an adequate amount of milk. Aim for at least 8-12 breastfeeds in 24 hours.

Changing sides before the baby has finished the first breast, eg setting a time limit for baby to feed from the first breast, rather than watching your baby. The general rule is to allow baby to finish the first breast first (they will come off the breast when they are finished with a very satisfied look on their face). You can offer the second breast but many newborns will not take it and will thrive on one breast per feed for the first few months.

Incorrect attachment of your baby at the breast. Baby is not able to suck properly and remove enough of the milk, which in turn gives the breast the message that less milk is required. Baby should have a good mouthful of breast, chin should be against the breast, head slightly tilted back so he/she can swallow well and the nose should be clear to allow baby to breathe.

Poor sucking technique. A baby who has not learned to milk the breast correctly may not adequately stimulate the milk supply or may not get most of the milk available in the breast. This will result in not enough wet nappies, slow weight gains and a falling supply. This can happen in some newborns, weak, sick, sleepy or over-warm babies, if not put to the breast early and often, or if baby does not have to work for the milk because of mother’s strong let-down or initial oversupply. It may also happen if a baby has become confused about how to suck by having bottles or dummies in the early days.

Tongue-tie is when the baby’s frenulum (the string-like attachment underneath the tongue) is too short and can affect the baby’s ability to remove milk from the breast.

Tension, pain or fatigue which can inhibit the efficient let-down of your milk. This may mean that baby will not be able to obtain enough of the milk for her needs.

Physiological reasons. Very occasionally, insufficient glandular tissue in the breast, hormonal problems (such as thyroid or PCOS) or some types of breast surgery may result in an inability to produce sufficient breastmilk.

Anatomical or neurological reasons. Sometimes there are anatomical reasons that can affect the baby’s suck such as tongue-tie, a high arch, low or high muscle tone.

Retained Placenta. Even if a fragment of the placenta is retained after birth (this can happen with both vaginal births and caesarean births) the body will still think it is pregnant and this will affect milk production which is started by the drop in progesterone that is caused when the placenta is delivered. If a small fragment remains it will still produce progesterone which prevents the milk-making hormones from kicking-in.

Use of a hormonal form of contraception may cause your milk supply to drop. Doctors usually prescribe only the progesterone-only type (eg the mini-pill) for breastfeeding mothers, but some mothers have reported that even this has caused problems with their supply. Others report that it has made their babies irritable. Some have found that frequent feeding has been enough to offset this drop in supply, while others have not. You may need to discuss alternative methods of contraception with your doctor. You might like to consider learning about the Billings Method (a natural method of contraception which is as effective as the Pill but without any side effects).

Regular use of complementary feeds. If you frequently use artificial baby milk (infant formula) when leaving your baby, or to ‘top up’ after a breastfeed, your supply may have temporarily decreased. Complementary feeds reduce your baby’s time at the breast and replace some of the milk your baby would normally take from the breast. This gives a message to your breasts that less milk is required, thus reducing your milk supply. Mothers who have returned to work sometimes notice a drop in their milk supply if they are using artificial baby milk to complement or replace expressed breastmilk (EBM). More frequent breastfeeds in the evenings and/or at weekends or expressing your milk while away from your baby can overcome this.

Early introduction of other foods. Your baby’s need for breastmilk will diminish if solids or fruit juices are introduced in the early months and your supply will drop. All other foods are less suited to your baby’s digestive system and are less nutrient dense. The national health recommendation is that breastmilk alone is a complete food for at least the first six months of a baby’s life. Family foods can be introduced slowly, after breastfeeds, once baby is more than six months old. Breastmilk is still baby’s main source of nutrition until she is 12 months of age.

Times of hormonal change. When hormone levels in your body are undergoing change, your baby may want to breastfeed less often. Sometimes a baby may refuse to feed altogether at these times, but will usually make up for it once things have settled down again. The following are two specific instances:

Just before your monthly period and sometimes during ovulation as well, your baby may be fussy and even refuse some feeds. Your baby may prefer short, frequent feeds, or feed more often at night, when she is sleepy. Things will usually settle down in a few days.

If you become pregnant, your nipples may suddenly become more sensitive, your supply is likely to temporarily decrease and your baby may become fussy at the breast. However, as long as you look after yourself, there is no reason that you have to stop breastfeeding if that is what you and your child would like to do. If your child is still very dependent on your milk for her nutrition, and your supply drops due to the pregnancy hormones, you may need to consider offering some replacement feeds.

Many drugs (both prescribed and bought off the shelf) can have an effect on breastfeeding, either by passing through to the baby in the milk or by affecting the process of lactation itself. It is important to discuss with your doctor or pharmacist the effects of any medication taken while breastfeeding. Vitamin preparations and herbal remedies may also have an effect on your milk supply. Research has shown that excessive amounts of alcohol, nicotine and caffeine (in tea, coffee, cola and other drinks, chocolate, etc) and some other recreational substances may also have adverse effects on breastfeeding. These include inhibiting the let-down reflex and the production of milk or making the baby irritable or restless. Pseudoephedrine, a drug used commonly in cold and flu medications, is known to decrease milk supply.

If you have been ill or had surgery, your milk supply may be low. By getting plenty of rest, drinking enough fluids and feeding your baby frequently, both during your illness and after, your milk supply will soon increase again.

If you suspect you have a low breastmilk supply please make an appointment with a certified lactation consultant or telephone the Breastfeeding Helpline on 1800 686 2 686. Giving your baby infant formula will only lower your supply further and will not address the cause of the problem. In some cases a baby’s inability to breastfeed can be a red flag for further infant problems.

As a certified lactation consultant (IBCLC) I am available for breastfeeding consultations for those living in the Brisbane area.

Source:

Australian Breastfeeding Association Increasing your Supply booklet 2006
Breastfeeding...naturally book, 2nd edition, Australian Breastfeeding Association 2004

Recommended websites:

Australian Breastfeeding Association www.breastfeeding.asn.au
Low Milk Supply Information and Support www.lowmilksupply.org
To find a certified Lactation Consultant (IBCLC) www.alca.asn.au