Addressing low milk production

This post was written by Josie Smith RN, IBCLC, LCCE, lactation consultant, Parkview Whitley Family Birthing Center, and Ashli Pershing, BSN, RN, CLC, birth planner/lactation consultant, Parkview Wabash Family Birthing Center.

Some women may find breastfeeding to be frustrating or overwhelming, especially if they don’t think it’s is going well. Some moms feel like they are letting their baby down if they don’t think they’re producing enough breastmilk. Here are some recommendations for working through some of those feelings and possible solutions.

Frequency of feeding

Instead of looking at a bottle to know how much milk a baby is receiving, we measure baby’s consumption by monitoring their urine and stool output each day and by weighing the baby. In the hospital, nurses and lactation staff make sure baby is breastfeeding a minimum of 8-12 times a day, is urinating and stooling the appropriate amount of times for their age, and watching for weight loss. 

After the baby goes home, the baby’s doctor will want to know the status of this output and weight loss patterns at check-ups as well. In the first few weeks, they may expect 6+ wet diapers a day, 3+ stools a day, and at least 8 feedings a day on the baby’s demand. There are many apps for smartphones now that moms can download to help track these occurrences so they are easy to report at the baby’s visits. Parents can also keep track on a piece of paper near the baby’s changing table, your favorite place to nurse or tacked to the refrigerator. They will also check to make sure the baby is gaining appropriately, so it is important to keep those follow up appointments even if baby appears well.

Nurturing

Breast milk feeding is known to be the healthiest way to feed baby, but it’s also only one part of nurturing a baby. The most important part of nurturing is providing love and closeness to your little one. Many women have found that skin-to-skin contact with their baby helps to facilitate that closeness. This is true for almost every mother and her baby, no matter how the baby is fed. Mothering is not about perfection. It’s about a loving relationship. No matter what kind of milk a baby gets, only love can nurture his or her soul.

Troubleshooting 

With breastfeeding, demand is the most important factor that impacts a mom’s supply. The body is intuitive enough to know to make more milk based on the need the baby is placing on it. That is why we want mom and baby to spend as much time feeding in those early days as the baby requests.

There can be medical variables hindering mom from making an adequate amount of milk, such as breast surgeries, illness or disease, or medications, so make sure to contact a lactation consultant or speak with your physician if you feel like you may need extra help with increasing your supply or have questions about medications you are taking.

There are mothers who, despite their best efforts, find their milk supply is low or have other difficulties with breastfeeding. There are some primary reasons for failure to produce an adequate amount of milk, including thyroid issues or other biological conditions, as well as secondary reasons, such as an inefficient latch. There could be multiple factors interfering with milk production. Identifying and addressing each issue is necessary to increase milk production, even if it means making a partial milk supply.

One of the most effective approaches to troubleshooting these issues in an effective manner is to work with a knowledgeable professional such as an International Board Certified Lactation Consultant (IBCLC). There may be bumps in the road and dead ends as you work through potential issues. It can take a lot of persistence and not all mothers are emotionally equipped or committed to the time and effort it may take to meet their breastfeeding goals. Nevertheless, if the goals are achieved completely, partially or not at all, it can be worth the effort.

Gauging milk production

It’s important to question if there really is a problem with your milk supply. There are a lot of misconceptions about what constitutes a “good” production. For example, at 2-4 months postpartum, sometimes mothers experience what seems like a drop in milk supply because baby is fussy and not content after breastfeeding. A simple explanation may be that baby is going through a growth spurt and therefore has an increased appetite. This is completely normal and only requires allowing baby to breastfeed as much as he/she wants to get the extra calories he/she needs during the growth spurt.

Another misconception is holding off feeding baby so more milk accumulates in the breasts so that baby gets more milk. The problem, however, is that in time milk supply will actually decrease, because retained milk in the breasts triggers feedback inhibitor of lactation (FIL), a protein which causes the breasts to slow down milk production when the breasts are very full. In the end, the body will make less milk.

A solid foundation

Knowing how to get off on the right foot in the beginning can make a huge difference in milk supply for the early days and also long term. Here are some strategies for avoiding low milk production, beginning at delivery day:

• Breastfeed baby early and often after birth.  Initially feeding baby within the first hour can help trigger the process of increasing milk supply. If there is a medical reason that causes a delay in breastfeeding, ask your nurse to help you express milk within the first few hours.
• Keep baby close.  Practice skin-to-skin with your little one for at least an hour as soon as possible after birth and frequently thereafter in the hospital/birthing center and at home.
• Strive to achieve an optimal latch.  This is one of the most important ways to insure a good milk supply. Baby should open his/her mouth with a wide angle and latch deeply onto the breast. This latch helps him/her remove more milk and mother to be comfortable, with no pain.
• Delay routine care like baby’s first bath for several hours and until first breastfeeding.
• Breastfeed frequently.  Aim for 8-12 times or more, every 24 hours in the early weeks. Recognize that cluster feeding (several feedings in a row) is a normal feeding behavior for newborns.
• Listen for swallowing sounds during feedings. This sounds like a soft “kuh” sound or gulping sounds as baby gets more volume of milk.
• Allow baby to breastfeed fully on the first breast during a feeding until he/she drains the breast.  Then offer the second breast. At times baby may not take the second breast.
• Be aware of visitor syndrome.  Visitors can sometimes arrive at inopportune times, when some new moms are not comfortable breastfeeding in the presence of others or feel obligated to focus their attention on the visitors rather than feeding baby. When visitors show up a lot, mom is exhausted, baby is frazzled and breastfeeding gets off to a slow start.
• Don’t skip nighttime feedings.  Prolactin, the milk-making hormone, is at higher levels at night when mom is resting. Also, milk flows more easily when mother is relaxed. It may seem tempting to pump some milk during the daytime and have someone else feed baby your milk from a bottle at night, but keep in mind that this can cause your milk production to decrease because FIL builds up in the accumulating milk. A better strategy may be to take naps during the daytime when baby is asleep, even if they are short naps. Again, prolactin will rise during rest periods providing another hormonal boost. Family members can help care for older children.
• Feed baby on demand. Baby knows when he/she’s hungry or not. Once your milk supply is well established (approximately 4-6 weeks) and he/she is growing appropriately, he/she may sleep in longer stretches.
• Fussing is normal.  Babies have growth spurts, in which they will breastfeed more frequently, at around 3 weeks, 6 weeks, 3 months and 6 months. During these fussy days, you feel like you’re running out of milk but really your breasts are making more milk because baby is feeding more often.
• Changes in breast feel are normal.  After your “milk comes in”, your breasts will feel fuller and then soft again after feedings. Later on, breasts feel soft most of the time. That’s normal as baby matures.
• Expressing your breasts after feedings in the early days may help to increase milk production.

Factors that hinder supply

With breastfeeding, demand is the most important factor that impacts a mom’s supply. The body is intuitive enough to know to make more milk based on the need the baby is placing on it. That is why we want mom and baby to spend as much time feeding in those early days as the baby requests.

There can be medical variables hindering mom from making an adequate amount of milk, such as breast surgeries, illness or disease, or medications, so make sure to contact a lactation consultant or speak with your physician if you feel like you may need extra help with increasing your supply or have questions about medications you are taking.

Encouraging milk supply

If your supply is in fact low, don’t get discouraged! There are things moms can do to help boost supply. Local herbalists can help suggest appropriate supplements, such as Fenugreek and Blessed Thistle, for each individual’s own needs. There are also products believed to help at the local supermarket. Certain teas, carrots, nuts, fennel, garlic, oats and spinach are all credited with supporting milk production. Some moms might opt for pharmacological treatment. You can discuss these options with your OB/GYN or primary care provider to discuss the pros and cons of using a prescribed medication to help boost milk production.

Lactation consultant help

There are countless suggestions online and in social circles for how to increase milk supply, but the best place for advice is always to call a lactation professional. If you need help finding local support, your infant’s doctor will be able to help you find the right lactation specialist for you.  Lactation consultants and specialists have had special training to be able to identify any issues with your breastfeeding practice and we want to help you and your baby be as successful as possible.

Lactation professionals also have special training on the anatomy of a baby’s mouth and can observe if the baby is sucking and swallowing appropriately, where online research isn’t as adequate. We also have special tools and tricks we can suggest based on what we observe, so establishing a good relationship with your lactation professional is very important. As always, mothers know their bodies and their baby best, so if you feel like something is not right, contact your provider for the special care you need.