Low Milk Supply

Do you worry about low milk supply? Lots of the mothers I see in my practice do.  one small remark from a midwife or even from a family member or friend can make you really nervous that you aren't feeding your baby enough!

Do you want to know how tell if your baby is drinking well at the breast?

Do you feel like your baby is just drinking all the time?

Find the answers to all these concerns and more and feel comfortable with breastfeeding.

How Long Should My Baby Breastfeed From Each Side to Get Enough Milk?

Why Will Good Latching On Make a Difference to My Supply?

How Can I Tell If My Supply is Low?

What Causes Low Supply?

How Can I Increase My Milk Supply?

What Can I Do If I I Still Can't Produce Enough Milk for My Baby?

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How Long Should My Baby Breastfeed From Each Side to Get Enough Milk?

I get really worried about these poor mothers who are watching the clock during their baby's breastfeed thinking a certain number of minutes need to elapse before their baby will have "had enough". This is a recipe for nipple soreness!

The answer to this question will be different for every baby and even every feed to an extent. To feel confident that your baby has finished from one side you need to know a few things.

• The difference between drinking and comfort sucking or "nibbling"
• Whether or not your baby is latching on well
• How to use breast compressions to keep the baby awake and drinking during the breastfeed

This video answers all those questions: 

In it you can see how the mother

• Waits for the baby to start sucking then compresses her breast to encourage milk to fill the baby's mouth
• When the baby drinks there is a little pause in the chin during the sucking motion (you can sometimes hear a little swallow too)

You will know your baby is finished drinking from the first side when they stop having that little drinking pause in the chin and start getting sleepy After this offer the second breast and use the same technique again.

You will know if your baby is not getting enough milk by:

• Less than 6 heavily wet diapers each day
• Does not pass a bowel motion within a week of passing their meconium
• Has not gained weight in line with the percentile along which they are tracking

To interpret the chart properly what you are looking for is to see the baby's weight stay in a similar percentile to that of when they were born. So to give an example - if your baby was very light when they were born and started off in the 40th percentile, this means they will most likely stay between the 35th and 45th percentile with their weight gain. If you had a really heavy newborn in the 80th percentile you would expect them to continue on in around that range, dropping a little to perhaps the 75th.

When those numbers may not be quite right

• If you had gestational diabetes and your baby was quite chubby coming out you may find they drop a little more than they would have otherwise as their glucose levels return to normal
• If you had a baby who required quite a lot of suction after the birth then they will automatically have dropped a little weight with that and their "birth weigh" may be a bit heavier than it really was
• If your labour was quite a long one and your baby was distressed they may have some swelling from the labour which will make their birth weight seem heavier than it would have been

If you are worried contact an Internationally Board Certified Lactation Consultant. 

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Why Will Good Latching On Make a Difference to Low Milk Supply?

Again, and I know from personal experience, poor latching on is a recipe for nipple soreness!!

This video gives an excellent demonstration of how milk supply when the nipple only is stimulated is very little compared to when the areola is compressed. It makes sense that a baby would spend a lot more time breastfeeding if they are getting such a small trickle of milk than if they were attached well.

If your baby wants to feed more often than every two hours or your baby breastfeeds for longer than forty minutes it is possible that they are not attaching well, and therefore not getting as much milk as you are able to produce. 

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How Can I Tell If My Supply is Low?

Please, please, please don't rely on you mother or mother in law saying you've got low milk supply. I see so many mothers who have lost a lot of confidence because someone close to them has told them their supply is low.

by the way, many mothers speak about the witching hour and quite frequently this time of day is associated with a lower milk supply (don't be alarmed if your baby wants to breastfeed evry hour or so in this time, that's quite common for mothers with high supply too).

Always check with a lactation consultant first.  They are going to ask you whether you baby has:

• Less than 6 heavily wet diapers each day
• Does not pass a bowel motion within a week of passing their meconium
• Has not gained weight in line with the percentile along which they are tracking

These signs in combination can mean you have low milk supply or your baby is failing to thrive. It is important to speak to a lactation consultant to help you work through your specific case as every baby has different signs and you may not necessarily have low supply, but in general if your baby has:

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What Causes Low Milk Supply?

• Stress
• Lack of sleep
• Poor hydration and not enough food for the mother
• Not offering a breastfeed frequently enough
• Poor Attachment
• Thyroid Deficiency
• PCOS (polycystic ovarian syndrome)
• Tubular Hypoplastic Breasts (Insufficient Glandular Tissue)

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What Can I Do If I Have Low Milk Supply?

Offer a Breastfeed More Frequently - You may be using a pacifier/dummy or giving a bottle of formula. Neither of these are going to help you increase your supply. The more milk your baby removes from your breast, the more your breast will produce. Offer a feed really frequently to help your baby remove as much milk as possible.

Also, if you must supplement in the time it takes to increase your supply (though this is usually only 24-48 hours) it is advisable to do this with a spoon or very small cup (such as a shot glass) rather than a bottle as your baby may refuse your breast after having milk that comes easily from a bottle.

To do this place your infant in a fairly upright position and offer them small amounts each time. It is time consuming but worth it if you want to establish breastfeeding well. Spoons and cups are also quicker and easier to sterilise than bottles and are available everywhere so there is no need to pay for a bottle which may never be used again.

Try Using a Breast Pump - If your baby is sleeping for extended periods of time and you are unable to offer them a breastfeed try breast pumping each hour you aren't sleeping. Don't be worried by how much comes out, a breast pump is not very efficient at removing milk when compared to a baby so it is not so much how much you are getting out, but how often you are stimulating your breast to produce milk. Even a five or ten minute session of pumping will make a difference to your level of milk, regardless of if you only get a few drops out.

Try Using a Supplemental Nursing System - A Supplemental Nursing System is a great way for mothers with low milk supply to stimulate milk production while giving your baby some extra milk (be it donor milk or formula).  You basically use a tiny tube next to your nipple to feed them whilst they breastfeed.

Lower Stress and Increase Sleep - Being the parents of a new baby is tiring enough, but all the entertaining of well wishing relatives and friends is more than some parents can handle. If you are having problems with low milk supply you need to be aware that you can refuse visitors or tell that you will need them to stay for a short interval rather than a long one.

Try not to get too worried about cleaning up for visitors, they will understand, and if they are close you may be able to get away with asking them to do the dishes or clean some clothes or sheets for you.

If your baby is sleeping lie down at the same time. It sounds simple but if you are worrying about entertaining or cleaning you are unlikely to lie down. Remember, it's not going to be long before you settle into a routine with your baby. In this early time take all the sleep you can get.

Make Sure You Are Eating and Drinking Frequently - There are some great recipes or even ready made biscuits out there which help to increase supply, but you can also do a lot on your own

Try to make sure you're drinking at least 8 glasses of water each day (preferably 12 or more in the early days) and following a good breastfeeding diet. It is very hard for your body to produce much milk if you are dehydrated or hungry.

Try sitting down to each breastfeed with a glass of water and a snack.

Speak to Lactation Consultant - These amazing people will be able to provide ideas about herbs such as fenugreek to help increase your supply and will be able to get you the right help if you need a drug like Domperidone or Motilium to help stimulate your breasts to increase their supply.

They will also check how your baby is attached and help you by diagnosing whether or not you have Tubular Hypoplastic Breasts. If this is the case they will help you take the next steps including sourcing a supply of donor milk or choosing an appropriate supplement and teaching you how to use a supply line during supplemental feeds.

They may also suggest you see your doctor to have your thyroid checked as this is another possible cause of low milk supply. 

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What Can I Do If I I Still Can't Produce Enough Milk for My Baby?

It is very unusual that you won't be able to increase your supply enough to meet the needs of your baby if you are breastfeeding on demand. In the case of thyroid disorders, PCOS and tubular hypoplastic breasts though (and sometimes for no apparent reason) you may not have enough milk. In this case look into Donor breast Milk. The World Organisation recommends donor milk before any formula as a substitute to breast milk. Here is a link to more information about Breast Milk For Sale or For Sharing.

Don't be shy about asking friends around you if they would like to donate too. many women jump at the chance to help, knowing that they are helping to set your baby up with a life long advantage.

Rather than using a bottle why not consider using a supply line so that the milk is being given while you are breastfeeding as well so that your breasts are getting stimulated to produce as much milk as possible.

If this option is not available to you then formulas such as organic goats formula. If this is not available to you it is worth considering the more expensive cows milk formulas. They are more expensive because the casein (protein in the milk) has been broken in two making it easier to digest (human casein is a lot smaller than cows). 

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Low Milk Supply