Low milk supply is one of the biggest concerns of breastfeeding mothers. It is the stuff their nightmares are made of. Very few women have a physiologic inability to make milk. Hormonal imbalances or insufficient glandular development can be responsible for some women’s true low supply. Breast surgery or trauma can be another factor potentially hindering a breast’s ability to make milk. For all the other breastfeeding mothers out there, the general rule of thumb is:
If your breast can make milk, it can make more milk.
There is generally a reason for low supply. If you are unsure if your baby is getting enough milk, consider reading THIS POST to help you determine if your supply is adequate. Once we determine the reason, we can deal with it head on and make MORE MILK. For more tips on how to INCREASE SUPPLY or how to PUMP MORE MILK, check out these related posts. Click this link for further discussion of SUPPLY AND DEMAND.
Too many bottles
Too many bottles is a common reason for low supply. The problem is not the bottle… per say… the problem is baby missing a feed at the breast. Amount of milk you make is directly related to demand. When the breast is emptied, it triggers an increase in supply. Every time baby is bottled and a feed is missed, your body is interpreting the missed feed as a decrease in demand. The more frequently this happens the more supply will diminish. This is especially troublesome in the early days when your body is still establishing a healthy milk supply.
Another hindrance that can manifest is some babies begin to prefer bottles. Eating from a bottle uses a different kind of suck creating a more passive feeding experience than breastfeeding. Some babies will strike at the breast when they begin to prefer the bottle. To help prevent bottle preference and overeating, I recommend using PACED BOTTLE FEEDING to mirror the pace of breastfeeding. Inexperienced breastfeeders may mistake this as a sign of early weaning. Babies will RARELY self-wean before 12 months. Nursing strikes or baby’s disinterest at the breast can sometimes be related to mom’s dwindling supply. This is a self-fulfilling prophecy as mom continues to offer bottles and further reduces her supply.
There are many reasons babies go through nursing strikes at different stages. Do not consider reluctance to feed or distractibility as a sign of baby led weaning before a year of age. If your wish is to continue breastfeeding, these strikes usually resolve without intervention if the breast is consistently offered. Sometimes there is a reason for the strike and it can be resolved once the source of the strike is determined.
When I have a mom come to me with concerns of low supply, my first question is whether the baby has been evaluated for a tongue-tie. Babies with a tongue-tie that is impeding breastfeeding are unable to latch properly and fully empty the breast. Because the breast is consistently not being emptied, supply dwindles or is never really established.
Commonly, these moms will report having a stable supply for the first three months and then it begins to drop off. This is related to the body’s ability to coast off the initial hormone wave that initiates lactation following delivery of the placenta which triggers the onset of lactation. Around three months, the body settles into an established equilibrated supply responding to demand signals. When demand is low (or baby is unable to empty the breast), supply begins to diminish.
Many of these moms are COMPLETELY unaware a tongue-tie exists or of it’s potential effects on their supply. Commonly, they are told to begin supplementing by their pediatrician when the infant’s weight begins to fall off their growth curve. Supplementation along with the tongue-tie further diminish supply culminating in early weaning.
The crime of this story is that these mothers think they are unable to breastfeed because they have low supply. Many come in to deliver their second baby and are on the fence about even attempting to breastfeed. The disservice is that these mothers are never informed to begin with. A simple procedure to release the tongue-tie could have yielded different results for the dyad’s breastfeeding experience.
Similarly, a bad latch can have the same effect. Check out THIS POST for tips on how to get a deeper, sustaining, pain free latch! If you have sore nipples from a shallow latch, click on the image below for my bonus “Tips for your Nips” handout detailing how to heal and protect your nipples.
Prolonged nipple shield use
Nipple shields are phenomenal tools that can be extremely beneficial when used properly. With that said, too often parents are sent home using nipple shields with no real plan for weaning off. Using a nipple shield deceases stimulation and generally interferes with emptying the breast at feeds. It is a two-pronged problem. The shield itself can be an interference combined with the fact that shield was needed because their is some kind of latch disfunction in the first place. These combined factors can both contribute to decreasing supply. If you are using a shield, you should be pumping after feeds. This will help boost supply until you are able to wean off the shield.
Always check after feeds for visible colostrum/breastmilk in the shield. You want to hear your baby actively swallowing while nursing with a shield. Baby’s can look deceivingly busy with the shield while not actually transferring much milk. Make sure you are using SANDWICH HOLD to ensure you are getting a deep latch so the baby has breast tissue along with the shield in the mouth. This will help boost supply until you are able to wean off the shield. Get in touch with a lactation consultant that can help you formulate a plan for transitioning off the shield or to look further at why baby is requiring the shield to achieve a latch.
The removal of the placenta initiates the lactation cycle. When a piece of the placenta is not removed, it can cause a number of medical problems AND impede milk supply. As the placenta is removed, estrogen and progesterone levels(the hormones that maintained pregnancy) decrease. This signals a rise in prolactin. Prolactin is one of the hormones responsible for lactation. Other considerations associated with retain placenta is increased vaginal bleeding at delivery and postpartum. Extreme blood loss, such as seen with postpartum hemorrhage, can decrease supply.
Some signs and symptoms of retained placenta are:
- Foul Smelling Discharge
- Cramping/ Pain (not associated with breastfeeding cramping early on)
- Persistent blood clots/ heavy bleeding
If you suspect retained placenta follow up with your OBGYN or CNM immediately. If you had a retained placenta, schedule a consult with an IBCLC help establish a milk supply.
Hormonal birth control
Hormone based birth control methods have been well-documented inhibitors of supply. As previously mentioned, estrogen is a hormone that maintains pregnancy and impedes lactation. Taking an estrogen based birth control, especially in the first 6-8 weeks postpartum, directly interferes with the hormone processes at work to establish your supply. While breastfeeding has been shown to decrease fertility, it is not a sure fire contraceptive. After 6-8 weeks, a progesterone based contraceptive pill is generally recommended. Supply can still be affected so it is advantageous to take pill forms so they can be discontinued if supply is decreasing.
Early sleep training
I am a BIG fan of babies sleeping through the night. BIG fan. But, early sleep training can be detrimental to supply. Nighttime feeds are really important for supply. During the milk building days, prolactin levels are responsible for how much milk you make. What is crazy cool and crazy important to realize is that the amount you breastfeed during the first 6-8 weeks actually determines how many prolactin receptors your body will make. While establishing your supply, your body makes more receptor sites if your breastfeed more frequently early on. The more sites you have, the more prolactin your body can read and interpret as a request for MORE MILK.
Prolactin levels are highest at night. Nighttime feeds are a great opportunity to boost your supply from the get go. It is estimated that baby gets around 20% of their daily intake at night. If you cut out nighttime feeds, that’s essentially 20% less demand. Early sleep training and/or bottle-feeding at night will decrease supply and could potentially affect your ability to produce throughout your lactation cycle.
While it maybe tempting to get the baby sleeping through the night ASAP, it may bite you in the butt later. Get your supply established; adopt healthy sleep habits for your baby, and you will both be sleeping more before you know it.
Not offering the breast enough
Mother’s unintentionally affect their supply by becoming too regimented with their feeding schedules. One of my favorite quotes from an amazing friend and lactation consultant begins, “In the jungle, there are no clocks.” Our bodies are not meant to be regulated on tight schedules. Biologically, babies are made to feed when they are hungry. On demand feeding, especially in the early days, is nature’s way of laying the groundwork for a healthy milk supply. Restricting baby so they feed on “our schedule” may limit your production.
Another frequent mistake is not offering both breast every feed. Young babies often fall asleep while feeding on the first breast and many mothers mistakenly assume they are done. Both breasts should always be offered. Think of the second breast as dessert. It should be offered but is not required. An attempt to stimulate both breasts is a good practice for baby and your supply.
Overuse of the Pacifier
Pacifier, how I love thee…
No, I am not going to preach the evils of pacifier use to you. I was a mommy before I was a lactation consultant and I fully appreciate what a lifesaver pacifiers are. The problem lies when they are used and abused. It is easy to use a pacifier to soothe a baby that is giving feeding cues and essentially miss a feed. Remember, your milk production is all supply and demand. If your baby really wants to be at the breast, they are expressing a physiologic need to feed. Your body will only be able to keep up if you allow baby to breastfeed on demand. So love your paci, just don’t abuse it.
Shortened maternity leave
I know I sound like a broken record, but the first 6-8 weeks of breastfeeding a crucial to your supply. Mothers who have to return to work before 8 weeks find themselves trying to pump to establish supply. It is SO hard. A variety of factors are working against these moms. One is that the pump is not as efficient at emptying the breast as baby. Less demand = less supply. It is also very difficult to find time to pump as frequently as baby would be feeding at home. Ideally, mom would pump at work every time baby would be feeding at home… That would be every 3 hours or so. It is really hard to manage while balance work responsibilities.
If you can, try to extend maternity leave to 8 weeks. If that is not an option for your family, don’t fear. An amazing pumping series with amazing pumping tips for increasing your pumping yield and ultimately your supply! Check out the four part series:
Yes, pregnancy can cause your supply to decrease. If you are breastfeeding a baby over a year, this is not a big deal because your baby is well established on solids and not requiring breastmilk for the majority of calories any longer. Most mothers do not notice a drop in supply until about halfway through their pregnancy. So, if your supply has dropped and their is no discernible reason why… you may want to go pee on a stick.
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Bonyata, K., IBCLC. (2017, December 2). Increasing Low Milk Supply. Retrieved December 11, 2017, from https://kellymom.com/hot-topics/low-supply/
Flora, B., IBCLC. (n.d.). Hidden Hinderances to a Healthy Milk Supply. Retrieved December 11, 2017, from http://www.motherandchildhealth.com/breastfeeding/hidden-hindrances-to-a-healthy-milk-supply/
Gray, K., IBCLC. (2017, July 10). Why Breastfeed at Night. Retrieved December 13, 2017, from http://www.nursingnurture.com/why-breastfeed-at-night/