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Do You Think You Have Low Milk Supply?

Saturday, 01 September 2012 10:05
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“Not enough milk” is one of the most common causes for stopping breastfeeding or choosing to supplement with formula. Unfortunately often it is a perceived notion of not having enough milk which is  loosely based on one or several of the following:

  • feeling as if the breasts are not as full as they used to be
  • baby feeding more frequently
  • low maternal confidence
  • misunderstanding/mismanagement of growth spurts
  • Lack of support from partner/family/society
  • baby pulling away from the breast/restless at the breast/fussing between feeds
  • limited amounts of breast milk when pumping to assess the amount (never a good idea).

More often than not, the milk supply is adequate but is perceived as being low by the mother.  With limited support available and a lot of misleading advice on available on the internet, a perceived low supply can easily become an actual low supply due to incorrect management. 

Low milk supply, whether perceived or actual, is an issue that needs to addressed and managed if prolonged breastfeeding is to occur.

Causes

Insufficient removal of milk from the breasts leading to a reduction in milk production is the most likely cause of low supply. This is associated with:

  • Poor attachment
  • Insufficient breastfeeding and restricting breastfeeds
  • Sleepy infant
  • Mother-infant separation
  • Unresolved engorgement
  • Use of infant formula, teats and dummies/pacifiers
  • Ankyloglossia (tongue-tie)and other infant oral cavity abnormalities

If you think that your supply is less than before or not enough then use the following list to assess if the problem is real or perceived. Note that there is a vast difference depending on the age of your baby as their needs are constantly changing.

For newborn babies:

  • Fewer than 3 wet nappies/24 hours by day 3
  • Fewer than 5-6 heavy wet nappies/24 hours after day 5
  • Concentrated urine
  • No change to normal breastmilk stools by day 3-4 and scant stools thereafter
  • Dry mucous membranes
  • Weight loss greater than 10% birth weight
  • Further weight loss after day 3-4
  • Less than 20 gm weight gain/day after day 3-4
  • Failure to regain birth weight by 2 weeks of age
  • Limited evidence of milk transfer during feeds
  • Prolonged or continuous feeding with little evidence of satiety
  • Persistent jaundice
  • Persistently sleepy or lethargic infant
  • Excessive crying, weak cry
  • Infant appears unwell
  • No signs of lactogenesis II on day 3-4 (breast fullness and heaviness)
  • Breasts remain soft in between feeds (normal after around 3 weeks).

Week 1- 3

  • Fewer than 5-6 heavy wet nappies/24 hours
  • Concentrated urine
  • Scant stools (expect 2-3 breast milk stools in 24 hrs often while feeding)
  • Dry mucous membranes
  • Limited evidence of milk transfer during feeds
  • Prolonged or continuous feeding with little evidence of satiety
  • Excessive crying, weak cry
  • Infant appears unwell

Growth Spurts

Growth spurts occur at around week 2, 3 and 6 weeks and are a very real cause for concern and perceived low milk supply because during a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual.

The increase in baby’s milk intake during growth spurts is temporary. Physical growth is not the only reason that babies may have a temporary need for increased nursing. Babies often exhibit the same type of behavior (increased nursing with or without increased fussiness) when they are working on developmental advances such as rolling over, crawling, walking or talking. Mom’s milk is for growing the brain as well as the body!

They occur again at month 3,4, 6 and 9 so take note and do not despair. Go back to the list, meet up with other mom’s with babies of similar age and find support to reassure yourself.

Things to do when you have perceived or actual low milk supply

  • Correct positioning and attachment, and management of any nipple trauma
  • Increase the number of breastfeeds: wake the infant more often and/or offer the breast for comfort instead of using a dummy/pacifier
  • Understand and read your infant hunger and satiety cues and the signs of effective milk transfer
  • Decrease non-medically prescribed or unnecessary use of artificial infant formula
  • Implement ‘switch feeding’ if infant is sleepy: change the infant from one breast to the other several times during a feed to keep the infant alert during the feed while milk supply is low
  • Increase skin-to-skin contact
  • Breast compression during feeds may increase milk transfer
  • Additional breast stimulation and drainage through regular expressing after or between breastfeeds

Good maternal nutrition, rest, relaxation and domestic support and reduce smoking, caffeine and use of alcohol

I cannot stress enough the value of rest and diet when there is a perceived or actual low milk supply. Breastfeeding takes time and energy. Slow down. Watch your baby.

If none of these help then seek advice from lactation consultant who will take a full history, watch your feeding and give you a plan to work with going forward with regular follow up.

 

Read 6546 times Last modified on Sunday, 22 September 2013 11:30

Karen Wilmot is the only licensed midwife offering community based antenatal, postnatal and birthing services in Muscat.
 
With a wealth of experience and a kind and compassionate nature, Karen is the "go to" person for anything pregnancy or baby related! 

Website: www.pregnantinoman.com

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