Poor Milk Supply
Perceived low milk supply is one of the most common reasons that women give for electing to artificially feed. They erroneously assume that they don’t have sufficient milk because their baby is often unsettled or their breasts feel soft. It is interesting to note that when breasts are very full the fat content of the milk is less than when the breasts are softer. It is in this way that the nutritional needs of the baby are fulfilled as they will require less of the fat rich milk. It is important for parents to be aware of their baby’s output and understand what constitutes normal infant output as this can be reassuring. It can also act as an early warning sign if the baby is becoming dehydrated (see Intake and Output on this site).
True lactation insufficiency occurs when the mother’s body fails to produce sufficient milk for her baby’s needs. Hormonal causes include polycystic ovarian syndrome, hypothyroidism and retained remnants of the placenta. Hypoplasia (restricted breast development resulting in insufficient glandular tissue) is another cause. Damage to the nerves involved in the letdown process (4th intercostals) as a result of breast reduction, breast surgery and sometimes breast augmentation may also complicate milk production, while breastfeeding management may be to blame.
The precious hours following birth are very important for successful breastfeeding because it is then that the baby is naturally ready to self-latch. Babies born by caesarean section or to mothers who have used certain analgesics, such as Pethidine, during labour often struggle at the breast because they are sedated by the drugs which make them disinterested in latching and unable to suck rhythmically. They may take many days to overcome these issues during which time the breasts are not stimulated sufficiently. In such cases early manual expressing should be commenced together with lots of skin-to-skin time for mother and baby.
Anatomical abnormalities of the baby such as tongue tie, cleft lip/palate and Pierre Robin sequence may also result in poor milk transfer and subsequently, a reduced supply. These issues should be addressed as soon as possible and expert assistance sought to maximise breastfeeding success.
Milk production is initiated by the hormones in the woman’s body but soon ‘supply and demand’ begins to control the volume. The more milk that is removed from the breast the more the body produces, so the secret is to increase the daily volume removed by whatever means possible. Positioning and latching the baby well is very important in order to achieve this goal. Below are numerous suggestions, some of which may work while others may not but the aim is to increase your milk volume to about 780mls per day for babies between one and six months of age.
Troubleshooting low supply:
Maintain a good fluid intake - particularly water
Maintain a healthy diet
Sleep whenever there is an opportunity
Ensure the baby’s latch is deep and comfortable with good milk transfer
Allow baby to determine the length of the feed
Empty one breast before offering the second or …
Try switch feeding – swap breasts once nutritive sucking stops; then repeat
Keep baby nearby twenty-four hours a day
Watch for early feeding cues and offer the breast frequently
Increase the number of feeds – on average babies feed about eleven times a day
Feed through the night – dream feed if necessary
Use massage and/or heat for about ten minutes prior to feeds
Use breast compression to assist flow – constant pressure while baby is sucking; or rhythmic
Express after feeds – either with a pump, manually or better still, both
Express an hour after feeding if breasts were well drained at feed
Don’t give a dummy until breastfeeding is well established – after six weeks
Consider herbal galactagogues such as Fenugreek (not recommended for diabetics)
Discuss prescription galactagogues such as Motilium with your doctor
Sadly, a small number of women will never be able to produce sufficient milk to fully meet the needs of their babies. It is important for them to remember that some breast milk is better than no breast milk and to persevere for as long as they feel able. They should seek the assistance of professional support and be mindful of the fact that breastfeeding success may improve with subsequent pregnancies.
Brisbane is lucky to have the services of a milk bank, The Mothers' Milk Bank Charity, which collects, screens, pasteurises and distributes donated breast milk. If you would like to donate milk or you are unable to supply sufficient breast milk for your baby you can visit their website for more details: www.mothersmilkbank.com.au
Breastfeeding for Beginners
Experienced Lactation Consultant (IBCLC) & Midwife
providing breastfeeding support in North Brisbane