Low Milk Supply

One of the most common concerns of the breastfeeding mother is that they aren’t making enough milk for their baby. Let me assure you, true low supply, or the inability to produce adequate milk, is rarely the problem. What signals your body to make more milk? Removing milk!

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“But he wants to eat all the time!”

Ok…Let’s look at the whole picture:

  • Is baby very young? Newborns have a stomach that, at 10 days old, is still only the size of an egg, and he’s eating a perfect food that is completely digested quickly.
  • How old is he? Just like a teenage boy that eats all the time, babies are growing…and fast! There are several physical and developmental spurts that occur, usually around the same time for each child. Take a look at the Wonder Weeks chart (http://www.whosthatmom.com/wonder-weeks-week-by-week/) and see if your baby is either having a growth spurt or about to have one.
  • Is he latched correctly? Can you hear him swallowing? A proper latch is comfortable for you, not painful, and allows baby to efficiently remove milk from the breast. If you have access to an IBCLC, have them check baby’s latch. There are several valuable resources here, as well: http://kellymom.com/ages/newborn/bf-basics/latch-resources/

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“He fusses at the breast. I don’t think any milk is coming out.”

  • Let’s talk about supply and demand. Babies demand milk…and you supply it. Fussing at the breast, beating on you, on-and-off nursing, etc, all signal your body to make more milk. Your breasts don’t ever truly become “empty”, they continuously make milk.
  • Does he need to burp? Is he distracted or overstimulated? Are you distracted or stressed?
  • Is he getting too much milk? Check our document on oversupply to see if it sounds like you.

“I’m pumping barely anything.”

  • Pumping is never a good way to judge what you’re actually producing. Babies are much more efficient at getting milk out than a pump.
  • Also see our document on Pumping Tips for help when pumping at work.

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“My breasts feel empty. I think my supply dropped.”

  • Probably not. Most of us only experience super-full feeling breasts for a limited time. What is most likely happening is that your supply is regulating. Your body and your baby’s demands have come to an understanding and your are meeting his needs without becoming overfull.
  • Your breasts always make milk. When milk is removed, they make more. “Your breasts are a factory, not a storage facility.” They are never truly empty.
  • Babies can typically always get out more milk. Even if it’s minimal; they are very efficient at their job.

“How do I make more milk?”

  • Firstly…nurse your baby more. Most concerns about supply can be fixed by simply nursing more.
  • Nurse baby on demand. Let him decide when he wants to eat.
  • Pay attention to baby’s hunger cues. Rooting, smacking lips, sucking hands, etc, are all signs of hunger. Crying is a late hunger cue.
  • Soothe at the breast. Comfort nursing can be frustrating sometimes, but it is the best means of comforting your baby and ensuring an abundant supply of milk.
  • Nurse until baby lets go. Let him decide when he’s done.
  • Don’t be a clock-watcher. Allow baby to run on his own time.

Signs that your baby is getting plenty of milk:

Birth-2 weeks:

  • baby starts gaining weight after your milk comes in. Remember, weight gain varies with every individual. Don’t compare your baby to your friend’s or yourself.
  • baby is having at least 3 quarter-sized poops per day. These can be spread out over a 24 hour period. More than three is fine.
  • baby is swallowing when he’s nursed.
  • baby is nursing at least every three hours until he reaches about 10 pounds. Again, more is fine.

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2-6 weeks:

  • baby passes birth weight by around 2 weeks. Remember to calculate that by baby’s lowest weight.
  • baby continues to gain weight.
  • still has 3 quarter-sized poops per day. Until around 6 weeks, this is what we want to see. Others may tell you that it is normal for exclusively breastfed babies to go several days or even a week or more without pooping. That is not true until around 6 weeks, and even then, not the norm.
  • baby has gotten the hang of latching on and staying attached.
  • baby is sucking with long, steady sucks soon after latching.

6 weeks on:

  • baby continues to gain weight.
  • baby is meeting developmental milestones.
  • baby has plenty of wet diapers and regular poops (they become less frequent around 6 weeks).
  • baby is getting longer and gaining in head circumference.

What if your supply is truly low?

Sometimes baby really isn’t getting enough milk. It’s important to understand why.

It’s important to figure out if he’s not taking enough because you’re not making enough, or if you’re not making enough because he’s not taking enough, or if he’s taking plenty but not using it well.

Source: The Womanly Art of Breastfeeding, 8th ed., p.396

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What might be the issue with baby?

Possible causes of baby taking too little milk are:

  • he’s improperly positioned
  • his nursing time is being cut short
  • he’s being fed too infrequently
  • he has a tongue-tie or other latching issue

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What might be the issue with me?

Possible causes of mother making too little milk are:

  • thyroid problems
  • PCOS (Polycyctic Ovary Syndrome)
  • breast surgeries

If your supply is truly low and your baby is not thriving, it is our advice at Milky Mommas to seek out and meet with an IBCLC to identify and correct the problem.

Most of these scenarios are completely reversible, so don’t give up hope. Remember, if you must supplement due to medical indication – and at the recommendation of a professional – there’s a strong chance that supplementation need be only temporary and you can return to being your child’s sole source of nutrition.

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Galactagogues (Supply Boosters)

A galactagogue is a substance that increases milk supply. There are herbal galactagogues, like fenugreek, and prescription medications. Before you decide to use a galactagogue, ask yourself why you think you need to.

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  • Do you think your supply is low? Many women think they have low supply when really their supply is perfectly fine. Babies — especially newborns — nurse often; they nurse for long periods of time, they enjoy comfort nursing, and they nurse for everything (not just food). As long as baby is having plenty of wet and dirty diapers, is gaining weight, and is happy, there’s no supply issue to worry about.
  • Click here to read about what to expect in the early weeks of breastfeeding  http://kellymom.com/bf/normal/newborn-nursing/.
  • If your baby isn’t having adequate output, isn’t gaining weight, and isn’t happy, you should see a lactation professional for an in-person evaluation.
  • Click here to find an IBCLC in your area http://www.ilca.org/why-ibclc/falc.
  • Click here to find a LLL leader or group near you http://www.llli.org/webindex.html.
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The average mother does NOT need galactagogues to increase her supply. Here are some examples of situations when galactagogue use may be helpful:
  • Some working mothers use herbs to increase their pumping output, even though their supply is fine when baby nurses.
  • Some mothers with a genuinely low milk supply use galactagogues in combination with increased nursing/pumping to increase supply.
  • Adoptive moms may use galactagogues to increase the amount of milk they are able to provide for their babies.
Using galactogogues can often be, at best, a bandage, covering up the actual problem, which doesn’t get resolved and may cause problems in the long run.
  • Galactogogues may cause side effects for mother, baby, or both.
  • The quality and quantity of herbal preparations is not consistent.
  • Galactogogues cost money and time.
  • Suggesting galactogogues reinforces the notion that breastfeeding requires special stuff in order to work.
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The usual, non-herbal, non-medication methods for increasing milk supply are sufficient for most mothers. Click here to read more about Increasing Milk Supply without galactagogues.
If the usual methods have not proven sufficient and you feel that a galactagogue is needed, keep these things in mind:
  • Remember that any galactagogue will be most effective in increasing milk supply when combined with increased breastfeeding frequency and milk removal.
  • Some types of galactagogues work better in particular situations and not in others. You should be working with someone who is knowledgable in their use.
  • All of these galactagogues, whether herbal or prescription medication, have potential side effects and drug interactions that must be considered for each individual mother. You should talk to your health care provider and/or a knowledgable herbalist about whether a particular galactagogue is safe for you.

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