Strategies for Breastfeeding at the Breast with Low Milk Supply
Having low milk supply does not automatically mean that feeding at the breast will never work.
There will never be a one size fits all solution for any nursing dyad (a mother and her baby), but there are lots of strategies that can be evaluated to determine what might work for an individual dyad.
Factors to consider when assessing each strategy:
Storage Capacity: This refers to how much milk an individual mother's breasts are capable of holding. Some mother's have more than average storage capacities, and their babies can meet their needs for milk nursing less frequently in 24 hours (ex. a storage capacity of 4-5 oz would allow a baby to take in 30 ounces of milk nursing only 6-7 times in 24 hours). Some mother's have smaller storage capacities which would mean their babies need to feed more frequently (ex. a storage capacity of 2 oz would mean a baby would need to nurse 15 times in 24 hours to take in the same 30 ounces of milk). On average mothers have a storage capacity of 3-4 ounces which requires a baby to nurse 8-12 times in 24 hours to take in 25-30 ounces of milk.
Refill Rate: This refers to how fast the body can generate the maximum amount of milk the milk-making tissue of an individual mother is capable of generating. A mother with a high storage capacity and a slow refill rate would likely find that despite their ability to hold a large quantity of milk they have to nurse more frequently, just as a mother with a small storage capacity and fast refill rate does. Insulin resistance can be a large part in milk refill rates and I encourage all mothers finding themselves feeling like their breasts are slow to generate milk to talk to their health care providers about insulin resistance, and possible treatment options.
Glandular Tissue: Some mothers find they have a condition called insufficient glandular tissue, which means their breasts contain very limited milk making tissue, and even with optimal breastfeeding practices their bodies will only produce an amount of milk that will not entirely meet their babies nutritional needs. Mothers with insufficient glandular tissue (IGT) may have physical markers such a significant asymmetry, widely spaced breasts, stretch marks in the absence of breast growth, tubular shaped breasts, large/bulbous areola, and absence of changes to the breasts during pregnancy or the postpartum period. These physical markers do not mean that a woman will definitely have a low milk supply, but she may want to seek an evaluation from a lactation consultant to make sure breastfeeding gets off to a good start and is managed in a manner to allow breastfeeding to continue as desired. Insufficient glandular tissue impacts the milk supply of a mother to a degree where the capacity to make a sufficient milk supply is impaired, but the degree of impact may vary by mother. A mother who can produce 18-20 ounces of milk a day may have IGT, but her situation will look different than a mother with IGT who only produces 2-4 ounces of milk per day. This is why each strategy needs to be individually evaluated.
Efficiency of baby at the breast: Some babies are very effective at draining a breast, regardless of the amount of milk contained. These babies spend only a few minutes breastfeeding at any given time, and effectively transfer the milk available which stimulated their mothers continued milk supply. Some babies are ineffective at the breast, and either struggle to adequately drain the breast or take a very long time to do so. These mothers may find that nursing sessions take 30 minutes or longer, and the idea of nursing every 60-90 minutes would mean almost all of the mother's time is spent nursing, which may not be tolerable to her.
Strategies that may be considered:
There are many strategies that can be evaluated when determining how to optimize breastfeeding with low milk supply, if you take into consideration how the factors discussed above are impacting a particular nursing dyad. The strategies that may work for one dyad would be unacceptable for another, and that is perfectly fine! The beauty of breastfeeding is that it does not have to look any one particular way, it doesn't have to be all or nothing, and success is defined by each individual dyad. A lactation consultant should be able to help you determine the suitability of each strategy for your individual situation so that you can make an informed decision.
Nursing more frequently: Increasing the total number of times in 24 hours that a baby is breastfeeding may assist in feeding at the breast meeting more of the baby's milk intake needs than would be met feeding less frequently. Emphasizing feeding during the night and early morning hours will have the greatest impact, as prolactin levels are highest at this time of the time which optimizes your body's ability to produce breastmilk during these hours.
Switching breasts more than one time per session: Switching breasts during the feeding can assist with a higher milk flow rate which may encourage baby to nurse more actively at the breast and support optimizing the mother's milk supply potential. This may be ill advised if the baby is struggling to meet their needs at the breast without expending extra calories, but for some nursing dyads can increase total intake without causing issue for the baby.
Utilizing a supplemental nursing system: Supplemental nursing systems allow mother's own pumped milk, donor milk, or formula to be feed to the baby at the breast utilizing a small tube that is placed in the baby's mouth while nursing, and allows any necessary supplements to be given while allowing additional stimulation to the mother's breast to maintain her own milk supply. This strategy is most often used during the early weeks of nursing to encourage the mother's own milk supply to come in fully, but can be utilized long term as desired. There is a learning curve to utilizing a supplemental nursing system, and it can be intimidating at first. There are many different commercially available supplemental nursing systems, and they can be made at home.
Bedsharing to allow frequent night nursing: Before the pitchforks come out from the "bedsharing is a barbaric form of child endangerment camp", The Academy of Breastfeeding Medicine has recently released a protocol defining how bedsharing can be done to promote breastfeeding by carefully managing the risks. Bedsharing is a common cultural practice in many countries, and many breastfeeding dyads bedshare whether they plan to, or find themselves desperately pulling their infant into their bed unexpectedly. Bedsharing allows a nursing dyad to nurse frequently through the night while allowing both mother and baby to sleep through the majority of the nursing sessions. Bedsharing mothers often find they are unaware how frequently the baby is nursing during the night as it is not perceived as disrupting the rest the mother is getting at night. This practice may allow a mother who finds sleep deprivation intolerable to increase the frequency of nursing without diminishing her quality of life. This is an extremely personal decision for each family to make, and should be made by taking an honest look at their risk factors pertaining to bedsharing. This article by LeLeche League International discusses risk factors to be considered. If you choose to bedshare you are a good parent. If you choose not to bedshare (even if that decision hinders your overall milk supply) you are also a good parent. Make the decision that is right for your family, but make the decision consciously in the waking hours and utilize risk management techniques to assure everyone sleeps safely.
Breast first then the bottle: Some nursing dyads find success nursing directly at the breast, and then immediately providing a bottle after each feeding to meet the additional nutritional needs of the baby. Many babies are content with this arrangement, particularly when slow flow nipples and paced bottle feeding are utilized to help prevent flow preference (often referred to as nipple preference).
Breast as dessert: This is the opposite of the strategy just discussed, and is used to meet the bulk of the baby's nutritional needs by bottle so that baby can finish getting satisfied at the breast when they are not frantic, and more content to work to get their milk. This can be a great strategy for a mother who finds she has a naturally slow flow of milk at the breast, and her hungry baby becomes agitated if nursed before receiving the supplement.
Timed supplements: Some mothers find their baby is satisfied at the breast certain times of the day, but requires supplements at other times of the day. These timed supplements are typically utilized in the evening hours when milk supply is naturally at it's lowest, and can be delivered via bottle or supplemental nursing system.
To recap.........every nursing dyad is different......there are a lot of options for preserving feeding at the breast with low milk supply.......a lactation consultant can help you evaluate your options in the context of your personal situation. There is no one size fits all solution, and declaring a solution that would not work for your personal situation as unacceptable only serves to prevent other mother's from considering that they may work for them.
Mother's are often incredibly creative in figuring out how to meet their baby's needs, if you have come up with a solution to preserve nursing at the breast with milk supply please share it! Information and options are vital to helping more mother's decide how to proceed with their own situations!
