Low Milk Supply
Variety of Causes | Understood by Few | Downplayed by Many
Definition: Production of less milk than required by the nursing child
Low Milk Supply is a difficult concept.
The lactation community has at times downplayed this issue because the majority of mothers can produce a full milk supply with proper breastfeeding management. Concerns about lack of sufficient breastmilk production is a common reason for early cessation of breastfeeding, and failing to adequately provide education about this issue is not supportive of parents meeting their goals.
Often, when parents are concerned about low milk supply, the issue is their perception and understanding of normal infant behaviors at work, not an issue with the milk supply.
Here are some common reasons parents report for their concern about their milk production:
Breasts no longer feel full
Baby waking at night
Changing length of baby’s feeds
Grumpy baby behavior
Evening fusiness
Low Pump Output*
Lack of breast leaking
Not feeling a letdown
Baby take a bottle after nursing
While these concerns are valid, and changes in baby’s behavior should be evaluated, these are not signs of low milk supply. The changes in the feelings of breast fullness, changes in leaking, and not feeling a letdown anymore are normal experiences with breastfeeding as the milk supply regulates. Changes in baby’s feeding patterns, sleep patterns, and fussiness are normal infant behaviors. Pump output is not reflective of milk supply overall, and if that is a concern, seeing a lactation consultant for a weighted feed may help ease your mind.
Read this post to learn more about assessing if your baby is getting enough breastmilk.
These are signs of low milk supply, and if your baby experiences these signs, it is vital that you supplement your baby immediately with the amounts suggested by their health care provider, and see a lactation consultant as soon as possible.
Poor weight gain
Not enough wet or dirty diapers for their age
Dehydration
Low Pump Output on its own is not an indicator for low supply. If you are experiencing Low Pump Output, you should book a consultation to figure out why. It could be related to your flange size, pump technique, the time you are pumping, the type of pump you are using, or your let-down response may not be conditioned to the pump. These are all simple things we can work on to help improve your pumping experience.
While you are waiting to begin working with the lactation consultant, it is important that you protect your milk supply by continuing to nurse and pump frequently to provide stimulation and keep your breasts emptying.
So what is the cause of low milk supply?
Well, that depends on each individual dyad and the unique challenges they face.
To determine the cause of low milk supply, we have to look at the variety of reasons for lack of sufficient milk production. The milk making equation gives a starting point to understand what could be influencing the difficulty with milk production and to help create a plan to improve the situation. When dealing with low milk supply, it can be really hard to determine what probable causes might be, and how to proceed. So, how do you figure out if your milk supply issue is related to a simple breastfeeding management issue, like needing to pump or nurse more often, flange fit, a simple latch fix, or a much bigger issue related to underlying hormonal conditions, or anatomy concerns?
That is where scheduling a breastfeeding consultation makes all the difference in your journey! When you are struggling with low milk supply, you need a comprehensive evaluation that looks at:
Basic breastfeeding management
Breast pump flange fit
Assessment of latch
Assessment of nipple pain and damage
Assessment of breast anatomy
Screening for likelihood of underlying hormonal concerns that influence milk production
Screening for signs consistent with tongue tie
Assessment of galactagogues you have tried, their results, and determination of galactagogues to avoid or consider.
In order to support you in this I developed a specialized screening tool that takes all of these things into account at points us quickly in the direction most likely to help you meet your goals.
Check out the free Low Supply Checklist to better understand this issue.
So, what can be done to “fix” low milk supply?
There is sadly no magic fix for low milk supply, at least not one that is easily identified with a treatment that is guaranteed to work. The best solution when struggling with milk supply issues is to book a consultation with a lactation consultant. Low milk supply issues are best addressed taking a holistic look at your health history, assessing risk factors, considering the need for lab work, and assessing breastfeeding management. Approaches that do not cover all of these areas are approaches that often fail to help support your breastfeeding success.
Can you continue your breastfeeding relationship with low milk supply?
Yes! Yes you can! Many parents breastfeed well into toddlerhood with low milk supply!
Low milk supply presents unique challenges, and there are cases where no intervention will result in increased milk supply. This just takes some creativity to determine which strategy is most likely to work best for an individual dyad! When choosing a strategy, it is important to consider the individual factors such as extent of the low supply issue, causes of the low supply, ability of the baby to effectively transfer the available milk, and compatibility of strategies with the family’s lifestyle. It is always important to make sure the baby is being adequately fed, and this means supplements may be required. Some strategies that help sustain the breastfeeding relationship include:
Nursing more frequently: it may be possible to manage low milk supply by nursing more than the 8-12 times per day average. Feeds during the peak hours of production (night feeds and early morning feeds) may be emphasized at ensure highest intake possible.
Switching breasts more than one time per session: Switching breasts 2 or more times may allow a baby to elicit additional letdowns and increase the amount of milk consumed.
Utilizing a supplemental nursing system: To provide needed supplements while allowing for breast stimulation to maintain the milk supply. These can be used short-term or long-term. There is a learning curve to using a SNS system, but with practice, it can be a great tool!
Pro-tip: Use a small bandaid on the breast to feed the tube through, so you do not have to place and remove medical tape several times per day.
Bed-sharing to allow frequent night nursing: Bed-sharing can allow a breastfeeding dyad to more frequently nurse without exhausting the parent. Bedsharing should be done with safety in mind, and only in families without risk factors that make the practice higher risk.
Offering the breast before the bottle: This allows the baby to remove all available milk before having their supplement, and will help to assure adequate milk removal when baby is most hungry.
Breast as Dessert: For some babies, the idea of nursing with low supply when hungry is frustrating, so we flip the strategy mentioned above and offer the supplement first, and then, the breast, when the baby is not as hungry and is less likely to become frustrated.
Timed supplements: Some baby’s will need a fairly predictable amount of supplement, and they thrive when offered these supplements by bottle or sippy cup at predictable times of day. These might be offered to an older baby at meal times to meet their need that goes above what they can obtain from nursing.
Comfort nursing: Nursing is more than just food, and some babies are happy to continue the comfort part of the nursing relationship even in the absence of a substantial milk supply. There is no reason this cannot be maintained if the parent and child are both satisfied in this element of the relationship.
Read more in-depth information about the considerations for choosing a strategy
Galactagogues
Galactagogues are foods and herbs taken to try to increase breastmilk production. The evidence for these is mixed, and we lack solid studies to show us what will be effective. To make things more complicated, in order to choose a galactagogue that might help you, the issue it helps with needs to be identified, and you have to be cautious about issues it could exacerbate. That said, many parents feel that galactagogues have assisted them in meeting their breastfeeding goals, and it is certainly something you can consider after assessing safety and compatibility. It is always prudent to check with your health care provider to determine if any particular herb or supplement is safe for your personal medical situation.
It is important to remember that there is no galactagogue that will compensate for issues with breastfeeding management! Secondary reasons for low milk supply have to be corrected in order to increase milk supply. These issues would be breastfeeding management practices like how frequently and completely the breasts are emptied, breast pump flange sizing, and your baby’s ability to effectively nurse. Galactagogues may be a great option to support milk supply increase while we are fixing these issues, but they will not on their own correct the milk supply while these problems continue.
While the mechanisms for how these galactagogues might work are often unclear, it is believed that when they do improve milk supply, it is related to their impact on an underlying issue that is impeding lactation:
Thyroid dysfunction
Insulin resistance
Hormonal imbalances
Nutritional deficiencies.
Things to consider when deciding if a galactagogue is the right choice to try:
Is there truly a low milk supply issue? How substantial is the low supply issue?
What are the likely causes of the low milk supply?
Do you have any health concerns that indicate the need for medical assessment and labwork, or clusters of symptoms that should steer your to or away from certain galactagogues?
Do you have any other health concerns that would be a contraindication to a certain herb or food? Allergies or pre-existing conditions can greatly influence the safety and suitability of certain galactagogues?
So what are the galactagogues that might be considered if the situation suggests this might help?
To help you better understand your options, check out the “Guide to Galactagogues” with a personalized decision making guide, information about available options, information about where to purchase, and suggested dosages supported by the literature and years of lactation practice outcomes.
So, which of the popular lactation blends from companies such as Legendairy, Euphoric Herbals, Milky Mama, etc, would be best for me to try? When it comes to blends like this, we don’t know the exact dosages in these blends, and we need to be careful that we have checked each ingredient for suitability. If the ingredients in a particular blend pose no contraindication or concern, trying these blends may be supportive of meeting your goals. The “Guide to Galactagogues” contains charts to help facilitate choosing a blend based on your individual needs so that you can more confidently choose a blend likely to help you.
What about Reglan or Domperidone?
Both Reglan and Domperidone are gastrointestinal drugs that have the effect of raising prolactin, which in some people can result in increased milk supply. Neither of these are magic answers to low milk supply, as they will only work for people with low prolactin levels.
So, should you get your prolactin checked?
There are mixed opinions on this, as prolactin levels vary by person, and what is adequate for one parent may not be for another. Levels vary throughout the day, and rise and fall based on nipple stimulation. You will need to discuss this with your health care provider. I personally recommend to my clients to have this test done when requesting blood work for low milk supply. It can be helpful to know as part of a much bigger picture.
Side Effects:
Reglan has significant side effects, including anxiety and depression. This medication is available in the United States by prescription only, and can used for short periods of time to help increase milk supply.
Domperidone has fewer side effects than Reglan, but it is not currently approved by the FDA in the United States. The FDA has issued a statement that there is cause for concern about heart arrhythmia in people using this drug, but there is significant criticism of this concern as being misapplied to the younger, relatively healthy, nursing parent population. While this medication is banned in the United States, parents are making the choice to import this drug from Canada or Thailand at their own risk. If you decide to make this decision, you should still discuss this medication with your health care provide. It is not without some degree of risk and should be properly monitored.
