Sometimes it is not the case that low milk supply is just a false perception, and it is often the case that mums are experiencing a genuine milk supply problem that needs to be dealt with if it is important to the mum that breastfeeding continues. Here are some of the reasons you may want to seek help for a possible milk supply issue, and what you might want to try in order to rectify it.

Delayed start

It may be that you experienced a long delay between the birth of your baby and the time when he is able to breastfeed. This can cause problems thanks to the need for milk to be removed as frequently as possible as early as possible after birth, which helps to increase your breasts’ capacity to make milk. If this happens to you, you may find that frequent expressing during this time can really help, as well as plenty of skin-to-skin contact if possible.

As soon as your baby is able to feed at the breast, more skin-to-skin time and frequent opportunities for your baby to feed should make it possible to build up a supply to what he needs.

Supplementation

Offering a baby a bottle of expressed breast milk, formula milk (or solid food if offered before six months) can cause your supply to drop because there is less milk being removed by your baby so less stimulation for your breasts to make more milk. This can lead to a downward spiral where you  may find you need to supplement your baby with ever more bottled feeds.

For some mothers, this downward spiral is terribly disheartening and disempowering. You feel you’re not making enough so you supplement your baby’s feeds, so you make even less…it feels pretty crap to think your body’s not working the way you expect it to, but it is possible to reverse the situation if you want to.

Try spending a day or two in bed with your baby, skin-to-skin and feeding as often as possible. Only offer a supplement if your baby becomes frantic and only enough to settle him. As I showed in the first post in this series, your breasts make milk faster the more frequently you feed, so this strategy can really work to rebuild your supply to match your baby’s requirements. Bear in mind, though, that you may well need a lot of support to also rebuild your confidence in your ability to produce enough milk for your baby.

You may want to be able to give your baby some formula milk and some breastmilk, often known as mixed feeding. As every mother has a different storage capacity, some mothers will be able to mixed feed with very little effect on her supply, yet others will struggle to maintain a supply. If you’re one of the mothers who struggle, you may find you  need to express frequently or occasionally spend a day or two feeding more frequently from the breast to give your supply the boost it needs for breastfeeding to continue.

Unfortunately, you don’t know which end of the storage capacity spectrum you’re on until you try and sometimes then it is too late so mixed feeding, if due to your preference, should ideally be left until after your milk supply is well established – usually, although not always, around when your baby is around 6-8 weeks  old.

Mothers returning to work will sometimes arrange to express milk during their breaks either to store and give to their baby the next day, or to discard, solely in order to keep their breasts comfortable and to maintain their supply. I’ll write more about breastfeeding and returning to work another time.

Positioning and attachment

Sometimes frequent feeding can be a sign that a baby is not getting enough milk, which is different to a mother not making enough. This distinction is important, because if your baby is not latching on very well, then he may be feeding so inefficiently that the only way for him to get enough over a 24-hour period is to feed nearly constantly.

Other signs that the baby isn’t getting enough milk are a lack of wet and dirty nappies (see the NCT information sheet What’s in a Nappy? for normal stooling patterns in a newborn baby); slow or no weight gain; and a generally unhappy baby. In addition, if you are experiencing sore nipples, engorgement, blocked ducts or mastitis this would also suggest that your baby isn’t latching on well enough.

In this situation, the answer is to get your baby latching on well and feeding frequently and effectively. If your baby isn’t receiving enough milk, he also won’t be removing enough milk for your breasts to receive the message to make more milk and this, too, can cause a downward spiral.

Scheduled feeding

I think this is one of the biggest causes of the ‘lots of mums just can’t make enough milk’ myth. If you don’t feed often enough or for long enough, your milk supply can drop, and this happened a lot in the days when all mothers were strongly encouraged to follow strict routines of only feeding every three to four hours and to feed for only a certain amount of time at each breast. Sadly it still happens today when mothers are following routines set out in some modern baby-care books or by well-meaning friends and relatives.

Mothers are often concerned about a baby having too much ‘foremilk’ if they feed too frequently, or not having a ‘full feed’. If a baby is latching on well and being exclusively breastfed responsively, then the issue of ‘foremilk’ and ‘hindmilk’ sorts itself out –  I’ll write more about this in another post one day.

The idea of ‘full feeds’ comes from an age where bottlefeeding and scheduled feeding was the norm. An exclusively, responsively breastfed baby will have many feeds during a day, lasting different lengths of time. Small frequent feeds will allow a well latched-on baby to receive the same amount of milk over 24 hours as large infrequent feeds would.

As long as a baby is allowed to feed when he wants for as long as he wants, and is latched on well enough, then nearly every mother will be able to make enough milk for him.

Unplanned long intervals between feeds

Low milk supply due to too infrequent feeding can also occur when babies use dummies a lot, which leads to less time spent at the breast; mothers have told me that stopping using a dummy has made a real difference to their milk supply.

For some babies, starting to sleep through the night from an early age also seems to cause problems. I’ve spoken to many mothers for whom co-sleeping really helped in this sort of situation, as babies who sleep next to their mothers often feed more frequently at night (see safety guidelines if you want to try this). Other mothers have found that offering a sleepy feed to her baby just before she goes to sleep and then another one in the early hours of the morning has helped.

If more frequent feeding really isn’t an option, then frequent expressing, although not as efficient as a baby, may also help to increase your milk supply.

Some mothers also find it helpful to do ‘switch nursing’ for a couple of days. This is also helpful with sleepy babies who fall asleep very quickly during feeds. Switch nursing involves switching breasts between let-downs (will write about this too some time!) and mimics very frequent feeding. Every time your baby pauses between periods of long, drawing sucking and swallowing (while the milk is ‘letting down’ and flowing fast), the baby is put onto the other breast until another let-down is finished (there are usually 3-4 let-downs during any feed). This swapping is continued until the baby has completely had enough.

Medications and conditions in the mother

Mothers sometimes ask if there is anything they can take to increase their milk supply. There are some herbal remedies that have been used for centuries known as galactogogues; however these are unlikely to be helpful if a baby isn’t latching on well or isn’t feeding frequently enough.

On the other hand, it may be helpful to ensure that you’re not taking any medication or suffering from any conditions that could be
inhibiting your milk supply. Some hormonal methods of contraception can cause problems, as can postpartum haemorrhage; anaemia; smoking; rapid weight loss; previous breast surgery or injury (which can damage or cut the milk ducts); pieces of retained placenta; a history of hormonal problems; and a rare condition where the mammary glands fail to develop sufficiently.

Stop by next Monday to read about mothers feelings when they find they’re not able to make enough milk for their babies.

See also: Breastfeeding milk Supply 1: How does breast-milk supply work? : Breastfeeding milk supply 2: Why do mothers lose faith in their supply? : Breastfeeding milk supply 4: how does it feel to lose faith in your milk supply?

Images – thank you to: Grahamandsheila, Flickr; spilltojill, Flickr; indraw, Flickr; ECohen, Flickr.