Monday, January 18, 2010

Low milk supply

What is it?
Almost all mothers go through a period of questioning whether their milk supply is adequate, especially when they begin breastfeeding. When mothers are questioned about why they didn't breastfeed, or didn't breastfeed for longer, their number one reason is "I thought I didn't have enough milk". But according to many experts, it is very rare for a mother not to have enough milk.

Many women think their milk supply is low when it is not. This can happen if you stop feeling a strong letdown reflex or lose the feeling of fullness in your breasts, or if milk stops leaking from your nipples. These are actually natural, common signs that your body has adjusted to your baby's feeding requirements. A baby going through a growth spurt may also want more milk than usual and may lead you to question your supply. Some babies simply become more efficient and faster feeders, and so the feeds become shorter, giving you the impression that you don't have enough milk.

There may be times when some mothers do not produce milk to their full capacity but for the vast majority, understanding the breastfeeding process can solve the problem. Only about two per cent of mothers are physically incapable of producing enough milk.
What causes it?


For most women, the real problem is delivery, not production. They produce plenty of milk but because their baby is not latching on well and feeding effectively, the baby doesn't get enough.

Breasts are designed to produce milk to match your baby's demands. The more he feeds, the more milk you will produce. If your milk supply has gone down temporarily, you may:
• be suffering from sore nipples and find feeding painful; or
• have a sleepy baby who needs encouraging to feed;
• your baby may be often using a dummy, which cuts down the amount of time that he is breastfeeding; or
• feeding to a strict four-hourly routine has reduced your milk supply. This is why it is helpful to feed your baby on demand, not according to a routine.

For a few women, biological or physical conditions such as hormonal disorders or breast injury/surgery, can cause their milk supply to be low. However, as milk production is so important, most mums with these conditions find that they can still produce enough milk to feed their babies.
What should I do?

First, rule out false alarms about your milk supply. It's fairly easy to determine if your baby is receiving the right amount of milk.

Weight gain is the best way to make sure that your baby is getting enough milk. Although newborns typically lose five to ten per cent of their birth weight in the first few days, your baby should start to put on weight after that. If he is weighed again at five to seven days, you should see that he is starting to grow.

If you answer yes to the following questions, your baby is probably getting enough breastmilk and therefore, you are producing enough.

• Does he wet five to eight nappies a day?

• Does he have a healthy and alert appearance?

• Does he produce yellowy-mustard stools and are the stools beginning to lighten in colour by the fifth day after birth?

Read our article on signs that your baby is getting enough milk to give you more information.

If you feel you are not producing as much milk as you (and your baby) would like, get the best latch-on possible. Expert help from a breastfeeding counsellor or infant feeding specialist is available. Ask your health visitor or midwife if she can recommend someone or look at our directory of breastfeeding organisations for sources of help.

To increase your milk supply:

• Let your baby feed as often and for as long as he wants and offer both breasts at each feed.

• Give him only breastmilk and avoid using dummies which may reduce the time he spends at the breast.

• Do not be tempted to top him up with a bottle of formula (this is called "supplementing"). Your milk supply will adjust to the demands your baby makes on it. If you satisfy his hunger with formula he will require less breastmilk and your supply will reduce.

• While you are working on improving the way your baby latches on, you could also try expressing your milk after each feed. Removing as much of the residual milk in your breasts as you can will help stimulate your milk supply. If you store this milk in the fridge or freezer, you can use your own breastmilk to give him a bit extra if he gets particularly hungry at one time of day, perhaps in the evening.

• Some herbs (such as fenugreek) are said to increase a mother's milk supply – they are known as "galactagogues". There is no research evidence to support their use. Most pharmacists and pharmacologists would advise against using herbal remedies during pregnancy and while breastfeeding.

One of the side effects of a group of drugs called dopamine antagonists is to increase the blood levels of prolactin, the hormone responsible for getting milk production started and maintaining it in the early days. However most of these drugs also have other side effects, which are potentially serious. The exception is Domperidone, which you can buy over the counter. Breastfeeding specialists sometimes suggest this drug to mothers, when other means of increasing their milk supply are not working well enough. It is used as well as, not instead of, other ways to increase the supply.

However, Domperidone is not licensed to be used in this way and is not advised in all situations where your milk supply is low. Talk to a breastfeeding counsellor or infant feeding specialist if you want to know more.

In the first few days after birth, you may need to wake and encourage a sleepy baby to feed more often. This will stimulate your breasts to produce more milk. If he is difficult to wake or does not feed well, expressing colostrum/milk and giving it by some other route (cup, spoon or bottle) will help to meet your baby's needs and encourage your milk supply to build up at the same time.

After this time however, a full-term baby should be much more awake and alert. If your baby needs stimulating to keep him feeding, he is either not latched on properly or possibly not well in which case you should contact your GP.

Certain medical conditions may also cause a low milk supply:
• low (and sometimes high) thyroid levels
• losing a large amount of blood during labour or afterwards, (your milk supply may be affected until you recover).
• a fragment of the placenta still in the womb, may stop your breastmilk production until it is passed or removed.
• medicines (such as the combined contraceptive Pill and cold remedies with decongestants such as pseudophedrine) may lower milk supply.
Will it affect my baby?

Yes, if your baby regularly needs more milk than he gets, he could fail to thrive, a condition that can inhibit physical and mental development. Call your doctor and make an appointment right away if he's not gaining weight, or is losing weight. Often improved breastfeeding techniques will help but in some cases, slow weight gain may indicate a health concern.
Can I still breastfeed?

Yes, especially if you're suffering from a temporary decrease in milk supply because frequent, effective feeding is the key to boosting milk production.
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