Low Milk Supply

By Barbara Wilson-Clay

Concern about low milk supply is the number one reason mothers give for discontinuing breastfeeding. Because we live in a bottle-feeding culture, first-time mothers may find it hard to trust in a process they cannot easily measure. It is reassuring to learn that weight checks and counting wet and dirty diapers can help you tell if your baby is getting enough to eat.  The important thing to remember is that most women are physically capable of making enough milk for their babies to be healthy and happy.

The first few weeks after giving birth are a critical time for establishing the milk supply. During this time, frequent, thorough emptying of the breasts sets and controls the level of milk production. This process depends upon a physically healthy mother and a robust baby. 

Some maternal conditions may delay or affect the amount of early milk production.  Some of these conditions include:
 *  Long, stressful delivery
 *  Cesarean delivery 
 *  Excessive loss of blood during delivery and anemia
 *   Hormonal disorders (polycystic ovarian syndrome, thyroid disease, uncontrolled diabetes)
 *   Maternal infection or illness
 *   Previous invasive chest or breast surgery, or a history of unusual breast development
 *   Smoking
 *   Pregnancy Induced Hypertension (PIH)

In most cases, as the mother’s physical status improves, so will her milk production.  If the baby loses interest in the breast owing to a temporary low supply, double pumping for 15 minutes a minimum of 8 times each 24 hours will help bring in the milk.  This is called insurance pumping.  The infant can be supplemented at breast with an SNS until the milk supply recovers.

Some infant conditions may affect early milk production.  The milk supply can rapidly drop if the baby is too weak or small to adequately stimulate the breasts, or is not latched on well. For example, babies who are “just a little early” are often weak feeders until they reach their official due date.  These infants may sleep at the breast but not effectively drain the milk on a regular basis.  Insurance pumping after the baby breastfeeds protects the supply/demand process.  Infants with significant tongue-tie or other anatomical challenges may also struggle to maintain an adequate milk supply.

The milk supply will also be affected if engorgement is not relieved or if the baby is not breastfeeding often enough. Giving the baby a bottle at night so the new mother can sleep may sound reasonable, but it often leads to a low milk supply down the road. A better way to help the new mother is to provide good nutrition and to free her from household duties so she can nap when the baby naps.

Other reasons for low milk supply in later lactation include:
 *  Medications (example, antihistamines, decongestants, and estrogen lower milk supply)
 *  Pregnancy
 *  Maternal illness
      
It is important to remember that babies fuss for reasons other than hunger, but any mother with concerns about her milk supply deserves the reassurance of a weight check to make sure her infant is growing well.
      
If a problem does exist, remember that most causes of low milk supply can be corrected with assessment and timely help from your lactation consultant. Your doctor can select antibiotics that are safe for the nursing infant to treat any infections. Low milk supply generally improves with improved management of lactation.

References:

Chapman D and Perez-Escamilla R: Identification of risk factors for delayed onset of lactation, J Am Diet Assoc 1999;99(4):450-54.
 
Hall R, Mercer A, Teasley S, et al: A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age, J Pediatr 2002; 141(5):659-64.
 
Wilson-Clay B. and Maloney B: A Reporting Tool to Facilitate Community-Based Follow-up for At-risk Breastfeeding Dyads at Hospital Discharge, In Current Issues in Clin Lact 2002, ed. K Auerbach, Jones and Bartlett, Boston. Pg.59-66.
 
 
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