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Inadequate Milk Supply

Milk SupplyBy Barbara Wilson-Clay, BSEd, IBCLC
Concern over low milk supply is the number one reason mothers give for discontinuing breastfeeding. Because we live in a bottle-feeding culture, it can be difficult for first-time mothers to trust in a process they cannot easily measure. It is reassuring to learn 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. The milk supply can rapidly drop if the baby is too weak or small to adequately stimulate this process, or is not latched on well. 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 encourage her to rest with her baby at the breast, provide her with good nutrition, and free her from household duties so she can get breastfeeding off to a good start.

Most mothers find that they have plenty of milk for their babies, even as baby grows into an active toddler. Sometimes, in spite of good support and the mother’s best efforts, there is a real problem with milk supply. In rare cases, hormonal imbalances during adolescence have affected breast growth and development. Conditions such as Polycystic Ovarian Syndrome, thyroid disorders, chest surgery, or invasive breast surgery can create problems with full milk production. Severe dietary restrictions during pregnancy and lactation can affect some women’s milk supplies, as can smoking or overuse of alcohol.

Excessive loss of blood during delivery and anemia can both reduce milk production until the mother recovers. If a fragment of the placenta remains in the uterus it will prevent full milk production until it is passed or removed. Some medical conditions such as diabetes can delay full milk production for several weeks. Typically, lack of frequent and effective removal of milk from the breasts, along with infections, fatigue and excessive stress are the major causes of early problems with milk supply. Some medications, especially head cold remedies, may dramatically reduce milk supply.

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 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 more rest, improved diet, reduction of stress, and improved management of lactation. Your physician and lactation consultant can suggest herbs or prescription medications that may boost your milk production, and breast pumping is often suggested to re-stimulate the milk supply.

Editors:

Kathleen B. Bruce, BSN, IBCLC
Catherine Watson Genna, BS, IBCLC
Mary Bibb, BA, IBCLC

References:

W Fawzi, M Forman, A Levy, et al: Maternal anthropometry and infant feeding practices in Israel in relation to growth in infancy: The North African Infant Feeding Study, Am J Clin Nutr 1997; 65:1731-40.

T. Hale, Conference Presentation, Medford, Or, 2001.

S Henly, C Anderson, M Avery, et al: Anemia and insufficient milk in first time mothers, Birth 1995; 22:87-92.

K Hoover: Insufficient Milk Supply, in Core Curriculum for Lactation Consultant Practice, ed. by M. Walker, Jones and Bartlett, Boston, 2002. Pg. 219-229.J Hopkinson, R Schanler, J Fraley, et al: Milk production by mothers of premature infants: Influence of cigarette smoking, Pediatrics 1992; 90:934-938.

K Huggins, E Petok, O Mireles: Markers of lactation insufficiency: A study of 34 mothers, in: K. Auerbach, Ed. Current Issues in Clinical Lactation 2000. Jones and Bartlett, Sudbury, MA. Pp. 25-35.
N Hurst: Lactation after augmentation mammoplasty, Obstetrics and Gynecology; 87(1): 30-34.

R. Lawrence and R Lawrence: Breastfeeding: A guide for the medical profession, 5th edition, Mosby, St Louis, 1999, Pp. 412, Pp 507-540.

J Mennella, G Beauchamp: The transfer of alcohol to human milk, New England J Med 1991; 325:981-4.

M Neifert, J Seacat, and W Jobe: Lactation failure due to insufficient glandular development of the breast, Pediatrics 1985; 76(5): 823-827.

S Neubauer, S Ferris, C Chase, et al: Delayed lactogenesis in women with insulin-dependent diabetes mellitus, American J Clinical Nutrition 1993; 58:54-60.

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