When should we be concerned that our milk supply might be low?
- Insufficient Weight Gain
- Babies are expected to gain approximately one (1) ounce per day for the first two months and then half an (.5) ounce per day until around six months of age. Remember however that all growth charts are just guidelines to follow. They were developed to help monitor the growth and development of a large amount of babies especially in poor areas to watch for anything going wrong. Now we utilize them for every baby but often we put too much stock into those numbers instead of looking at the whole child.
- Lack of bowel movements
- The first several days of life a baby's bowel movements are what we call meconium. Usually by day four, the baby is transitioning to bowel movements that are lighter in color and moving towards yellow or brown and mustardy. If baby is still having meconium bowel movements at day five, you should contact your health care provider. During the first few weeks of life, a baby should have frequent bowel movements. If a newborn baby goes more than 24 hours without a bowel movement, you should contact your health care provider. After three weeks of age, the bowel movements may space out more. As long as baby is happy and healthy there is no cause for concern.
- Lethargic Baby
- Some babies are very relaxed. Relaxed and lethargic are quite different. We want to see a baby being "active and alert" at the breast when feeding. Your baby should be moving actively, looking around, making noises, etc. If your baby seems inactive or overly sleepy you may wish to contact your health care provider.
What can cause a low milk supply?
*Note that the majority of maternal issues would be present from the onset of the breastfeeding relationship.
- Breast Surgery
- Breast reductions and augmentations would be the top of this list however biopsies, injuries and surgeries of other types fall into this category. If you have had any of the above at any time you should consult with your OB/GYN and an International Board Certified Lactation Consultant (IBCLC) to discuss how these may effect breastfeeding for you and what you can do to improve your chances of being able to provide a full or partial milk supply to your baby.
- Insufficient Glandular Tissue (IGT)
- These breasts have less milk making tissue and so mothers who have IGT may need to supplement.
- Thyroid Problems
- Can cause issues with milk release.
- Milk production can be affected if insulin requirements are not well managed. Mothers who are diabetic can reduce their child's risk of developing both type 1 and type 2 diabetes in adulthood by breastfeeding.
- Polycystic Ovary Syndrome & Other Fertility Issues
- If a mother had issues preventing her from becoming pregnant without assistance these issues may also affect lactation.
- Retained Placental Fragments
- Can occur even after cesarean birth.
- Breastfeeding Mismanagement
- Most often IBCLCs find that milk supply has been reduced due to what we call breastfeeding mismanagement. This can mean that either baby was not being put to the breast often enough (early scheduling or sleep training) or baby was at the breast but with poor positioning and thus unable to nurse effectively.
- Premature babies may be smaller or have weaker jaws and may need assistance transferring milk in the beginning. Usually these babies will become more efficient as they grow.
- Oral Concerns
- Tongue Tie and/or Lip Tie are the most common however there are other oral irregularities that can affect breastfeeding. Congenital malformations such as Cleft Palate and/or Cleft Lip can also make breastfeeding challenging and cause mom's supply to drop if baby is unable to nurse effectively.
- Muscle and Neurological Issues
- As with prematurity these babies may need help until they are able to develop their oral muscles more or may need continued assistance but can transfer a portion of their food at the breast. Remember that breastfeeding is more than food. The closeness and comfort for many babies will help them to grow and develop and provide comfort to both mom and baby.
- Chromosomal Disorders
- Down's Syndrome is among the most common. Many Down's Syndrome children are able to breastfeed with little assistance but perseverance from their amazing mothers.
- Heart Conditions or other illness
- These babies may be too weak to transfer milk effectively.
What can we do?
With any of these concerns the first step would be to work with an experienced Health Care Provider (HCP). This can be your OB/GYN, Pediatrician and/or an International Board Certified Lactation Consultant (IBCLC). Who you work with depends on which issue you are dealing with. While seeking out a professional who can assist you and working on a care plan you will want to:
- Make sure baby is being fed.
- Make sure you are protecting your milk supply by pumping and/or hand expressing in addition to breastfeeding.
Ways to Increase Milk Supply
- Increasing Milk Removal
- Breastfeeding more frequently, pumping more frequently and in general increasing the removal of milk from the breast. Breast compressions may also assist with this.
- Assist Baby in Gaining Oral Strength/Developing Orally
- Working with an IBCLC you can develop a care plan to work with Pediatric Dentists, Pediatric Ear, Nose and Throat Doctors, Speech Therapists, Occupational or Physical Therapists, Chiropractors and/or Cranio Sacral Therapists to aid baby in gaining oral strength and function. By doing this you will find baby is able to stimulate your breasts to make more milk.
- Bring Mother's Health into Balance
- Your OB/GYN or other HCP can work with you to check maternal hormone levels, thyroid function, etc. to bring mother's health into balance to assist her body in being able to produce more breastmilk. This includes checking for retained placental fragments which must be removed.
- Utilizing Galactagogues
- Galactagogues are any substance that increases milk production. These include herbs, foods and prescription medications. A list of common galactagogues is below.
- Goat's Rue - Often used for IGT and Breast Surgery situations
- Shatavari - Often used for hormonal support
- Fennel - Often used for milk release problems
- Brown Rice
- Domperidone (Motilium) - Often used to increase Prolactin
- Metoclopramide (Reglan, Maxeran) - Often used to increase Prolactin
- Metformin (Glucophage) - Often used to stabilize blood sugar
There are many great Low Milk Supply Resources. Following is a list of just a few:
If you have questions or concerns about your milk supply we will be happy to meet and discuss those concerns with you either prenatally or after baby arrives. www.TheMILCGroup.com 210-960-MILC/210-960-6452