Thursday, August 27, 2009

Ask the Experts: Insufficient Supply of Breastmilk


by Cynthia Good Mojab,
Maternal Mental Health, International Board Certified Lactation Consultant, Clinical Counselor


Should I be concerned about not having enough breastmilk to nourish my baby?


Many mothers are concerned about not having enough milk. Yet the likelihood that a woman will be physically unable to produce sufficient milk for her nursling is actually low. So why is this such a common concern? Part of the answer lies in our loss of the art of breastfeeding. Many mothers have grown up in families where they are the first women in generations to breastfeed. These mothers are pioneers, doing the best they can with the information and support available to them. Unfortunately, because they are breastfeeding in a formula-feeding culture, the information they receive may be inaccurate and the support they have may be inadequate-which can undermine their efforts to breastfeed. In addition, exposure to formula advertising and being given free formula in the hospital after birth can decrease the confidence of mothers in their ability to breastfeed.

Milk supply is dynamic. It follows the law of supply and demand. The more frequently and effectively a nursling breastfeeds, the more milk the mother's breasts make. That's why recommendations to rigidly schedule and limit feedings or to never breastfeed at night (instead of responding to a nursling's cues for frequent, flexible feedings) can result in a reduced milk supply. It's also why nursing more frequently and ensuring that a nursling is effectively draining the breast are good first steps toward increasing milk supply.

Sometimes the misinterpretation of a nursling's behavior can lead mothers to think they don't have enough milk even though they actually do. Let's say a baby seems fussy after a feeding. The mother-or someone around her-may interpret the baby's behavior to mean that the mother doesn't have enough milk. A mother can have plenty of milk, but if she is engorged, the baby isn't positioned and latched on well, or the baby is using an incorrect suckling pattern because of exposure to artificial nipples, then the baby may not nurse effectively. (Such problems have solutions: they do not have to result in low milk supply or weight loss in a baby.) Or perhaps the mother has plenty of milk and the fussy baby is nursing effectively, but has thrush (an oral yeast infection) or is teething or needs to have a bowel movement. Fussiness can even be due to an ample milk supply that flows so quickly the baby has difficulty managing its abundance! These are just a few of the many reasons a baby might be fussy at the breast and that might lead to someone suggesting that a mother supplement with formula. Regardless of what leads to supplementation with formula, it is a very effective way of decreasing a mother's milk supply if her breasts are emptied less frequently and thoroughly because of it. Remember: milk supply follows the law of supply and demand.

Before or after the birth of a baby, International Board Certified Lactation Consultants and La Leche League Leaders can help mothers sort through breastfeeding advice to identify what is helpful and what might get in the way of building and maintaining a good milk supply. They can help mothers learn about positioning and latch-on so that nurslings can effectively obtain milk, how to tell a nursling is getting enough milk, and how to increase milk supply, if needed. They can also refer mothers to healthcare providers to evaluate a nursling's weight gain and development or to determine if there are any physiological causes of low milk supply in mother (e.g., a hormonal imbalance, retained placenta, previous breast surgery) or nursling (e.g., tongue-tie, low muscle tone, respiratory problems)-many of which are treatable.

9 comments:

  1. The best book I have found to prevent breastfeeding problems from occuring and trouble shoot effectively if/when they do is, "Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers"

    Here on Amazon: http://www.amazon.com/Breastfeeding-Made-Simple-Natural-Nursing/dp/1572244046/ref=sr_1_1?ie=UTF8&s=books&qid=1251519390&sr=8-1

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  2. Our first son was born two years ago, he developed Pneumonia and was put in the NICU his second day of life for 7 days. I pumped from the first (as I wasn't allowed to breast feed while he was in level 3 NICU) and started putting him to breast on his 6th day. The hospital lactation consultant helped me. My son was use to tube feedings and bottles by then and after trying for hours she gave me a nipple shield to use. It took me 3-4 weeks to get him off of it...he was solely breastfed for those weeks. Then he started to loose weight, Dr. said my milk supple was bad or insufficient...and had me start supplementing with formula...which I didn't want to do. -Talk about feeling Major guilty too!!!- (My son had lost almost three pounds since leaving the hospital...this was after the customary loss after birth.) We changed formulas twice in two weeks, going "thinker" for "more" weight gain all the while I put him to breast first...I contact L.L.L. and one of the consultants helped me change my diet (high natural fat) increased feedings, pumpings, order of both, frequency of both...over all I worked on it with her for six months...and I gained 20+lbs on that diet. In the mean time we discovered two weeks after my son started loosing weight he had a condition call Pyloric Stenosis... I hated the formula and stopped it on my own two days before taking my son back it to see the doctor -my son was throwing up everything at that point it seemed except the breast milk- THICKER is WAY worse in a case of P.S. If you are acquainted with this condition you will know why. My son had to have surgery to save his life. At this point, at six weeks of age he weighed less then he did at birth. So, I was told to continue breastfeeding and formual b/c he was so far behind. It took us 2+ months to get him back in to normal percentials. All the while I put breastfeeding first. Did everything the lactation consultant(s) told me to do...from 4-6 months of his life I was only ever able to pump a total of 3oz from both breast. By 6 months, fighting all the way to increase my milk with my baby still nursing I dried up. I wanted to nurse to at least a year...and was only able to do 6 months. I did everything I was told and more by lactation consulatants... My OB says there's really nothing physically wrong that she could see with me. I know our situation was not normal...but any clues as to why I could never get the supply to build even trying so hard and doing as much as I did??? Is it me? Or the situation? What happens next time when I have more kids???

    Disappointed Mama (...who's VERY thankful for what God did grant though!) : )

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  3. How do I get into contact with the administrators? I'm the editor of a parenting magazine and find the topics fascinating and would like to know if we could use some of the information (will of course give credit).

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  4. I'd like to contact the administrator of the site. I am the editor of a parenting magazine and find your topics interesting and content insightful. I would love to use some of the information (will credit, of course.

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  5. If I am the author, I do not cite myself as such. Otherwise, if the particular article was written by someone other than me, they are listed in the first blog line as the writer. You can email me directly with specific questions ddfrisbie@gmail.com

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  6. My wife had an insufficient supply of Breast milk, and it was so hard because we knew our son wasn't getting enough. He unfortunately had to adjust because nothing we, our doctor nor LLL helped, and yet we persisted until he was 6 months old. Poor kid was so skinny, and he had a low appetite till he was about 8 yrs old. It was so hard not to be able to satisfy his hunger.

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  7. To the anonymous who had the kid in the NICU and the insufficient milk supply: I can relate. Nursing was the hardest thing I've ever done. Something similar happened to me, despite LC visits, nursing on demand, pumping 8 times a day, getting his tongue tie clipped, etc. It's hard when all you want to do is feed your baby from the breast and he's just not gaining weight. It's scary. All I did for the first two months of life was work on upping my supply. I never slept for more than three hours (becaue I was nursing, then pumping in the middle of the night). When I went back to work I pumped and saw how little milk I was really making (3 oz was my high, 1.5 oz combined was more typical). But he always liked it, and despite the low supply, he is still nursing now at 16 months, for comfort, obviously.

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