I think my milk is drying up!
This is one of the most common phrases I hear in relation to breastfeeding in my work as a midwife and child health nurse.
Breastfeeding can be really stressful, especially if you think that your baby is not getting enough and you start to become guilt-ridden or full of self -doubt. However, I find in many cases a mum’s perception that her milk supply is dwindling is based on a few myths relating to breastfeeding, and everything is actually going ok. I invited Justine, Lactation Consultant (pending International Board Certified Lactation Consultant (IBCLC) exam result) from Cherished Parenting Services to write a guest blog on milk supply, to clear up some of these common misconceptions.
What are the signs of an adequate supply?
The most important sign is output – if something is going in, it is bound to be coming out. Once the milk is ‘in’ (i.e. around day 4) baby should be having 5+ good wet nappies (a disposable nappy should make a ‘thud’ sound if it is dropped onto the floor), and 3+ ‘splats’ of yellow poo, per day. Some people say that breastfed babies can go up to 10 days without pooing – this is true but ONLY after 6 weeks, up until then baby should be having at least three per day (there are of course variations to this ‘rule,’ but baby should be examined by a Dr or IBCLC if this isn’t happening).
The next sign is weight gain and growth – generally babies should gain 150+ grams/week until 6 months of age, as well as be meeting milestones and growing in length. Again some babies may be slightly slower to gain weight, but anything less than this should be checked out by a Dr or IBCLC.
You should be able to see the baby swallowing milk – as they are sucking there should be a bit of a pause in their chin. The general teaching is ‘suck-breathe-swallow,’ but it might be more like ‘suck-suck-suck-pause-swallow.’
What are the signs that I may potentially have an issue with low supply?
The opposite to the above could indicate a supply issue – i.e. less than 5+ good wet nappies and 3 yellow poos (or poos that are dark green/black after day 3-4) per day, less than 150 grams /week weight gain, not meeting milestones, or showing signs of lethargy. A sleeping baby is also not necessarily a sign of a well-fed baby; sometimes an under-fed baby may not have the energy to wake up and ‘demand’ to be fed.
Of course there are always exceptions to these things, but if your baby is showing any of these signs they should be checked out by a health care professional (preferably someone ‘breastfeeding friendly’).
Things that aren’t signs of low supply
There are some common misconceptions relating to signs of low supply. The following signs do not necessarily indicate low supply:
– Breasts feeling soft.
– Baby demanding to be fed frequently (i.e. not sleeping for long periods, being fussy, feeding frequently – even when baby has been in a ‘good’ routine previously).
– Not being able to express large amounts.
– Not leaking or feeling a let down.
Causes for low supply
Hormonal and/or physical factors are the leading causes of low milk supply (previously thought to affect approximately 5% of women, although in my experience this number is higher).
Thyroid problems, insulin resistance and polycystic ovarian syndrome can all lead to difficulties in milk production. A retained placenta will also cause low supply because progesterone levels will still be high, blocking prolactin, the hormone responsible for signalling milk production. Although rare, if mum loses a lot of blood during delivery she can develop ‘Shenan’s syndrome,’ where the pituitary gland loses blood flow and cannot produce the hormones needed to make milk.
If baby has oral motor issues that lead to an inability to transfer milk, supply will be affected. This can simply mean that baby is not positioned or attached well, or that they have a tongue/lip tie. Other issues can be congenital, such as clefts, low tone (as with Down Syndrome babies), or cardiac issues that make the baby tire easily. Building a milk supply is mostly all about demand and if baby isn’t removing the milk then the body will not know it needs to make more. If mum has ‘insufficient glandular tissue’ this can also lead to a reduction in the volume of milk being produced however this is difficult to diagnose, and is usually diagnosed through a process of elimination of other factors.
How to boost supply
If supply does need boosting the best way is to increase feeding/expressing and DRAIN the breast – a well drained breast will make more milk and quickly, thereby increasing overall supply.
If there are hormonal issues impacting milk supply then addressing those issues can help (although sometimes not enough to make a full supply). The same goes with addressing oral motor issues with the baby – i.e. correcting the latch, revising ties, and/or ‘suck training.’
Mums often turn to medication or herbs to increase milk supply (known as galactagogues), however there are a few things to be aware of in using these substances;
– The medication Domperidone is prescribed when the mother is feeding/expressing often but supply is still low. It works by increasing prolactin levels (a side effect of its usual purpose), however it can take 2 – 6 weeks to cause an increase in milk supply and is not without side effects (consultation with a Doctor is required).
– Other potential galactagogues are fenugreek and brewers yeast. The evidence around these foods is anecdotal rather than scientific, and caution should be taken as there is some evidence that fenugreek can actually lower supply in women who suffer from hypothyroidism (which itself can cause low supply – so it therefore follows that many women with hypothyroidism may take fenugreek and actually compound the problem). Other herbs that are believed to help include milk thistle, blessed thistle, goats rue, moringa, and sharvati. Very few (if any) of these will directly act to help the body to MAKE more milk, rather they treat the issues that may cause low supply, boosting milk production in the process – for example, goats rue can lower blood sugar levels and insulin resistance.
– Drinking more water and eating certain foods should not be considered ‘quick’ fixes – yes a mother should be drinking water and eating well, but the body will still make milk, even in malnourished women – there is a story of a woman who breastfed her child and baby for 9 days during a severe snowstorm, when all the other food and water ran out!
The take home message is that finding the reason for the low supply (if there is indeed a supply issue) is the most important priority so that it may be treated (where possible), rather than commencing formula top ups or jumping straight to tablets, biscuits etc without consultation with the appropriate professional.
Need some individualised advice and support?
You can find Justine’s contact details here