Bianca Rei

Low Breastmilk Supply

“How do I increase my supply?”

“Baby won’t stop crying. Maybe s/he’s still hungry.”

“Baby feeds too frequently. Maybe s/he’s not getting enough.”

Low milk supply has been a common issue raised to me by mommies on my Facebook page and in mommy groups I belong to. It’s also the common reason why most moms (even the moms I know) mix feed or completely stop breastfeeding.

UNLILATCH (Unlimited Latching aka Latch as long as baby wants). That is the common solution you’ll see/hear from well-meaning moms and counselors. While it actually is the solution, there’s more to it than that. For someone who has been struggling, anxious, stressed, and at their wits end trying to calm their babies, this answer is no help and sometimes would sound offensive. How can you latch to no end if the baby doesn’t want to? Right?

As a counselor, before I give advice, I always diagnose first if there really is a supply problem. Sometimes, there are just that makes moms feel that what they are giving is not enough. So, how do you know? 

Below are NOT indicators of low milk supply:

1. Baby cries a lot… even while on breasts.

First of all, it is very normal for babies to cry. It’s their first language. It’s the only way they can communicate any discomfort they feel NOT JUST HUNGER. The challenge for us parents is to figure out what’s causing the discomfort. Is it too hot/cold for them? Is the room too bright/too dark? Is it too noisy/too quiet? Is there something itchy? Is the diaper wet? does the baby want to be cuddled/swayed? does the baby want to be held differently? Is the baby going through growth spurt?And the list goes on. To avoid thinking of hunger as the reason, eliminate it from the list by knowing if the baby is hungry before they cry, so they can be fed before you get stressed. Check out the hunger cues below to guide you in finding out if your baby is hungry.

hunger cues

 

2. Milk is not squirting out of your breast… even when you press it.

Your milk will not squirt out of your breasts without proper stimulation and not all women respond to pumps. Even proper hand expression is a tricky skill to learn. So, don’t be surprise if no milk comes out if you press or pump. Sometimes, the only way it would come out is if the baby will directly latch. Also, when your milk supply has already stabilized, sometimes you won’t even experience a letdown (milk dripping down your breasts even when your baby is not latched) that often anymore. But don’t fret! As long as the baby is thriving, baby is getting breastmilk.

3. No milk came out when the baby was born.

First of all, most newborns are packed with enough liquid, fat, and sugar to last them 24 – 48 hrs after coming out of the womb, some others even more. Babies are not born hungry. So, don’t be in so much rush to see milk dripping down your breasts. Just relax and snuggle with your newborn as much as you can to introduce your breast and provide the colostrum. Trust that your body is designed to provide how much your baby needs. If the baby cries, snuggle. It’s normal for babies to cry (see no. 1). They just came out from the comfort of the warm womb. So, everything outside is new to them and it makes them uncomfortable. If you can keep baby on your chest and breast all day, great!  If not, offer your breast every 2 hours to help establish your milk supply. Use the first week to establish the breastfeeding relationship, correct what needs to be corrected, ask for support if needed, to make sure baby gets all the breastmilk they need when your mature breastmilk comes in (within 3-5 days).

4. Pump output is too low.

Your pump output is not an indication of how much your breasts contain but an indication of how much you can pump. There are moms who do not respond well with pumps, you might be one of them. And of course, if your baby is already directly feeding regularly, your body makes enough for him/her only, (demand = supply) little to no extra left for additional demand. If you need to build a breastmilk stash to prepare for when you go back to work, you will have to train your body to produce an extra supply for the additional demand (pump or hand expression). That means you will need to express milk a few times a day in addition to breastfeeding directly. It will have a low output at the start but as your body adjusts to the additional demand, the output will increase.

5. The size of the breast is too small.

Women are not created equal. Some have small breast, some have big ones. But small breasts don’t mean less milk than those with bigger containers. Always remember that the amount of milk we make is dependent on how much demand our breast receives. The more you ask, the more you receive.

6. The breasts stopped getting hard.

Most moms think that when they don’t feel that their breast is getting hard and full, they are not producing enough milk anymore. The thing is, when our milk starts coming in 3-5 days after giving birth, our body overproduces milk, making our breasts hard because it doesn’t know how much the baby needs yet. That’s why it’s crucial that you directly breastfeed often so your body would recognize your baby’s feeding pattern and adjust the production accordingly. When your body already knows how much your baby needs, it stabilizes the production, so your breasts won’t get hard too often anymore. It happens around 6 weeks postpartum. Your body needs to stabilize the milk production to protect you. Because when you are overproducing, your breast gets too full, and when it’s too full, the milk will have a hard time getting out, making you prone to plugged ducts. And when it’s plugged too long, you get an infection (Mastitis). See how amazing our bodies are? It protects baby by producing healthy milk without forgetting to protect you, too.

7. Baby feeds too long.

Whenever I check the breastfeeding forum I belong to, there is always a mom who would think she is running out of milk because either the baby is on the breast too long or the baby finishes too fast. Please note that your breasts do not only provide food, it also provide comfort to your babies. If baby stays too long even after feeding, it’s because being at your breasts comforts them. So, don’t be surprise when the baby gets cranky when you take away the boob before he’s comfortable. I know it can be exhausting but hang in there! They are not babies forever.

8. Baby is not sleeping through the night

Newborns are supposed to feed every 2-3hrs on their first 6-8 weeks of life. Since the size of their stomachs is small, it cannot store much to last them long. By feeding them frequently you ensure that baby has enough on his/her stomach. By 6-8 weeks, some babies start sleeping longer than when they were newborns in between feeds, some sleep through the night. BUT every baby is created differently. Some likes to be comforted every few hours in the night and it’s not an indication that they are not getting enough.

How to know if your baby is getting breastmilk?

You probably think, “OK, so now I know what is NOT an indication of a low supply. But, how do I make sure that baby is getting milk from me?” Well, fortunately, there are ways to know.

1. You can observe that they are swallowing

You know why they always say, “Observe your baby, not the clock“? It’s because there are babies who are efficient latchers, they’d get the milk they need in less than 10 minutes and proceed to go back to sleep. Some babies take their time. They are all different. Also, babies nurse not just to feed but also to comfort themselves. One way of knowing if they’re getting milk from suckling is if you can hear them swallowing. Listen closely to your baby’s breathing when they are latched on you. When they are swallowing, you would hear those pauses from breathing.

2. They have output

As soon as your mature milk comes in (within 3-5 days after delivery), your baby should be getting 6-8 wet diapers a day. In the hot days, babies pee less because they are sweating. When they are sweating, increase feeding to make sure you keep them hydrated. 

During the first few weeks of the newborn, the baby should be pooping at least once each day. If they are not, check for feeding issues. After your milk supply stabilizes (around 6 to 8 weeks), exclusively breastfed babies poop less frequently because breastmilk is easily digested and absorbed that there is not much waste to expel from the body.

3. They are growing

Of course, if they are not getting anything from you there won’t be any growth. Note that there are more than one aspect of growth. So, don’t just focus on weight. Look at the height, and brain development as well.

Babies lose about 10% of their weight on their first few days (that extra water weight is proof that your baby came out of the womb with a full tummy). There should be a consistent weight gain if they are breastfed regularly.

breastfeeding

What causes breastmilk supply to drop?

Yes, it’s true breastmilk supply can drop and somehow go away IF you have the issues below. 

1. Less demand

I’m sure you have heard countless of times that demand = supply, that’s you’ll always be advised to unlilatch whenever you say you feel you’re not producing enough. The more you breastfeed, the more milk your body makes. It’s impossible for you to just stop producing if you are feeding directly regularly. It’s the removal of milk from your breast that signals the body to make milk. So, the more milk is removed, the more milk is produced. 

2. Feeding issues

You might say that you always latch baby but they still cry or would not gain weight. If that’s so, there might be feeding issues such as tongue/lip ties, inverted/flat nipples, baby is nipple confused, or the baby is not latched on correctly. These issues have to be corrected early on (YES, all of them have solutions) to ensure that baby is getting the milk out of your breast well. If you can’t figure out the issues and how to solve them on your own, do not be shy or afraid to consult lactation experts – doctors who have studied lactation management, lactation consultants/counselors, or me.

3. Taking certain medications

Certain prescription and over-the-counter medications inhibit the production of milk, so be careful with what you take and make sure to consult your doctor and ask for an alternative if you find that what is prescribed would be an issue with your breastfeeding. If you’re not sure if a certain medication you are taking is safe to take, search the ingredients at e-lactancia.org or LactMed.

4. Having certain health issues

Physical, emotional, and psychological stress, diabetes, hypothyroidism, and pregnancy can reduce your supply of breastmilk. While it slows down production, it shouldn’t completely stop. It is still possible to give enough nourishment to the babies even with these conditions.

Yes, there are moms who have hypogalactia (legit and not self-diagnosed), but it can be treated by increasing demand (direct feeding + hand expression) or with galactagogues. Only 5% of moms are unable to produce milk (agalactia) because of inadequate glandular tissue resulting from hypoplastic breasts, breast surgery such as mastectomy, breast reduction, or cyst removal.

What can you do to increase breastmilk supply?

Every breastfeeding issue has a solution (except when you have agalactia). So, if you are certain that you have low milk supply (see all the non-indicators I listed above), then follow the tips below to increase your breastmilk. 

1. Increase demand

Breastfeed often. Breastfeed longer. More demand = more supply.

2. Fix the feeding issues

Make sure the latch is correct. Have the tongue and lip ties removed (if there are). Fix inverted/flat nipples (ask help from lactation consultants/counselors if watching videos or reading literature on how to do so does not help). Once all of these issues are fixed, do the first tip (increase demand).

3. Galactagogues

This is rarely needed but if you are really diagnosed with hypogalactia, you may need help from drinking galactagogues to increase your supply. 

Remember, all women are created with the ability to give and sustain life. All women can produce breastmilk, even those who have already stopped breastfeeding for a long time like grandmothers (relactation), and those who have not even given birth (induced lactation).  Not only that, women can produce healthy breastmilk no matter what she eats, whether you are rich or poor.

If you believe your are having breastmilk supply issues, do not hesitate to ask for help. A lot of us lactation counselors and consultants would be happy to assist you.

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