Low Milk Supply 101

7/12/2015

Forgive me for asking but...

Do you REALLY have low milk supply?

This is a very important place to start. Please bear with me. I don’t mean to doubt your situation and be annoying patronising lactation consultant woman but it’s crucial to note that the MAJORITY of new mothers who fear they have low milk supply DO NOT.

The majority of women who start to use formula because they worry they aren’t making enough or baby isn’t getting enough DO NOT HAVE A PROBLEM.

I cannot emphasise this enough.

Every day mothers panic and end breastfeeding or start using formula and there is not an underlying problem with their milk supply. But of course – once they start using formula without correct support, they often will start to send signals to their breasts to really reduce supply.

· You do not have low milk supply just because your baby won’t go the X number of hours between feeds that the book on your coffee table tells you they should. Or your mother-in-law. Or the X number of hours your friend’s baby is going between feeds.

A normal happy healthy baby who has a gorgeous mummy with a normal healthy milk supply might get hungry an hour after the last feed, or 90 minutes, or 45 minutes or two hours. They might be cluster feeding and hardly want to come off the breast at all. They might be having a growth spurt and feed every hour for a day.

·You do not have low milk supply because your breasts have stopped leaking. Some mothers leak less than others. MOST mothers notice that leaking reduces at the weeks go by and the teeny tiny sphincter muscles responsible tighten.

· You do not have low milk supply because your breasts feel softer than they used to. The excessive fullness we experience in the early days of breastfeeding is about vascular engorgement (blood and lymph) and it’s about the body inefficiently storing unnecessary amounts of milk between feeds. As time goes by, the breasts get cleverer at storage (don’t forget milk is also made while a baby is actually feeding). There is also less blood and lymph needed in the breasts as breast tissue growth slows down. At the beginning, it’s often very obvious which breast is going to be fed from next. That feeling goes. And many mothers mistakenly connect it with a reduction in milk supply. We are not all supposed to continue feeling heavy and full throughout our breastfeeding experience. Don’t ever think ‘I’ll wait to let my breasts fill up!’ Noooooo. This shows a misunderstanding of how lactation works to a spectacular degree. When breasts are fuller, milk production slows down. When breasts are emptier, milk production increases. Emptier softer breasts may well be making a heap more milk in a 24 hour period than the engorged full versions.

· You do not have low milk supply because your baby feeds for a short time. Plenty of babies get everything they need in under ten minutes. Probably not five – but sometimes a feed might even be five minutes long. Lots of babies use their tongue and jaw muscles super efficiently and gulp and glug and slow down as the milk gets fattier and thicker and then come off happy. It might take them nine minutes or nineteen. A baby might start off life needing 30 minutes to drain a breast (when we say ‘drain’, breasts are never completely empty, it just means the baby has taken out all the milk they usefully want to). As a baby gets older, this can dramatically reduce. It doesn’t mean less milk is going in. If a small sleepy jaundiced baby falls asleep very quickly at the breast without some solid minutes of good swallowing, that’s a different story. Overall however, a longer feed does not always mean a better one.

· You do not have low milk supply because you have small breasts. Large breasts are a combination of fatty tissue and glandular tissue. You cannot tell much about someone’s milk production by the size of the breasts. If you are really worried your breasts don’t ‘look right’, we’ll come back to this later.

· You do not have low milk supply just because your baby wakes up a lot. Plenty of young babies feed with similar intervals day and night. Plenty continue waking every 2-3 hours for a while.

· You do not have low milk supply because your baby won’t ‘go down’ after a feed. So you feed your baby and they drop off to sleep on the breast. You move them to the Moses basket and they wake up as if you just placed them on a sheet of molten lead. And they seem to be rooting again. This happens because being next to you skin-to-skin was nice and cosy and relaxing and warm and it smelt good. The Moses basket is cold and NOT YOU. You probably triggered the Moro startle reflex when you moved them. You probably moved them about 15-30 minutes after a feed when the hormone cholecystokinin had dropped in their blood stream causing them to be more wakeful. Your teeny primate mammal baby finds the breast a lovely place to be. They like to suck to relax themselves. Babies like second helpings. This does not mean you are not making enough milk.

· You do not have low milk supply because your baby will take milk out of a bottle after a feed. Put a teat against a young baby’s palate and you trigger that baby’s sucking reflex. Babies will usually continue to take milk beyond the point that they need it. This is one of the reasons we see links between bottlefeeding and obesity.

You do not have low milk supply you cannot feel your 'letdown' reflex (milk ejection reflex). Some women feel an electrical tingle at the point the milk lets down. Some don't. Crucially some feel it for the first few weeks and then it fades. This fading sometimes worries people. It does not mean anything has changed with your milk supply and it is perfectly normal for the sensation to go.

·You do not have low milk supply because you don’t pump very much milk. Pumping and breastfeeding are surprisingly unrelated. Your baby removes milk in a completely different way. Plenty of women with healthy milk supplies fail to pump much at all. Their bodies can’t be tricked into eliciting the milk ejection reflex (or ‘letdown’). Plus pumps don’t always work. Suction goes as valves get old.

These are the things that REALLY tell you a mother might have low milk supply:

·         Weight gain problems. A newborn is born and then loses weight. They regain birth weight at around two weeks. They then put on about 150-200g a week after that. That slows down after around four months. If your newborn loses more than 10% of their body weight, we might pay attention but we’ll also want to look at things like your birth. Did you have a drip in labour that filled you and your baby with fluid? Did your gorgeous newborn look a wee bit like the Stay Puft marshmallow man in their first photos? That fluid elevated the birth weight and as it comes out again in the first few days, we might see more of a weight drop. That doesn’t necessarily mean feeding or supply is a problem. However we wouldn’t want your baby to lose weight after about day five or lose weight a second time. It might take some babies three weeks to get back up to birth weight.

Have a look at the chart in your red book. Notice how we have birth weight line and then a space where the curvy lines don’t go and they start again at week two. Just because your baby was born on the 75th percentile, that doesn’t mean we would expect them to definitely re-start on the 75th after that two week gap. That’s why the lines don’t continue. That’s why we have that space. We start again at two weeks. Your baby might be on the 50th then. They then ideally will roughly stick in the same vicinity. But babies wobble around a bit. They might dip below. They might get close to the 25th. And then they might bob back up again. We don’t expect all babies to hug a line exactly. This chart is a guide. It’s about averages. It’s not about mathematical certainties.

·         Nappies. In the early days (first four weeks), we look at poo and pee. After your milk has come in (around day two to five), we’d expect to see six wet nappies in 24 hours and three poos the size of a £2 coin or bigger. After week four, some babies' poo rate can slow right down. This doesn’t mean anything is wrong. Some babies can skip several days between poos and this isn’t anything to do with milk transfer or supply. However if someone tells you it’s OK for a ten day old baby not to poo for a few days, don’t believe them. We’d need to investigate that situation. Only later on do we relax.

Weight gain and nappies. That’s it. Those are the only things that tell us about milk supply. You may hear people say that ‘babies should be settled after a feed’ but some babies get wind or need to poo or have reflux or wake up and want second helpings. Let’s be careful about even saying that. Let’s look at weight gain and nappies.

So let’s now assume you do have low milk supply. How many of you are still with me? I’m sorry if you are. I’m sorry if your baby only put on 60g last week and 90g or less or nothing the week before that and they are slipping down the percentiles. I’m sorry because I know how scary that can feel. Nothing feels like it matters more. There are things we can do.

1.       Find people.

Find people who know about breastfeeding. Someone who tells you just to use formula in this situation is not who you need. If that’s all they can offer you, they don’t know about breastfeeding and you need someone else. You need someone who understands how lactation works. These people may actually still tell you to use some formula in some situations (or donor breastmilk) but they will do so alongside telling you how to protect and develop your milk supply. You also need people close to you to look after you. If you are going to do all the other stuff on this list, you need to have people who love you who will cook your dinner and run you a bath sometimes. And text you just before the weigh-in clinic next week to say they are thinking of you.

2.       Breastfeeding M.O.T.

Someone like a breastfeeding counsellor or IBCLC (lactation consultant) should check your latch. You might not be sore and your nipples might not be misshapen after a feed but something still might be going wrong. Your latch needs checking. Is baby’s chin deep into the breast? Is baby’s body close to yours? Is baby’s ear/ shoulder/ hip in a line?

They shouldn’t just check your latch but look at your breastfeeding management. Are you feeding enough? Maybe your baby doesn’t show cues very strongly and someone told you to wait for them and you’re sometimes going four hours between feeds? Maybe you need to feed more frequently?

They may also need to take a closer look at your baby. Is there a reason why baby may not be transferring milk effectively? Is this someone who can look at baby's tongue, jaw and palate? Are they familiar with the term 'tongue tie' and especially 'posterior tongue tie'? Would they know what to do if there was one? That might mean suggesting an exaggerated latch or different positions or it might mean referring you to a tongue tie specialist.

When are you changing sides? Too quickly? (and baby is missing the fatty milk). OR did someone tell you to stick on one side forever to get that ‘hind milk’ and the baby is on 45 minutes without doing a heck of a lot? Maybe you need to change sides at 20-30 minutes instead and get baby a greater volume of milk overall and fatty milk overall. Both of these habits can cause weight gain problems. Get someone to help you recognise what swallowing looks like so you’ll know when to change sides and when good feeding has finished.

3.       Google ‘breast compressions’. You’ll get to a video and handout from Dr Jack Newman. You can finish a feed with breast compressions and get an extra dose of fatty milk into baby.

4.       You have 3 sides and 4 sides. This is ‘switch nursing’. Try and go back to the first side. There will be milk there. The more breastfeeding you do, the more milk you will make. The second time you return to that breast, the milk will be fattier and richer and you’ll send great signals to your body to make more.

5.       Find time.

If you are going to build up your supply, get help. You can’t devote time to switch nursing and skin-to-skin when you have to go to Tesco to buy milk and pick up another child from school. If this is ‘Operation Milk supply’, who can help you? You’ll read people talking about a ‘babymoon’. Go to bed, they say. Just you and the baby. Feed lots. If that sounds appealing, go for it. Personally my babymoon would involve the sofa and box sets and crisps. However there’s no point in babymoooning until next Christmas if your latch and breastfeeding management are the issues. Get that checked first.

6.       Using a pump.

Baby feeding effectively is first choice but pumps can be useful. You can pump on an emptier breast to send even more signals to your milk supply. But we’re not going to take a baby off the breast do be able to pump.

You don’t need to wash and sterilize a pump every time you use it. Pop it in a plastic bag and put it back into the fridge between pumping sessions. 10 minutes is ample. If you are pumping for 30 minutes and ‘nothing is coming’ out, you are not getting a letdown and you are not doing yourself any favours. Use hand expression before and after (google ‘Marmet hand expression’) and prepare the breasts with warm compresses and massage if you can. You can take an hour and do some ‘cluster pumping’ or ‘power pumping’. Pretend to be a baby having a cluster feed. Pump for ten minutes. Break for five. Pump again and repeat.

Just check your pump is the best one available. If it’s second hand or you have had it a while, it might need servicing or replacement parts. You also might want to consider hiring a hospital grade double electric pump from someone like www.ardobreastpumps.co.uk to give yourself the opportunity to pump both sides together as effectively as possible.

Pumping shouldn’t hurt. Make sure your flanges are the right size – that means they are the right diameter for the size of your nipple. Don’t think that cranking up the suction will automatically do better things. And don’t think, “I don’t want to pump because I will empty my breasts and baby will have less milk.” Certainly they might be less appreciative if you pump just before a feed is due and you leave them with an emptier breast full of thicker fattier milk but pumping overall will increase milk supply and stimulate milk production. You are not ‘taking their milk away’.

You might also be someone who always gets better results with just using hand expression so stick with that.

Of course, you might not want to pump at all and just focus on feeding baby more effectively and frequently.

7.       Galactagogues.

Taking herbs and medication that increase milk supply. Not right for everyone but some women really feel they helped. You need to read about side effects and dosage on sites like kellymom.com. Fenugreek, blessed thistle and goat’s rue are popular. Some doctors prescribe domperidone in certain situations. These are never a substitute for good breast emptying and a breastfeeding MOT.

8.       The science part.

In a book, this bit would be under a little flap as we’re only talking to a small group of people.

Did you have breast surgery?

Are your breasts very widely-spaced or asymmetrical, or very tubular with a bulging areola? Did they not really change much in pregnancy (or puberty)?

Do you have PCOS? Some women with PCOS (not all) have a reduced milk supply.

These are times when it’s worth finding an IBCLC and getting technical.

Some doctors will do hormonal testing for you. There are medications that can help develop breast tissue especially in pregnancy.

What about your thyroid levels? This is something relevant for more people than you might realise. If you are trying everything and low milk supply continues to be a problem, ask your doctor to check your thyroid levels. There are sometimes medical reasons mothers have a low milk supply and doctors and lactation consultants may be able to help you. These are not the most common reasons why people have low milk supply by a long shot. Hence the need for the flap.

Most people who genuinely have low milk supply got themselves into a pickle with using artificial nipples or not breastfeeding enough or breastfeeding ineffectively. And it can almost always be reversed.

Also remember that just because you had low milk supply in your first breastfeeding experience, it doesn’t mean a subsequent lactation will also be a struggle. The development of all that breast tissue first time round often helps.

Hold in your mind the fact that women can relactate after not breastfeeding at all for several weeks. We CAN send signals to increase supply again in the vast majority of cases. There are tons of us in real life and online who want to support you.

My book is available now from Amazon.co.uk and from other retailers.

"You may be worried about breastfeeding and worried that it might ‘not work’. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it’s not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us.

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported.

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit.

Success comes when we tap into those instincts and when we know when to get help when our instincts aren’t answering all of our questions.

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let’s not start this journey by imagining you’ll be someone who won’t make it...!)"
http://www.amazon.co.uk/dp/B019JE5E44

Workitmamma link

10/15/2013 11:28:37 am

This is the best, most comprehensive and helpful post I've ever read. I was lucky, I breast fed without problem but know so many women who didn't and blamed it on low supplies and production. This info should be given to every woman who wants to breast feed so she knows there is help out there that this blanket response of low milk supplies is very rarely the case. Great stuff!

theresa sandahl

7/9/2015 05:45:06 am

This post couldn't have been more well written. I couldn't agree with it more!

sarasota plastic surgery link

11/1/2013 07:09:31 am

Wonderful post. I think it is very informative post.

Sophie Mills

2/14/2014 01:38:06 pm

This is the best information I've found. Thank you!!

Emma Whittlestone-Port

6/11/2014 01:28:34 pm

Great post Emma. Thanks for always explaining things in a non patronising way. And judging by your points above I may not have low supply after all!

Louise link

8/19/2014 12:23:30 pm

Fabulous post, so informative. My eldest needed formula supplementation not because I had low supply but because her heart defect meant she tired too quickly and couldn't take enough from me to meet her nutritional requirements. Although she did partly breast feed she also needed high calorie formula. My second is heart healthy and has no problem gaining weight on my milk. Great advice here for any mum who is worried about producing enough milk.

Naomi

8/21/2014 02:18:31 am

I have read this a couple of times, just to make sure I wasn't misinterpreting the tone. While there is some helpful information, the tone is very patronising. If I'd followed this advice to not touch formula, I suspect my baby would have ended in hospital with dehydration. My milk never came in at all, despite doing everything possible. We had to top up with formula, and after six and half weeks of almost killing myself doing everything possible (with lots of visits and help from breastfeeding support workers), I finally switched to formula full time. This was on the advice of our breastfeeding midwife. It is the case that some woman do have a low milk supply, and pieces like this that in effect are saying that there isn't such a thing, are one of the reasons I felt like (and continue) to feel like a failure for not being able to breastfeed.

I think a lot of the advice in here is helpful (and similar to the many things we tried) but the tone is off, and patronising. No wonder the research published yesterday said that rates of PND were higher in woman who wanted to but were unable to breastfeed. It this sort of tone and stridency that make us feel even worse about our inability to feed.

Rafa

1/22/2015 03:23:28 am

Naomi, I know this feeling, when one has tried hard at some thing and still cannot achieve the desired result.
I breastfed my three children and my breastfeeding experience with each of them was different.
Breastfeeding is very challenging and it is usually the baby, good breastfeeding support right after birth and if no other medical condition interfers with initiating breastfeeding to have a good breastfeeding experience . Examples, skin to skin contact with mother and baby as soon as possible after birth, getting help with positioning and attachment of baby to breast, if baby was not ready to breastfeed, when in Postnatal ward, asked for help to try 'Biological Nurturing' which is a a laid back way to breastfeed and encourages baby to naturally root for the breast. It usually takes between 3 to 7 days after child birth for the mature milk to come.

Breastfeeding is like learning to ride a bike or drive a car and it does take time and practice for both mother and baby to get used to the process.

Wish you all the best in your breastfeeding experience in the future, if you which to have another baby.

Emily

7/8/2015 09:40:22 pm

I agree with Naomi. It really does sound patronizing. The article even states that low supply is a pickle the mothers got themselves into. It suggests that there is no valid excuse for not breastfeeding exclusively (and also that not breastfeeding exclusively is something that needs excusing). It's unfortunate that the tone is so demeaning, because there is good information in the article.

Louise

3/7/2015 03:53:10 pm

I'm right there with you. I never breastfed because my daughter couldn't latch. She has an upper lip tie and a tongue tie, plus a high palate that I don't have the money or insurance to fix. I tried EPing and where others were producing 4-5 ounces each session, I pumped 8-12 times a day and got 2 at the most in one breast and 1 in the other. Mastitis followed, then my doctor basically forcing me on birth control because I guess he thinks I'm a single mother and must therefore want to go out and date immediately (not the case at all). I found out too late that antibiotics for mastitis and birth control, plus bad thyroid levels after birth, contributed to my crap milk supply.

I personally hate the attitude that ALL MOTHERS CAN BREASTFEED. It's so deeply offensive to the mothers WHO CAN'T and it treats us like we've done something wrong, when all of us are thinking about our babies and trying to do everything we can. I stayed 5 days in the hospital after a c-section and pumped 12 times a day to get my milk in. I tried so hard, and I'm continuing to pump even though I produce like, not even enough to fill the bottom of the bottle. I still try, but only because I can't let it go. I admire other women who are able to let it go in ways I cannot.

As long as our babies are fed, healthy, and loved. <3 You are doing what's best for your baby, Naomi!

Victoria

7/9/2015 03:22:43 pm

I agree with Naomi too, as I don't have much milk either and I am a Mommy who pumps and uses formula to feed our 2 month old son. I am taking pills to help me produce milk and it's one of the hardest things I have ever done. Breastfeeding is so hard,and we shouldn't be made to feel bad because we can't do it. I found out in hospital after my son was born that I have flat nipples so I went about using a nipple shield and tried as hard as I could to persevere. So for all the women that can breastfeed its wonderful and for those that can't we just have to do what's best for us and our babies.

heather

7/8/2015 07:41:29 am

Well put Naomi. Thank you.

Laurie

7/8/2015 01:55:56 pm

Please don't fight against helping the multitudes of people who don't have some ultra rare condition like you do -- but who think they do -- to realize that they don't have some ultra rare condition, just because you have an ultra rare condition.

Jay

7/8/2015 09:18:49 pm

Actually Laurie, issues with insufficient glandular tissue are not "ultra rare." I followed this link from an IGT support group where countless women were offended by the tone. They put more effort into breast feeding than any of the "normal" moms. Do you know what comments they are continuously met with? Have you tried fenugreek? Or countless other condemnations about a lack of effort.
The reality is breast feeding is a personal choice. No one should be guilted into it. There was good information in the piece but the tone was not appropriate.

7/9/2015 10:10:30 pm

I think that all of Emma's points should be considered by anyone worried about low milk supply. It's smart to pay way more attention to the weight loss/gain and the nappies than anything else. But for those of us who are unable to breastfeed exclusively, every time we hear things like "low milk supply is very rare," or anything that makes it seem like surely we have just fallen prey to some faulty advice and really we could be swimming in milk if we only realized what our bodies are capable of, it feels like a slap in the face. We are doing everything right. OK, maybe not everything, but we are doing our darndest to figure out what the "right thing" is. We are googling our eyes out trying to figure out the problem, willing to take any kind of galactagogue we can get our hands on, nearly (literally) starving our babies trying to make it work, and we are willing to pump our lives away (seriously, my life has at times revolved around the pump, and I have not felt like a martyr--I just wanted success). I have so many friends who are doing all the right things and still reluctantly have to supplement or pump or both. If it truly so rare, how come I have so many friends who seem to have low milk supply? And I mean those whose babies' nappies are too dry and whose babies are not gaining weight like they should. Go ahead and give your tips, but please, please don't forget us mommies who are really not so rare as you want to think.

Tami

7/10/2015 10:35:05 am

I totally agree! I tried so hard to do everything I could with both my first and second babies and I went through so much pain and struggle and nothing helped for months. Then eventually I made the decision to switch to formula because the lactation consultants were making me feel like crap and kept telling me the same stuff about how it's not about low milk supply! I felt horrible both times this happened but then realized that it just wasn't meant to be and people shouldn't make us feel bad if we tried our best!

Emily

7/10/2015 08:46:52 pm

I'm sorry for your struggle, but the article is for women who believe (falsely) that their supply is low when it's not. It's not intended for women who try and try and try, and there is a a physical problem or issue and they cannot breastfeed. If the Lactation Consultatants seemed pushy, it is because they are used to women who, like this article is directed toward, think they "can't" (but can). So, they are understandably passionate about making sure that a Mom has a fighting chance to feed her baby breastfmilk. There is nothing to feel guilty about , because if it's out of your control, then it's not a 'guilt' issue. It's okay to feel sad that you couldn't breastfeed when you wanted to, but that is different than guilt. No one can make you "feel guilty" because if you tried your best, like you said, than there was probably something else going on besides a perception of low supply.

Personally, I have a lot of friends who fall into the categories mentioned above -- they stopped breasffeeding because they thought their supply was "low", say around 8 or 9 months, with no real evidence except that they FELT their supply was low. This article would be helpful for a woman in that situation.

7/11/2015 10:43:32 am

To Emily-
I realize the point of this article, but my point is that low milk supply (or some other unknown physical issue that keeps women from breastfeeding successfully) is NOT as rare as the experts will tell you. Because of this, we feel like we are not being heard. We are blue in the face. ("No, REALLY, I have tried everything reasonably possible for me and I still need to supplement. For the 10th time, yes we have checked the baby's latch, yes, I've tried fenugreek, yes, oatmeal, yes, yes, I am pumping like a champ. Yes, etc. etc.) And, most importantly, NO, none of it is helping much. There have GOT to be some better answers for us, and this "everyone can breastfeed if they just don't give up and they have the right support!" is not helping us any. People need to continue educating (like Emma's article), but be very careful not to marginalize this very real problem for fear that it will cause other women to give up too quickly.

Kendra

7/10/2015 02:57:58 pm

I completely agree!! These were my thoughts exactly!!

7/12/2015 12:52:49 pm

I am sorry you had struggles. I mean this is the kindest way. Your guilt is harming your reading comprehension. This post is not patronizing. Everything is 100% fact. Facts cannot hurt you. If you are feeling emotional pain while reading this, it means that you have not worked through the pain that your situation caused. I really suggest a support group and a good therapist. Many women who cannot parent the way they imaged suffer like you. Disabled mothers, mothers with special needs children, single mothers...it is common.

In no way does this say that low supply does not exist. It is saying that most things that people believe are symptoms are not. It also does not mean to shame women who accidentally cause themselves low supply. This is not their fault. It is normally BECAUSE of misinformation and bad advice. These posts are needed to prevent accidental self sabotage.
So please, get some help, and stop trying to drag other women down to where you are. Preventing others from breastfeeding will not heal your pain.

Rachel

1/9/2015 02:13:23 am

Wow - such brilliant information. Thank you so much Emma. Personally, I found the tone friendly, informative & well-intended.

Kelly Pickersgill-Jones

2/2/2015 12:17:26 pm

My nearly one year old isn't getting enough milk so I think so anyway as I'm 16 weeks pregnant and ive heard your milk supply dips. There is milk in my boobs but have stopped feeling the let down and he's waking in the night more often.
I'm wondering what to do help.

Emma Pickett

2/2/2015 12:47:29 pm

Hi Kelly,

I'm afraid the supply dip that comes in pregnancy for most women is hormonally related and there is very little we can do to improve things. Increased feeding and stimulation doesn't have the same effect as it normally does. The herbs we might otherwise take are either considered hazardous in pregnancy or ineffective. However lots of nurslings continue feeding and soon your colostrum will arrive which may mean a bit more milk volume. It arrives during the second trimester and it literally could be any day.

Due to your baby's age, you may need to supplement breastfeeding with other milks or keep a close eye on solids intake to ensure he gets good sources of calcium, protein, fats and vitamins and minerals. He'll also need to drink more water perhaps.

I know this is a tough time for both of you and many mums find the supply dip with pregnancy hard when breastfeeding has been such a big part of mothering up until now. It's particularly tough to hear there's not much that can be done. But 'dry nursing' can have a value too in terms of emotional connection and comfort.

Do you have a copy of 'Adventures in tandem nursing'? It's a great book that has lots of information about breastfeeding in pregnancy.

Emma Pickett

2/2/2015 12:48:48 pm

Just to add that 'feeling the letdown' in itself doesn't mean a supply issue. The sensation comes and goes for many women. But it is still likely your supply has dipped and your sensation of fullness could be pregnancy and hormone related rather than milk.

Cassandra

2/13/2015 01:19:29 am

Fantastic advice Emma!
Everyone should read this. Not just soon to be and new mums.
I exclusively formula fed my 1st born 14yrs ago. Had zero exposure to breastfeeding. So when I decided (last minute) to try breastfeeding with baby 2 (almost 4yrs ago) I had no idea and no one close for experienced support and knowledge. Google became my biggest support.
Information like youve provided here could make allthe difference between having success and feeling like a failure. All too often I hear/read women say that their milk dried up at around 6 weeks when this more often than not isn't the case. Its so frustrating to see mothers feeling they've failed due to lack of support and helpful information.
Thank you x

Emma Pickett

2/13/2015 02:40:01 am

Thank you Cassandra. It's kind of you to leave a comment. In my work and on the helplines, I see misunderstandings about low supply every day. Mums who are experiencing normal breast changes or babies cluster feeding and having growth spurts lead so many to doubt themselves. It's an epidemic. Glad this post can help a little.

Oonagh

3/25/2015 08:09:37 pm

Hi. I'm exclusively bfing my second son. He is now 5 1/2 months old and still feeds every 2 hours round the clock.
My period returned a week ago and has affected my supply, particularly at night. I have calcium/magnesium supplements and mothers milk tea. However my period ended yesterday and my supply has not yet returned to normal.

Help?

Emma Pickett

3/26/2015 04:04:28 pm

What are the signs your supply has reduced? Any chance this could be corresponding with a growth spurt?

Sue b

4/3/2015 04:20:20 am

Mrs. Testa

5/26/2015 06:53:03 pm

I've had issues from day one. First she couldn't latch due to edema. That finally went away and I got mastitis. When that finally went away we went back to the pediatrician due to her not gaining much weight. I can't pump anything out ( before I was pumping full bottles, then 3 oz, then 1 and now none ) no matter how long or often I pump. She eats and gets frustrated and quits or falls asleep. We've worked on the latch. We've found out she haa lip tie, large over bite and possible jaw tension. She has biweekly appointments for weight checks. She's five weeks old and still in newborn. I can hardly hand express either. We've been to an LC and have an appointment to check out her mouth issues but she's not getting much milk anymore ( weight checks before and after feedings prove this ) and always hungry. We've had no choice but to supplement. I've tried everything on your list and I'm at a loss now as what to do. I don't want to formula feed but I'm not sure what more I can do.

Emma Pickett

6/21/2015 06:03:43 am

I'm so sorry you seem to be at the end of a road. I'm assuming from what you've said you've had a full set of blood tests which includes looking at thyroid function. Sometimes a second IBCLC opinion is worthwhile.

Mrs. Testa

6/24/2015 10:49:24 am

I went back to the IBCLC. She actually mentioned my thyroid to me. Which got me thinking. I was always told my MTHFR wouldn't affect my supply but I'm thinking otherwise. It can affect your thyroid, which in turn affects your supply. Why are these not connected when you talk to your doctor? We've changed my diet completely and I've stopped taking artificial folic acid. Since we've catered to my mthfr I've actually seen an increase in production. Not a lot. But it's only been about four days and the fact that it improved at all says a lot to me. I think instead of doctors simply stating mthfr doesn't affect supply they should actually look into it or at least offer the possibility and talk about diet changes to cater to it.

April

7/8/2015 10:52:02 am

I get where you are coming from but some women, like me, really do have low milk supply. With my first, I suspected it and freaked out and switched to formula at 3 months. With the second, I suspected it at 3 months but continued to nurse him, trusting my body so to speak. I never once gave him formula or a bottle of any sort. I kept denying it was really happening again until I took him in for a check up and he had only gained 6 ounces in 3 weeks. He had wet diapers between every feeding but still wasn't gaining weight. He was sleeping 8 hours at night and I nursed him 7-8 times during the day or whenever he seemed hungry. I trusted my body and it failed him and me. With #3 (now 5 months old and exclusively breastfed), I felt the same thing happening between 2-3 months and started domperidone. I believe that's the only reason she's still exclusively breastfed. Some women really don't produce enough.

Ivy

7/8/2015 09:02:42 pm

Agreed. As a new mother I had a lot of these "non-symptoms" and if I had simply read this, I might have thought nothing of it. I'd advice anyone with these non-symptoms to be checked to make sure before ignoring them. My baby was 5.5lbs at birth and when I finally had her weighed at 6 weeks old she had only gained 1 oz... yep 1 oz in 6 weeks. They had me start on formula immediatly and she reached 6 lbs by the time she was 7 and a half weeks old and from there kept climbing... from 0th percent to a bit over 50th pecentile now. (Which she's been at for many months) She was extemely skinny in those first few weeks.
That being said, I wish I knew about domperidone at the time, I'd have preferred to try that before the formula. They did give it to me later on and I was able to continue nursing part time. She's 8.5 months now and I'm still nursing her part time along with solids but would have liked to nurse exclusively if I could have

Emma Pickett

7/9/2015 04:01:14 am

Absolutely right. There is a small minority of women who aren't able to exclusively breastfeed although they may want to. This article hopefully contains suggestions for ways to maximise supply in these cases. It's obviously difficult to get a balance when I'm talking to the larger majority who often doubt their supply unnecessarily. If there are issues with weight gain, as this article explains, this should then lead you to get more specialist help. Weight issues are a sign that there may be a further problem and should not be ignored.

Ivy

7/10/2015 12:41:43 am

:) It's a great article, and very helpful for sure :) I just wanted to add that in to make sure people with those symptoms didn't ignore them completely and think everything is okay without checking to make sure. (Checking the weight I mean, I know you recommend it if there is weight issues, but I have friends that don't get the baby weighed...ever. So I wonder how they would know (if it's not a dramatic weight loss that's obvious) Even if it means doing an estimate by holding the baby on your own bathroom scale, you might not get the exact weight, but you should be able to tell if they are going up or not :)
To be honest, I wonder if it was these symptoms that caused the lack in my supply, rather than the other way around. While it's clear my supply was lacking because of my daughter's lack of growth, I think I may have had some common symptoms that were "normal" and I stressed about it, the stress causing the lack of supply. Hard to say for sure, but just my thought :)

7/10/2015 10:07:20 am

I don't think the minority is that small. I do appreciate much of your common sense advice. I posted above, but I would also like to say here that low milk supply is really a major problem, not a minor one. There are so, SO many women and babies suffering out there and we need answers! We desperately want answers as to why things have gone wrong with our bodies and what we can do about it. So far, the answers and suggestions barely help any of us. For most of the friends I have who struggle, the best help we can get is that with a lot of effort, and/or with a lip or tongue-tie fix, we are able to breastfeed a little better, for a little while longer, but not exclusively. I can think off-hand of maybe 2 dozen mommas that I know who struggle or have recently struggled, and even with all the advice and help they get, they still have to supplement or give up entirely. I really don't mean to disrespect your expertise, but it is hard for me to believe that the minority is so small. But since you actually work in this field, what percentage of women would you say have a true problem breastfeeding? All you doulas, nurses, doctors, and midwives out there, is the percentage of women who are unable to breastfeed really, really that small?

Jan

7/8/2015 11:44:57 am

First of all, what an excellent well written article. Full of solid information in a relaxed tone that was easy to read. I nursed all three of my kids and I'm hoping to pass this lovely article onto my daughters if / when it might be needed. Thank you.

Angie

7/8/2015 12:28:19 pm

I wish I had read this when I had my twins. They both lost over 10% in weight and were put straight on formula on the advice of midwife. I breast and bottle fed for 4 months and never felt I was doing it right. I felt so overwhelmed. I would have loved more support and to have exclusively bf my boys. My biggest regret. :(

Grace

7/8/2015 02:28:35 pm

A very informative and helpful article with lots of great advice. I wish you had been with me when my little one was 4 weeks old and I began to loathe BF. The only issue I have here - which was pretty major to me when I was having BF problems and later had to switch to formula - is the advice to "get help".

If your husband takes every opportunity to leave the house, if you don't have family or close friends in the country, if you are completely alone the first few weeks of baby's arrival - it is extremely overwhelming for a new mum with a screaming baby to "get help". Who from? Where does one find the time and energy to "find people" when baby does not sleep anywhere but the buggy and there is no one to give mum a break to research actual phone numbers for someone to help, and to get through to them? How many lactation consultants should one need to consult?

As another commenter wrote earlier, no wonder there are so many cases of PND, like myself. When you're too teary to choke a word out on the La Leche helpline and they just tell you to find a LC nearby anyway, then are faced with a huge number of them to call...sometimes it seems like a row of dominoes that slowly topple until you really do have low milk supply. Perhaps not naturally but through a series of unfortunate events linked with lack of both in-house and professional support. It is all too easy to advise mum to just "get help".

Poppy

7/8/2015 05:18:44 pm

Thank you for writing this article! It's so reassuring and I only wish I had read it before I gave breastfeeding a go! In fact all new mums should know this information to fully equip them with the tools they require in order to successfully breastfeed.
There is so much external pressure from family members to silence a crying baby which is often diagnosed as being a hungry baby. I hated hearing 'she's only crying because your milk isn't satisfying her'. Rubbish!!! Luckily I ignored the ignorance and I was able to breastfeed my baby. It wasn't easy, it took a lot of patience but we got there!
Anyway thank you again for writing this- it's amazing and I'm sharing it with all my friends!!!

Amanda

7/8/2015 05:35:06 pm

Wonderful article. You can tell you really know what you are talking about. I thankfully didn't have any issues breastfeeding but going into it was very concerned because several of my close friends stopped because it was too hard or they thought they didn't produce enough milk. I was worried I would not have the support I needed to continue if I struggled. I will definitely pass this post onto other mothers. Thank you so much for the good read!!!!

kelly

7/8/2015 06:57:53 pm

I'm in that tiny percentage of women that suffer from insufficient glandular tissue. Tubular breasts, gap of 3" between them and zero changes during either of my pregnancies. It's incredibly frustrating and the guilt you feel about not being able to provide for your children is immense. I pumped for hours every day for the first four weeks with both my children in adfition to having them nurse. Sometimes I even pumped enough during a 24 hr period for a whole 2oz bottle. I dried up before
6 weeks both times. Best advice/encouragement i ever got was "whatever you can give them is better than nothing", the best we can do is try.

Emma Pickett

7/9/2015 04:06:21 am

Thank you for posting Kelly. I think what you've said is very important. Sometimes we over-use the phrase 'every drop counts' but it is increasingly clear that even small amounts of breastmilk contains enormous benefits. I know guilt is a very personal thing but I can't see any reason for you to feel any guilt over something over which you had no control. You clearly tried your absolute best. I don't think guilt is ever appropriate in this context. I have yet a meet a mother (and I meet many at all stages of their breastfeeding experience and many with IGT) who did not make a decision that was the right one for her and her family.

Sara link

7/10/2015 02:07:00 pm

I am with you. I cried and struggled to nurse 3 babies. Did every possible thing to increase supply. Weeped a heavy mess when they wouldn't gain weight. Felt like a failure. Felt like supplementing was a failure. But giving them what I could gave me the experience of bonding. Letting go of the failure made it possible to not resent breastfeeding. All three of my guys were / are hard to wean. The youngest is 14 months and craves his time nursing. It is sacred for him and me. I think the breastfeeding community should be more inclusive and compassionate to the heartaches of new and experienced mothers.

Like infertility, inability to breastfeed can wound tender hearts who want nothing more than to be the best mom they can.

That said, I applaud efforts to educate and build awareness. So many people do not understand how the body works and education like this can help women find solutions or new confidence in their ability to nurse.

Xoxo

Kate

7/8/2015 11:10:19 pm

What about pregnancy? I had an oversupply and generously donated milk for the first 4 months and then my supply balanced out but was plentiful. Suddenly my baby can't get milk and is frustrated, wet diapers became a real concern, my normally happy 6 month old was never content...until we offered my frozen milk. Now I use an SNS so we don't add to the low supply cycle by supplementing with stimulating the breast. Turns out my supply tanked at around 7 weeks pregnant. I'm at 10 weeks now. Is anything going to help? I'm told galactogogues are to be avoided and won't help anyway (I assume foods aren't an issue just herbs). Is it possible to improve this? I've been very cautious about over supplementing and it seems with enough table food my baby needs about 3-4 oz more than I can give 3 times a day, and a few times a day I can nurse without the supplemental nursing system. Any advice?

Emma Pickett

7/9/2015 04:15:26 am

Hi Kate,

A little further up you'll see a discussion with a mum called Kelly from February about this.

Unfortunately what you've heard is right. This is hormonally driven and very little can be done in this situation. Galactagogues are unlikely to help (even the ones that are considered OK). Hilary Flower in 'Adventures in Tandem Nursing' describes how the storage areas become 'leaky' and this accounts for reduced volume. Women who do experience a significant supply reduction in the first trimester often appreciate it when the colostrum arrives at around 16 weeks.

However if a baby is under 12 months, it's likely even a decent amount of colostrum won't be adequate and other milk will be needed.

Using the SNS is a very sensible tool to use here. I hope you can continue to breastfeed for as long as you want to and obviously there are benefits to even small quantities of breastmilk. Though don't be surprised if the colostrum causes loose stools when it arrives!

Amanda

7/8/2015 11:46:20 pm

Great post! I'd recommend adding tongue tie as a potential reason for low supply and poor weight gain. I nursed my second baby around the clock with a supply that I had built up through pumping. I could feel that my milk had declined, he gained zero weight, and had a poor diaper count. That was when I switched to exclusively nursing from pumping and finger-tube feeding, and him gaining a pound in two weeks. Eventually, we figured out why, had his tongue tie revised, and now he transfers milk wonderfully

Lisa

7/9/2015 01:48:54 am

I agree. I was just going to post that myself. Tongue tie can be a huge contributor to low gain in babies. I've had 2 with tongue ties, 1 with a severe anterior tie and one with a posterior tie. The baby with the anterior tie was really obvious there was a problem. The baby with the posterior tie, it was only his lack of weight gain, his still somewhat crystallized diapers and his lethargy that were indicators.

He was my 4th though, so I had a lot of experience to know there was a problem. I was already getting worried, but at a couple weeks old, I had one night where he nursed for a long time and fell asleep. I got up and realized my breasts still felt as full as they had before he nursed. I instantly started using a nipple shield (which I know a lot of IBCLCs despise) which allowed him to transfer milk and got him in to get the tie cut.

He never had formula, but only because I was experienced and pro-active. If the shield hadn't obviously started making a difference, I would have resorted to formula until I could get the tie dealt with.

Interestingly, it wasn't until after I had him that I realized that I had low supply with my other 3 kids, especially my eldest. Most doctors use TSH to determine thyroid issues. It's a terrible test that misses lots of people. I clearly had thyroid issues since my early teens, but the TSH was always "normal". With my 4th, I was finally so desperate that I convinced a dr to give me meds just before I got pregnant. He was my heaviest baby and I had way more milk for him that didn't dry up nearly as early.

Emma Pickett

7/9/2015 03:56:40 am

I agree with both of you. I wrote this post a couple of years ago as you can see (and for some reason it's had a flurry of interest this week). Tongue tie should definitely get a specific mention and I've now added that in. Thanks.

Angel

7/9/2015 04:15:56 am

Thank you for this very informative post, it answered the questions I have in mind. Very helpful to those mommies out there who almost wants to give up breast feeding. Thank you.

Julie B.

7/9/2015 06:49:44 am

Although very informative, this article doesn't help me much. I was hoping to get at least six months of breastfeeding for my daughter, and I almost made it. She went on a feeding strike a few weeks ago and now my supply is non-existent. I've taken all of the herbal supplements out there, eaten all the things to keep my supply up, but to no avail. I did supplement with formula while breastfeeding because I couldn't keep up with her demand. It's harsh when you try everything possible to give your all and people condemn you for not "trying hard enough". People don't know the struggles of these women who can't breastfeed. I'm giving my child the nourishment she needs, regardless if it's breast milk or formula.

Sara

7/9/2015 11:42:28 am

You need to do what you feel is best for your baby but your situation does not prove the tips in this article aren't true or don't work. It sounds like you were giving your baby bottles, which is why she went on the nursing strike. The only thing to do in that circumstances if you want to continue breastfeeding is to stop all bottles completely and keep the baby on or near the breast until they come back to the breast. You didn't want to do that, and that's fine, but your decisions made your milk dry up, it wasn't due to some problem that couldn't be solved.

Julie B

7/9/2015 05:19:04 pm

SSara, she was actually doing fine going between both (I'm a working momma, so I have no choice but to give her bottles.) She went on strike because she got sick and couldn't breathe while feeding. I was hoping that after she got better, she would go back, but that wasn't the case. I pumped likecrazyy and I offeredher my breasts every single time she wanted to eat, but she just didn't want to.

Carole Thorpe link

7/9/2015 08:54:34 am

Wonderful post. Emma ... I shared it on Hypnobabies Official Facebook page this "morning" from the west coast of the US.

Brooke link

7/9/2015 09:34:47 am

Wow.. this is always going to be a controversial topic because let's just all admit right now these "issues" tug at our hearts! We ALL want to do what is best for our babies but I think the bigger problem comes in when we all begin to forcefully push our own beliefs on what BEST my be into each other's lives.
We all know I think we can all agree that it is HARD making these choices for our children and we all want to be the best mothers we can be!
We all know and understand that breast feeding is best and in a perfect world, I do truly believe we would all breast feed....
sometimes though it just isn't the case!
It is my HOPE and it is my wish that as mother's we would stop the judgement for one another. It is hard enough making tough choices for our families on a daily basis and judging ourselves and praying we are doing the right thing. Let's not do it to one another any more!

I love that there is so much information out there these days... articles like this that give us information that we can read to make sure we are making informed choices!

But at the end of the day... let's remember... not every child is the same! Not every child, not every mother, not every family is a text book case! We can't all understand the situations and the circumstances so maybe instead of passing blank judgement we should just acknowledge from one mother to another that a choice was made for a family that worked well and as long as children are loved, honored and respected... all is right with the world!

Andy

7/9/2015 10:40:06 am

Great concise article. I am a Canadian midwife and would like to handout to our clients with your permission. It contains all the things I say, but in written format!! And many women with PCOS are not aware it can affect their milk supply - and sometimes they don't tell us when we take their history

Odile

7/9/2015 10:49:10 am

Oh I needed to hear this information.. My little guy is three months.. And my breast has been feeling soft, bad I have being feeling like I am supplying enough for him.. Oh thank you and the clarity and understand of what really happening in my body and to keep on breastfeeding my little guy like I plan too.. Thanks!

Lindsay

7/9/2015 02:12:15 pm

This was a very informative article. Unfortunately all of the situations that applied to my experience were the ones In the latter part of the list. My first birth and breastfeeding experience were extremely traumatic and I don't wish to repeat that...however I do want to give breastfeeding #2 my best shot. to be honest I am terrified to the point of tears of a second failure..I am going to start looking for some local resources where I live and hopefully will be able to at least leave the hospital without open wounds on my nipples :(

Dima

7/9/2015 02:43:32 pm

Thank you for your useful article i wish i read it before quite some time, but still i think its not to late i hope cause im still breast feeding my five month old son.. you summarized every worry thought i had, it was like a nightmare not to be sure if my son is having enough milk.. and i couldnt find anyone to answer my questions.. the way u just did.. thank.. you..
Although im using formula milk aside breast feeding cause my son gose to the nursery.. im still trying to breast-feeding him as much as i can after work..
But regarding breast pumps i really need you to answer this question for me.. every time i used it my breast ends up very very soft as if there is no milk at all for the rest of the day.. so i stoped using it.. may i know why? Do u recommend to continue using it?
Thank you.

Angela

7/9/2015 08:17:28 pm

I wish more than anything I could brr successful at breastfeeding. I believe I have a low supply to feed twins and they have upper lip and possibly posterior tongue ties. They are 7 weeks old and we have gone weekly to meet with lactation. Now I'm pumping but still having to feed them 2/3 formula. Can I still get back on track? I'm doing everything I can, galactologues, hospital grade pump, power pumping, oatmeal and plenty of water.

Cara

7/10/2015 07:49:51 am

You have done well to go that long with twins! Mine are super healthy 8 month olds and were solely formula fed since 2 weeks. The decision I made to stop trying to breastfeed was highly emotional, but less stressful. I cried about it for a month after anytime anyone asked but I enjoyed the time I had with my babies and actually had more cuddle time with them since I wasn't nursing a pump all day. If you need someone to tell you it's ok to stop, I'll do it :) You sound like you are doing such a great job with their well being in mind - it will get easier, whatever you decide!

Nickie link

7/10/2015 12:32:58 am

Being a mother of 3 who had issues breastfeeding all of my boys, I used to hate the fact people said they didnt have enough milk, when I really didn't. All 3 lost a lot of weight, had red in their wee & no poos. I resorted to breast (more for my emotional health thinking they were at least getting something from me) & bottle for 4 months. NOTHING is more devastating to a mother who truly wants to breast feed & struggles than hearing someone say they don't have enough milk.i tried everything even with my youngest at 2yrs old I still get sad about it.

Natalie

7/10/2015 05:31:56 am

I am one of those "small group of people" that could not produce enough milk.
As a mum that desperately wanted to exclusively breastfeed, I foolishly listened to well-intended family and friends who told me not to supplement with formula and as such I starved my first for nearly 6 weeks, against my better judgement. I think whilst your article is useful, it doesn't acknowledge that most mums who are wanting to breastfeed are doing everything they can to continue to do so. They don't give up easily.
I would like to see more support for mums that do top-ups because they know that is the right decision for their baby.
I was lucky and able to breastfeed and bottle feed both my sons for 8 and 10 months. It doesn't have to mean the end of a breastfeeding relationship because formula is used. I had only one doctor tell me I could successfully do both and I am so thankful for that advice.

Sheya Nordby

7/10/2015 09:52:17 am

I was a person who could not produce enough milk for my last two babies, they both began losing weight and became undernourished losing weight. I tried and I failed miserably. My sons were about 5 months each when my supply wouldn't do any more and I still feel the guilt about that. Though in my heart of hearts I know that supplementing was the right choice when they finally got on track once again.

Emma Pickett

7/10/2015 10:59:53 am

To SB above, who asked the interesting question, how many women have low supply intrinsically and despite their best efforts are unable to exclusively breastfeed?

Perhaps we can look at Norway. 1.5% of babies in Norway have never been breastfed. They have 95% of women breastfeeding at 4 weeks and 82% exclusive breastfeeding at 4 weeks. They have about 75% breastfeeding at 7 months.

http://www.health.gov.au/internet/publications/publishing.nsf/Content/int-comp-whocode-bf-init~int-comp-whocode-bf-init-ico~int-comp-whocode-bf-init-ico-norway

Could we assume that some not breastfeeding choose not to for a variety of reasons, not just low supply?

Hungary is also interesting. About 95% are exclusively breastfeeding at 3 months (2005): http://www.oecd.org/els/family/43136964.pdf

I can't believe Hungary is a very different country from us in terms of population.

In the UK, we're struggling with statistics as the infant feeding survey has now been cancelled and the Department of Health collects statistics patchily. We also find many women are unable to access breastfeeding support due to an overstretched health service where many midwives and HVs lack time and training and have many other responsibilities. It's going to be hard to get a true picture.

As an IBCLC, I work with the 5+% who inherently struggle with low supply every day. I work with them to help them maximise their supply and manage supplementary feeding. It's very rewarding to work with the mum who uses the SNS and knows that although her baby is 90% formula fed, those few mls of breastmilk DO make a difference. Some mums do end up increasing their supply dramatically with the right support or perhaps after thyroid testing as has been described above. Of course, not everyone can. As an IBCLC, I am more likely to meet these women than most.

However these private clients are not who this article is for. Not every article can apply to everyone or feel right for everyone. In my drop-in groups and on the national helplines, I come across many more women who doubt their supply without reason. Babies are putting on weight and are healthy and happy but mums are worried about normal infant behaviour and normal changes to their breasts.

7/10/2015 02:03:52 pm

I understand that the article was not really addressed to women like me, but to the supposed "average woman," and that there are plenty of women who doubt their milk supply for no good reason.
Those statistics make me want to move to Norway or Hungary. Maybe it's their water supply.
I just wish there were some answers for me and countless others. I still believe the number of women who cannot breastfeed (in spite of all our efforts) is more numerous than the experts say.
Thanks for taking the time to respond!

Sissy

7/10/2015 11:57:21 am

I had trouble feeding all 3 of my kids. My middle child was the hardest. She didn't get back up to birth weight until she was almost a month old. It was heart breaking. I would feed, pump, feed. I took herbal and prescription medication. Drank the horrible teas. Ate what I was told would help and lived on no sleep. We also saw lactation 3 times a week. We tried everything and could not get my supply to increase. I cried when our lactation nurse told me it's time to supplement. I was set on her only having my milk but we couldn't let her continue to not gain or to lose more weight. Yes, breast is best but there is nothing wrong with formula. I know women who choose to never breast feed and go straight to formula. It is their choice. I feel for any women who tried like I did and couldn't make a supply for their babies. Then there are the women who think you are horrible for it. Those are usually the ones who didn't have an issue with their supply. When we had our 3rd, we went straight to supplementing. It worked for us and that's all that matters.

Alison

7/10/2015 01:58:55 pm

This is a helpful article. But, in my opinion I think the biggest contributing factor to women stopping bf'ing is we just don't see it enough. If we had more experiences of actually seeing and witnessing other women, relatives and friends in the home and strangers in public, it would just seem more normal. I saw my mum feed my sister as a kid and my sisters feed their babies as an adult and I never doubted that I could breast feed. Bottle feeding wasn't even a consideration. Even the smallest hint of doubt cab create a self fulfilling prophecy. So every time I feed my babies, at any age, not just newborn stage, I feel I'm doing a community service. Some future mum may be watching and either consciously or sub consciously consciously realising that this is how it is meant to be.

Charlotte

7/11/2015 05:48:00 am

This article couldn't have been more timely for me - this week my breasts stopped leaking, felt permanently soft and my 6 week old baby was only feeding for short periods, 5-10 minutes and quite infrequently. I've been in a panic that my supply has dropped because of this and because I could pump lots on Monday but very little on Friday. The counsellor at bf group said I need to get him to feed longer. Baby is happy, not seeming hungry, and seems to be putting weight on well. your article has really reassured me, thank you.

Sara

7/11/2015 09:04:44 am

Something to add to the medical side of things: gestational diabetes. I had low milk supply due to insulin resistance, a finding that has only come out recently. Note that this can affect a large number of moms!--not the small number you mention at the very end of the article.
http://www.cincinnatichildrens.org/news/release/2013/breastfeeding-insulin-07-05-2013/

Also, this is very helpful to most moms, but to those of us who truly have low supply, it's a little frustrating. Always the assumption that true low supply doesn't exist... while that's true for most of the breastfeeding population, for those of us that do have low supply this kind of article (and the tone of "all you need is more education") can really sting.

Emma

7/11/2015 10:30:10 pm

Hi Emma I have read your article again and again with great interest. Unfortunately I have a situation whereby my one month old has started to fuss and won't suck properly if the milk is not flowing fast for him. He is fine in the middle of the night when my breasts are very full as if comes quickly but he just won't work at it which stresses me out as he starts screaming and then of course the milk doesn't flow so it's a vicious circle. This has only started in the last 4 days. Before that he fed very well having had a good latch from day one. It has now affected my supply despite pumping after every feed because I have had to top him up first from expressed milk in the fridge and then in the evenings from formula as otherwise he's starving! Is there anything I can do about this as I know this is a vicious circle and a downward spiral unless I manage to increase my supply to meet his needs. I am sure this is not coincidental to the timing of the well documented 4-5 week growth spurt. It's a great article by the way. I have been forwarded it by several friends who have had to listen to my concerns over the past few days.

Emma Pickett

7/12/2015 12:25:21 am

Hi Emma, That sounds stressful. Sorry you are experiencing that. A couple of things may help. First off, check you are doing paced bottlefeeding during the bottlefeeds so that he still has to work on the bottles. We want to connect all feeding with the need to make an effort and create negative pressure and use muscles to draw milk out. You can search for Paced bottlefeeding on You Tube. I might also suggest using an SNS during this phase (if you are in the US it would be a lactaid). That's a device that allows you to supplement on the breast and keep the flow steady with a tube at the nipple so at least he continues to have a positive association with the breast while you gradually work on the issue. Then after a while of feeding well with the SNS (which will cure the problem in the short term), you make the SNS a bit harder but putting the end of the tube in a bottle that is then lower than he is. He has to draw the milk up with more effort. You can make it lower and lower. An SNS can have expressed milk in it or formula.

If an SNS doesn't feel right, you can use switch nursing. Don't feel you have to stay on one breast X number of minutes. I would get a letdown started before he gets on with hand expression or a very short pump so the letdown is there immediately. Then once he starts to fuss, try breast compressions (see Dr Jack Newman's handout and video) and then swap sides if that doesn't help. Go back again to the second side and keep swapping as long as he's happy.

If you're not already using one, perhaps hire a double hospital grade pump as double pumping will make it easier to protect your supply.

I'd also have lots of skin-to-skin and bottlefeed skin-to-skin so he knows the breast is the lovely place to be however the milk is delivered.

If his behaviour changed quite suddenly, it might also be sensible to visit your GP so they can just check his ears, throat and make sure there's nothing else going on. Something like oral thrush may make a baby reluctant to do deeper draws.

Some people feel taking herbs also protects their supply but stimulation and removing milk is the most important bit.

Nothing else going on in terms of you? You haven't started taking any new medication? Iron levels ever a problem before?

Very best wishes.

Emma

7/12/2015 05:49:54 am

Emma thank you for replying to me so quickly. I should check my iron levels which I will. He's definitely too used to the bottle now it's so frustrating. I tried the pumping to get the let down and then offering him the breast but it didn't work but I am going to try it again at the next feed. Onwards and upwards I am so keen to feed him myself and not from a bottle!

Best regards and thank you again.

Sigourney

7/12/2015 01:12:33 am

I was always worried I had no supply despite child health nurses saying- look at him ( he was a big healthy looking Bub, with plenty of wet/ pooey nappies a day). I am glad the child health nurses said that cause I breastfed till almost 2 and really enjoyed it in the end.

My babe was very unsettled at the breast, coming on and off and screaming. I would often feed standing and swaying. It would sometimes resolve by swapping to my "better" breast. I have had other women tell me about this experience- any comments, as this is comprehensive but doesn't cover "angry" at the breast.

Thanks

Emma

7/12/2015 05:51:02 am

Thank you. Unfortunately I think I gave into the bottle too early which has been the downfall. I will keep trying though and standing / swaying is a good idea. Many thanks

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Low Milk Supply 101

Author:
Emma Pickett IBCLC

Find me on twitter: @makesmilk

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Low Milk Supply 101

Author:Emma Pickett IBCLCFind me on twitter: @makesmilkFind me on pinterest: https://www.pinterest.com/makesmilk/youve-got-it-in-you-a-positive-guide-to-breastfeed/

Categories

Archives

Author:
Emma Pickett IBCLC

Find me on twitter: @makesmilk

Find me on pinterest:
https://www.pinterest.com/makesmilk/youve-got-it-in-you-a-positive-guide-to-breastfeed/