Concerns About a Low Supply and What To Do About It

One of the biggest concerns women have as they start their nursing experience is whether or not they have enough milk for their baby.  My goal when I first work with a new mother is to reassure her that she will have enough milk.  The colostrum she has after birth is exactly what her baby needs.  Sometimes though, she just might not have the supply her baby needs as her milk comes in.   I have written before about how a hemorrhage or a C-section can delay the initiation of milk production and most women in those situations expect that.  But what about the mom who just wants to nurse, has no medical issues, and can’t seem to provide enough to sustain her baby?  Is that a situation that can be fixed?

Before answering that question, I want to talk about two situations in which a woman might not physically be able to provide milk for her baby.   And I want to stress MIGHT, as many women have surprised me!  The first is a woman that has fertility issues and has gone to great lengths to conceive a baby.   If there has been any kind of hormonal imbalance that made achieving pregnancy a challenge, it is possible that those imbalances will negatively affect lactation.  In addition, some women have a medical condition called Mammary Hypoplasia. While rare, “women with mammary hypoplasia often have normal hormone levels and innervation but lack sufficient glandular tissue to produce an adequate milk supply to sustain their infant.” This is often suspected in women who have widely spaced, tubular breasts. In each of these situations, women can often produce some milk for their babies, it just isn’t enough to sustain them and they need supplementation. 

So, what is a woman to do if she suspects she is in one of the above situations, or seems to have no issues at all, but it just isn’t working?  My first piece of advice is to remember that it is not all about you. For many women, this is a huge relief!  In order for breastfeeding to work, both the Mom and the baby have to do the right thing.  Often, the baby just isn’t capable of that, and it impacts a Mom’s supply.  In order for your body to make milk, the milk that is in the breast needs to be removed. It is all supply and demand.  What the baby takes out, the body will replace. If the baby isn’t effectively draining the breast, the body isn’t making the milk to replace it, and a vicious cycle starts. 

In addition, the body requires frequent stimulation of both breasts throughout the day. Women who have a baby that “sleeps great” since birth, might have a baby that drains the breast effectively, but only does so 6 times a day, which isn’t enough to get breastfeeding off to a good start. Eventually the baby will start losing weight or not just not gain appropriately. Some reasons that a baby might not nurse effectively include prematurity, medications from birth, and/or their oral anatomy.  In addition, sometimes they just weren’t getting the calories they need, (because your milk wasn’t in yet) which makes them lethargic, and nurse poorly, which then impacts your supply. Once you feed them, they perk right up, nurse great and your body responds with an increase in supply!

The best way to prevent a low supply from an ineffective baby is to assess whether the baby is nursing well by having a lactation consult. The IBCLC can observe the feeding and weigh the baby before and after the feeding to measure an effective transfer. We can make changes if necessary early on to help get you on the right track. Weight checks at the pediatrician will also alert you to potential issues. But often the issue is detected two weeks in and now you are working to fix the problem rather than focusing on getting things off to a good start. 

And how do you get things off to a good start?  Two great prenatal resources are our monthly breastfeeding class and the book, The Nursing Mother’s Companion by Kathleen Huggins RN. They will both give you lots of anticipatory guidance about what to expect when nursing. Then when the baby arrives, the best way to get things going is to nurse frequently and effectively from the beginning. The baby needs to nurse at least every 3 hours, and this is from the start of one feeding to the start of the next.  This means approximately 10 nursing sessions from both breasts in a 24 hour period, with no pain and swallowing audible. Your baby should be pooping and peeing within normal limits once your milk comes in, which means at least 6-8 wet diapers and 3-5 dirty ones.  He should also be gaining weight, and if he isn’t, please don’t wait until the 2 week check up to get assistance. 

If the above milestones are not being achieved, you need to pump to protect your supply. If you have any concerns at all about your supply, we recommend renting a Symphony Breastpump for the first month. This pump is effective in getting your supply established, while all other pumps (provided by your insurance plan) are intended to maintain a supply that is already well established. Pumping after each nursing session, or in place of nursing, will drain your breast and signal your body to make more milk. It is very important that you nurse frequently and effectively or pump within the first week of delivery, to take advantage of the hormonal milk producing surge that occurs in the first 10 days.  If you do this, I am certain that you will be able to produce enough milk to sustain your baby. You will have done the most important thing, which is to get your supply established. Then we can figure out what is preventing the baby from nursing effectively and fix that!

The other scenario is that you have a vigorous healthy nursing baby, who seems ravenous, and clearly isn’t getting what he needs.  While rare, it does happen, and then we have to look at Mom’s history and see what we can do to enhance her supply. The obvious things are hydration, an effective latch, sleep, good nutrition, and ruling out the medical issues I mentioned above. For some women, it just takes a bit of extra time, and supplementation is necessary in the interim. Donor breast milk is now an option in RI, and some of the hospitals offer it.  You can also get it from the Mother’s Milk Bank of New England. These are excellent options for a woman who doesn’t want to use formula. But the bottom line is, the baby needs to be fed. And it is important to remember that this need for supplementation is probably just temporary. You are bridging the gap between what your baby needs now and what you are producing.   As your supply increases, the need for supplementation will decrease a bit daily, until you are exclusively nursing. 

So if you are worried about your supply, please don’t give up!! Meet with a lactation consultant to determine the cause of the problem, remembering that both you and your baby need to do the right things. Work to establish, protect and maintain your supply. Nurse with an effective latch. Feed your baby what is needed to maintain their health. Sometimes, this process takes a month, but I have seen it happen over and over again.   After weeks of working to get her supply what it needs to be, one day a woman realizes that she is exclusively nursing her baby and all is well. Remember, we are here to help you with this if you need it!