Knowing you have enough milk to satisfy and nourish your bub is most mums’ No. 1 concern. So imagine the devastation a woman feels when she finds out her supply is lacking and her bub is going hungry? According to the 2010 Australian Infant Feeding Survey, 56.3% of mums stop breastfeeding to due “not enough breast milk”. There are lots of reasons why a mama’s boobie milk isn’t flowing as it should be, and many, many of the issues faced are actually preventable, or fixable with the right help and support. Here's why your supply may be low together with tips on how to increase milk supply.
Why is My Milk Low?
Too many top-ups too soon: In the first days after the birth, when the milk’s not in yet, bubs can get unsettled, or lose more than 10% of her birth weight and many paeds prescribe formula top-ups. Yes, baby is more settled and her weight is boosted BUT this can play havoc with a delicate milk supply and instead of coming in with force when it was naturally supposed to, it kind of dribbles in because bubs isn’t terribly hungry for the breast, doesn’t feed enough and to make things worse, doesn’t equate the breast as a place of nourishment and just uses it to fall asleep on rather than remove the milk. This is how a slippery slope of topping up can begin. To avoid this happening, seek a second opinion when top-ups are suggested. Haul in the hospital lactation consultant or call in your own private one. Ask about expressing instead. Learn to hand express. Wait it out just a little bit longer. Have lots of skin-on-skin time with your baby. Sometimes formula is medically necessary but often it’s not.
Sleepy newborn: Babies can be pretty sleepy if there have been drugs in labour, are premature (even by a week or two), have jaundice, or have birth interventions such as delivery by forceps or vacuum. Others can be sleepy even without these things, but a woozy snoozy bub sometimes doesn’t tell you when she’s hungry which doesn’t send the message to your milk supply to amp up to the level it’s supposed to. A bit of switch feeding may help here, (left, right, left right — about four times is good) and using breast compressions (kinda like hand expressing while your baby is actually attached) every time she pauses too long or stops sucking to squirt a bit of milk into bubs’ mouth to remind her to keep it up and stay awake. And while many people say not to wake a sleeping baby, this is something you may need to do temporarily (8+ times per 24 hours) until she’s worked out to wake up herself when she needs some tucker.
Scheduled feeds: There’s a lot of talk about feeding a newborn 3-4 hourly and not to encourage ‘snack feeding’. Some new little bubbas naturally fall into a bit of a 3-hour (or even a 4-hour) rhythm, but many don’t. If bub wakes after 2 hours, rocking, patting and shushing until he reaches 3 hours can be counterproductive from a time perspective (especially if bubs is unsettled, which increases mum’s stress levels), but also you may be teaching your breasts not to make as much as they need to. Using dummies in the early weeks before your milk supply is established can also affect supply (not always, but it may be a good idea to hold off using them for the first 4 weeks or so). If you can (and bubs isn’t too sleepy), see how you go following a demand feeding routine, so the natural rhythms of your baby’s wake-feed-sleep pattern have a chance to work their magic. Not all babies want a 3-course meal at every feed; so don’t worry if bubs feeds for an hour one feed and only 40 minutes at the next. The worst that can happen after a shorter feed is he wakes earlier for the next one. A typical newborn feeds 8-12 times in 24 hours and this may not be so evenly spaced, there may even be spates of 4-5 hours between some feeds and 1-2 between others (known as cluster feeding). Go with it.
Mother-centred medical issues: Hormonal conditions can affect a mummy’s ability to produce enough milk, as well as breast-related surgeries. Some of these issues include an underactive thyroid, post-partum haemorrhage, retained placenta, polycystic ovarian syndrome, insufficient glandular tissue and breast surgery (most commonly breast reduction) where multiple ducts have been severed. Have a chat to a breastfeeding friendly GP, lactation consultant, maternal health nurse or other health professional if you are suffering from any of these conditions and seek appropriate treatment.
What Else Can I do?
I’ve given a few suggestions above of how to help increase the volume of your breast milk, but wait, there’s more!
- Expressing your milk by hand or breast pump just after a feed.
- Taking herbal preparations like fenugreek and blessed thistle, available online or at your local health food store.
- When lots of other methods to increase supply haven’t worked, there are prescription medications like Domperidone or Metoclopramide, which work on increasing prolactin levels, which is a woman’s primary milk producing hormone. You can read more about these medications on the Australian Breastfeeding Association's website here.
If bubs needs extra supplementation of donor milk or formula, I can’t speak highly enough of giving the top-up to bubs using an at-breast supplementer (often known as a supplemental nursing system or SNS), which is a very fine tube which is taped to the breast and delivers the milk while still attached to the breast. This can help avoid bottle confusion and stimulates supply at the same time. They are available through hospitals and some pharmacies.
Written by: Simone Casey, IBCLC
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