Navigating Low Milk Supply

Low milk supply can be a dicey area for new parents and is a frequent reason for ending a breastfeeding journey altogether. In fact, 60% of mothers don’t meet their breastfeeding goals and supply concerns are a main factor in the decision.

I want to demystify the topic today and give you some knowledge and tools to take with you. Whether you are pregnant, nursing, or have already had a breastfeeding journey this post is for you. Knowledge is power and can make it easier to advocate for yourself, your goals, and for adequate care from your providers. 

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What is a low milk supply?

Low milk supply is when you are not producing enough milk breastmilk for your baby to adequately grow.  When babies are between 1 month and 6 months, most babies require 24-30 ounces of breastmilk per day to meet their growth needs. If you suspect you may not be making enough milk for your baby, the first step is to reach out to your baby’s medical provider and an experienced IBCLC to help you navigate this journey. 

How common is low milk supply?

Our understanding of low milk supply is evolving, but new research is showing that it is much more common than we first thought. According to research by Shannon L. Kelleher, 10-15% of women may experience a low milk supply. 

What are some signs of low milk supply?

1) Poor weight gain–we want babies to be gaining, on average, one ounce per day by day 4 of life

2) You're not hearing swallows at the breast 

3) Your baby is not having enough pees/poops

• Day 1 of life you can expect on average, 1 pee and 1 poop.
• Day 2 of life…3 pees and 2 poops.
• Day 3 of life…4 pees and 2 poops.
• Day 4 of life…5 pees and 3 poops.
• Day 5 of life…6 pees and 4 poops.

4) You did not experience breast changes during pregnancy or after birth 

5) Your baby never seems satisfied after feeding at the breast 

6) Your baby is extremely sleepy and is not feeding well 

7) For our full list of possible signs check out this blog post here.

When will your milk typically come in?

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What are the causes of low milk supply?

The causes of low supply are varied but can be divided into 2 groups: 

1. Primary causes of low supply 
2. Secondary causes of low supply 
   

Primary Low Supply

Low supply results from any pre-existing medical conditions or anatomical issues in the mother that contribute to low milk supply. 

Possible factors include

• Insufficient glandular tissue
• Polycystic ovarian syndrome
• Insulin resistance or diabetes
• Luteal phase defect 
• Previous breast surgery 
• Postpartum hemorrhage
• Hypertension  
• Obesity 
• Hypothyroidism

Each of these factors influences lactation in a slightly different way. They may affect the complex hormonal pathways of lactation or they may have affected the number of glandular tissues present in the breast.  Having one of these conditions does not guarantee a low milk supply, but rather is a risk factor to be aware of when planning for breastfeeding or managing a low supply. If you know you have one or more of these risk factors, plan to meet with an IBCLC during pregnancy to come up with a game plan. 

How breast development impacts lactation

Glandular development of the breast happens over the course of a female's lifetime. During each monthly menstrual cycle and pregnancy, your body creates this glandular issue that is responsible for milk production. Any hormonal disruption, from irregular periods to PCOS, can impact the milk-making capacity of your breasts.  If you did not experience breast changes such as sensitivity or growth during your pregnancy this can be a sign of future low supply and a reason to book an appointment with an IBCLC. 

Secondary low milk supply 

Secondary low milk supply is related to ineffective or infrequent removal of milk that prevents the establishment of a full milk supply.  

Contributing factors include:

• Delayed start to breastfeeding or milk expression
• Infrequent feeding/pumping sessions
• Parent/baby separation after birth
• A baby having oral ties and not removing milk well 
• Poor latching and transfer
• Early supplementation with formula without breast stimulation
• Poor removal of milk with a breast pump 
  

What causes the most low supply?

While the term “primary” may make you think that it is the more common reason for low milk supply, it is actually secondary low milk supply factors that make up the vast majority of low milk supply issues. Additionally, a parent/baby pair may have both primary and secondary causes of low supply. For example, a mom may have PCOS and diabetes AND the baby has a tongue tie which makes it difficult for the baby to remove milk effectively at the breast. Basically the double whammy of low supply.

How is low supply treated?

How low milk supply is treated depends on the cause! For secondary causes of low supply, the focus would be on frequent emptying of the breast to tell the body to MAKE MORE MILK!

Options for stimulating your supply 

• Adding in extra pumping sessions
• Pumping one breast while you feed the baby on the other (parallel pumping) 
• Hand expression throughout the day
• Power pumping (pump for 10 min off for 10 repeats over the course of an hour) 
  

It usually takes 5-7 days to see an increase in your production. A full supply may not be possible, especially if your baby is over 6 weeks. Remember every drop counts and you can continue to breastfeed even when you aren’t making a full milk supply by adding in formula or donor milk by the bottle or with a supplemental nursing system. 

Watch my friend Kaia Lacy CLC @lowsupplymom demo an SNS here 

Meeting with an IBCLC, who can evaluate infants' suck and ability to transfer milk from the breast, is KEY! We want to make sure that when the baby is at the breast they are doing a good job removing available milk. 

Treatment options for a primary low supply 

Getting to the root cause of YOUR low milk supply may take some digging into both primary and secondary causes.  In cases of primary low supply, looking at the hormone levels in your blood work can help find out which factors are at play. Common blood work for low supply includes:

• Prolactin levels both at baseline and 15 min after feeding 
• Thyroid levels 
• Glucose/diabetes markers
  

Depending on the results of your blood work, your provider may recommend certain medications or supplements to support your milk production. 

Remember that some of the factors contributing to your low supply may relate to how your breasts developed during puberty and we will not be able to fully correct for these factors. Our focus should be on getting what milk-making tissue you do have to produce at its highest level. 

This is why it is so important to find a knowledgeable lactation provider that looks at both parent and baby factors when considering a low milk supply. The ideal provider has an open mind when navigating solutions to try. Interventions should be focused on what is SUSTAINABLE for you and centered around your mental health. Your provider should also be able to work in concert with your primary care doctor, pediatrician, and any other members of your healthcare team. 

Will I be able to make a full milk supply?

Not everyone will make a full milk supply, BUT the milk you can provide is VALUABLE no matter the amount! A full supply may not be the end goal. Each person's timeline and feeding experience is unique. The breastmilk you provide for your baby, no matter the amount, is valuable! Learning to celebrate and value the milk supply you do have and provide your baby is the ultimate goal. 

Our bodies are unique and the journey they take to get to this specific time and place can bring you to a different path than you may have imagined, but it is no less beneficial. You can still have a beautiful, empowered experience that helps you embrace and value yourself and the journey you do get to take.

Can I keep breastfeeding with a low milk supply?

Some mothers with low supply choose to combo feed with formula or use donor milk. Some moms will use bottles to supplement and others will use supplemental nurser systems to provide extra milk while at the breast. There is no, “right way,” to do this. 

Ready for more?

Want more information on this topic and how to advocate for yourself? I have a whole module in Boob School on low supply that is packed full of information. Boob School is designed to EMPOWER you in your feeding journey and beyond. You can walk into your feeding journey knowing whatever choices you make will be the best choice for you and your baby.  We also are lucky to have Kaia Lacy, CLC from @lowsupplymom as one of our support group leaders.  Low milk supply can be A LOT of navigating and having the support from compassionate expert providers will make a huge difference in your experience. 

Here are some other resources for low milk supply

• Low Supply Mom
• Low Supply Foundation
• IGT Mamas Facebook
  

Cheering you on, always!

XOXO

Kelly

Boob School Founder and CEO

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