One of the biggest concerns new mums have is whether they’ll make enough milk. This isn’t peculiar to our culture. For thousands of years, and in many different cultures, parents have used herbs, potions, spells, incantations, wet nurses and a variety of little cups and feeding devices to supplement. After all, before the advent of formula, a baby’s survival depended on his/her mother being able to provide enough milk, so it has always been a valid fear. I imagine it’s one of those evolutionary fears that runs deep, a bit like a fear of spiders or a fear of the dark…
How common is low supply?
Like any system in the body, lactation can malfunction. This may be due to insufficient breast tissue or underlying medical conditions. Women may also experience low supply due to events around the birth and the early days. Unfortunately, it’s hard to say what percentage of women have a true low supply, because the figures are complicated by birth practices and what happens in the first few days, as well as a perception of low supply. It’s probably true to say that most women can make enough milk for their babies, in the right circumstances. However, there will always be some women who despite their best efforts don’t produce enough milk. For these women, the impact can be devastating
Perceived versus real insufficiency
It’s important to distinguish between a perceived milk insufficiency and an actual milk insufficiency. As many as 60% of women who stop breastfeeding, do so because they think they don’t have enough milk! Mothers often worry that when their baby acts in a certain way, they don’t have enough milk. Understanding normal infant behaviour can be really important for reassuring you that your milk supply is fine. Often our perception of “normal” is very different from reality! I have a FREE online course that covers normal newborn behaviour in detail, which helps you understand when a baby is acting normally, and when they aren’t.
NORMAL NEWBORN BEHAVIOUR THAT DOESN’T INDICATE A LOW SUPPLY:
Frequent feeding (10-12 feeds in 24 hours is really normal)
Sleeping for short periods of time
Settling on a parent or adult in between feeds, but not settling in a cot
AND WITH AN OLDER BABY, THESE MAY BE CONCERNING BUT ARE USUALLY NORMAL:
A baby wanting to feed from both breasts where previously one would have been enough
Breasts feel soft between feeds or stop leaking (common around 6 weeks)
Waking more frequently at night time (very common around 4 months)
You’re no longer able to pump as much milk as you could at the start
As an IBCLC, I’d say around 1/3 of my clients contact me because of low supply or because their baby is gaining weight slowly (these are often two sides of the same coin). That doesn’t mean that 1/3 of all women struggle with low supply, of course! It just means that it’s a significant issue for some women.
SIGNS THAT THERE MAY BE A PROBLEM WITH SUPPLY, OR THAT BABY ISN’T GETTING ENOUGH MILK:
Baby not settling at all between feedings, cries constantly when not at the breast, constantly rooting and wanting to feed
Baby sleeps for long periods between feeds, especially in the early days (less than 8 feeds in 24 hours)
Baby latches on, takes one or two sucks and then falls asleep
Baby doesn’t have at least 5-6 heavy wet nappies by day 5
Baby doesn’t have at least one dirty nappy a day – once poo changes to yellow, this should be at least two dirty nappies a day
Baby has lost more than 10% of birthweight
Baby is slow to regain weight, and/or isn’t following their centile line on the chart
**If one or more of these is true for your baby, a thorough feeding assessment may help.**
What should you do if you're worried about your supply?
First of all, get help!
If the only solution someone can offer is to supplement with formula, get a second opinion.
As an IBCLC, I’ll take a full history that includes asking you about underlying medical conditions, how your pregnancy and birth were and how your breasts changed during pregnancy. If I see you in person, I’ll ask to see and examine your breasts too. If necessary, I’ll write to your GP asking for specific blood tests or investigations. We’ll look at positioning and latch. We’ll look at feeding patterns to maximize the milk your baby gets during a feed, and to make feeding as efficient as possible for both of you. If you do need to supplement, you get support and a plan to make sure that your baby is getting enough milk to gain weight adequately. If you need to supplement we discuss ways to do it that won’t affect your baby latching on to the breast. The plan should also help you maximize your milk supply and make that process of increasing your milk supply as easy as possible.
The sooner you ask for help, the more successful any plan is likely to be