Am I making enough breastmilk for my baby?

One of the biggest concerns new mums have, is whether they are making enough breastmilk.  This is a worry that new mums have had for thousands of years!  Throughout the world, parents have used herbs, potions, spells, incantations, wet nurses and a variety of little cups and feeding devices to supplement the breastfed baby. After all, before the advent of formula a baby’s survival depended on their 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… 

Newborn baby breastfeeding

How common is low milk 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 low milk supply

It’s important to distinguish between a perceived low supply and an actual low supply. Mothers often worry that when their baby acts in a certain way, they don’t have enough milk. Behaviours such as frequent feeding and a baby only setting in arms are often interpreted as a sign that babies aren’t getting enough milk. However, these are very normal behaviours for a newborn baby! 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!  

If you want to find out more about normal infant behaviour, I have a great course that covers the first 14 weeks of your baby’s life: Caring for your newborn baby : Rebecca Scott-pillai (rebeccascottpillai.co.uk) I also cover breastfeeding in quite some detail. 

NORMAL NEWBORN BEHAVIOUR THAT DOESN’T INDICATE A LOW MILK SUPPLY:

Frequent feeding (10-12 feeds in 24 hours is really normal)

Sleeping for short periods of time

Cluster feeding

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 a lactation consultant, almost half of my clients contact me for breastfeeding support because of low milk supply or because their baby is gaining weight slowly. Low milk supply and slow weight gain are often two sides of the same coin.  That doesn’t mean that half 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.

Or alternatively…

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, some skilled breastfeeding support will 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. Your midwife or Health Visitor may be able to help (if you’re in the UK). Other sources of breastfeeding support include breastfeeding counsellors and lactation consultants. 

As a lactation consultant (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.  It should also help get your baby’s weight back on track. 

The sooner you ask for help, the more successful any plan is likely to be.

Woman using a breast pump, while looking at and touching her baby

Top tips for improving your milk supply

Act early

The first four weeks are a crucial time in building your milk supply. If you can “fix” an issue during these first few weeks then you are more likely to see an increase in your milk supply. However, all is not lost if your baby is older than four weeks. It is still possible to increase your milk supply weeks and months down the line. 

Breastfeed more often

Offer the breast to the baby a little more often. I often see women who are only feeding their baby 7 or 8 times per day and weight gain is a bit slow. Increasing the number of times they feed to around 10-12 times in 24 hours can really make a difference! If your baby is already feeding 10-12 times in 24 hours (or more!) the following tips will be more helpful. 

Try switch feeding 

Often women are told to keep a baby on one breast as long as possible so that baby can get the hindmilk. This is not usually a problem if you have a good milk supply or baby is gaining weight well. However, for some women, this can actually reduce your milk supply and results in your baby getting less milk. 

Babies get the most amount of breastmilk in the first few minutes at the breast. You should see big sucks and swallows in the first few minutes. When these big sucks and swallows change and you’re just seeing shallow fast sucks, with very few swallows, SWITCH your baby to the other breast. You’ll see big sucks and swallows… When you see the shallow fast sucks again, SWITCH them back to the first breast. And then repeat. This gets a much bigger volume of breastmilk into your baby, plus it mimics a cluster feeding session, which signals your brain to make more milk. 

Add in breast compressions

I suggest this cautiously, as sometimes (especially if your breast is smaller), adding in breast compressions can actually dislodge the breast from a baby’s mouth. However, if you can do breast compressions without disturbing your baby’s latch, it might be worth trying. 

When you see your baby slowing down with those sucks and swallows, you can squeeze the breast. Think about squeezing it for a second, releasing for a second, then squeezing again. This increases the flow of milk and often stimulates your baby to suck a bit more actively for a few more minutes. 

Pump for 5 minutes after every feed

Pumping (or hand expressing) for a few minutes after every feed signals to your brain that your body needs to make more milk. You can then feed any collected milk to your baby – this is especially helpful if you’ve been told to supplement with bottles.

Eliminate dummy or pacifier use

Babies use suck on a pacifier often cue for feeds less often. Sucking on a pacifier can interfere with normal feeding cues and reduce hunger pangs, especially in young babies. Offer your breast instead!

Avoid sleep training

Most babies with slow weight gain will really benefit from frequent feeds overnight. Not only does this increase the number of breastfeeds your baby will have in 24 hours, it helps to stimulate the milk producing hormone, prolactin. This needs to be balanced by the fact that it is incredibly intense and time consuming trying to increase your milk supply. Worrying about your baby’s weight gain is exhausting. You do need to sleep too! If you can achieve a 4-5 hour block of sleep at night, that’s fine, don’t feel like you need to set an alarm to feed every 2-3 hours overnight. However, ensuring that your baby has at least 2 feeds overnight is really important.

If you’d like some support with breastfeeding, you can find out more here: Expert support with breastfeeding – Northern Ireland : Rebecca Sco (rebeccascottpillai.co.uk)

Published by Rebecca Scott-Pillai

Rebecca Scott-Pillai is a paediatric sleep consultant and lactaction consultant (IBCLC) based in Lisburn, Northern Ireland. She lives there with her two kids, two cats and dog! With over 20 years experience working with families, Rebecca uses her knowledge and experience to provide collaborative flexible plans for gentle, responsive families.