One of the top worries for breastfeeding mums is feeling like they might not be producing enough milk. The stress and concern about this can affect both a mother's confidence and the whole breastfeeding journey. Distinguishing between what appears to be a low milk supply and the actual situation is crucial to sustaining breastfeeding.

Understanding Perceived Low Milk Supply

Perceived low milk supply happens when a mum believes she's not making enough milk for her baby. This worry can cause stress as mums fear their babies aren't getting enough nourishment, sometimes leading to the premature end of their breastfeeding journey. Let’s look at some of the reasons why a perceived low milk supply might occur.

• Uncertainty about Natural Processes: Sometimes, new mums might not realise that milk production naturally varies. Changes in supply throughout the day, growth spurts in babies, and their varying feeding patterns can make it seem like there's not enough milk.
• Comparisons and Pressure: Comparing the breastfeeding experience with others can create undue pressure. Advertisements and social media can add to this pressure by showing unrealistic pictures of breast pumping, with full bottles that don't match the usual amount of milk produced.
• Breast Changes: As breastfeeding progresses, your breasts may feel softer than in the early stages, which doesn't indicate a lack of milk.

• Baby's Behaviour: Sometimes, a baby's behaviour might be misinterpreted as hunger due to insufficient milk, while it can be a part of their natural growth and development.

• Fussiness: Babies' fussiness doesn't always signal hunger or lack of milk. They express themselves through cries and seeking comfort, which might not necessarily mean they need more milk.
• Frequent feeds: During growth spurts, babies tend to feed more often, which might make parents worry about not having enough milk. However, this increased feeding is a natural part of their growth and encourages the body to produce more milk to meet their needs.
• Length of Feeds: The duration of feeds can vary. Some babies feed quickly, while others take their time. Both are normal.

How do you know if you have actual low milk supply?

It's quite common for mums to worry about having enough milk for their babies. However, actual low milk supply, where a mother's production doesn't match her baby's needs, happens less often. How can you tell if your milk supply might be low?

• Poor weight gain: Newborns usually lose 5-7% of their birth weight but should regain it by days 10-14. Losing more than 10% by day 6 requires immediate medical and lactation advice.
• Limited wet nappies: Initially, 2-3 wet nappies a day are common, increasing to 6-8 heavy wet ones when milk supply is established.
• Frequent hunger: Baby seems unsatisfied or continues to display hunger cues after feedings.
• General lethargy or tiredness: Baby might appear sleepy or lethargic instead of being alert and active.
• Signs of dehydration: such as dry lips or skin, or dark urine.

*It's important to note that these signs can vary, and some babies may show different behaviours. If there are concerns about a baby's feeding or growth, consulting a healthcare provider or lactation consultant is recommended.

What contributes to low milk supply?

• Poor Latching or Feeding Techniques: Ensuring your baby latches correctly to the breast is vital for a comfortable breastfeeding experience. Incorrect latching can cause discomfort, soreness, or even nipple damage. Additionally, if your baby doesn't latch to the breast well, they might struggle to get enough milk, affecting your milk supply.
• Stress and Nutrition: Increased stress levels can affect your body's milk release and production. When stress is high, the hormones responsible for milk letdown may not function as well, possibly impacting your milk supply. Also, not having adequate nutrition or staying properly hydrated can influence how much milk you produce.
• Your baby does not feed often enough: Nearly all babies need to feed at least 8 to 12 times in 24 hours. Regular feeding stimulates milk production. If a baby isn't feeding frequently enough, it can signal the body to produce less milk.
• You have started using formula: Supplementing breastfeeding with formula is sometimes necessary but it can affect milk supply by reducing the demand for breast milk, potentially impacting its production. It's important to be aware of how formula supplementation can influence breastfeeding dynamics. Remember to keep expressing milk to maintain your milk supply when using formula.
• You are taking oral contraceptive pills containing estrogen: Some birth control pills with estrogen can affect your milk supply. Estrogen might slow down milk production for some breastfeeding moms. It's a good idea to talk to your doctor about different birth control choices.
• You have had breast surgery that is affecting your milk supply: Past surgeries on your breasts, especially those involving tissue removal or affecting glandular tissue, could disrupt milk production. These surgeries might affect the milk ducts or the nerves needed for making and releasing milk.
• Some medications: Using certain over-the-counter medications or herbal remedies, like cold or flu tablets, might decrease your milk supply. Remember, both prescription and over-the-counter medicines, including herbal supplements, can affect how much milk you produce. Consult with a healthcare provider before taking any medication while breastfeeding.
• Medical Conditions: Specific medical conditions like hypoplastic breasts, insufficient glandular tissue, hormonal imbalances, pituitary disorders, PCOS, and thyroid issues can significantly affect milk production. It's important to seek specialised medical care to manage these conditions and explore alternative feeding options if needed.
• You have recently had mastitis: Mastitis, an inflammation of breast tissue, can temporarily reduce milk supply. The pain and inflammation might affect breastfeeding, leading to decreased milk removal and potentially reduced milk supply.

How to improve low milk supply while breastfeeding

1. Frequent Nursing: Encourage more frequent nursing sessions to boost milk production. The more your baby feeds, the more signals your body gets to make milk. Aim for feeding your baby at least 8 to 12 times in 24 hours to maintain a healthy milk supply.

2. Proper Latch: Make sure your baby latches on correctly for efficient milk removal and to sustain a healthy milk supply. Consulting a lactation consultant or healthcare provider can assist in addressing any latch issues that could affect effective milk transfer.

3. Emptying the Breast: Allow your baby to empty one breast before switching to the other. This helps in stimulating the breasts to produce more milk.

4. Skin-to-Skin Contact: Spend time with your baby skin-to-skin. This closeness can boost oxytocin levels, which is crucial for milk letdown and production.

5. Pump or Hand Express Between Feedings: Using a breast pump or hand expression between feedings can help increase milk supply by providing additional stimulation to the breasts.

6. Hydration and Nutrition: Ensure you're well-hydrated and maintain a healthy, balanced diet.

7. Reduce Stress: Stress can negatively impact milk production. Engage in relaxation techniques, seek support, and prioritise self-care to reduce stress levels.

8. Check Medications: Review any medications you're taking with a healthcare provider, as some medications might affect your milk supply.

9. Support Group or Counsellor: Connecting with a breastfeeding support group or seeking counselling can provide invaluable guidance and emotional support. To get tailored assistance with breastfeeding, reaching out to a lactation consultant or healthcare provider is a great step forward.

Feeling concerned about having a low milk supply is quite normal—it just goes to show how much you care about your little one's well-being. If you suspect that low supply might be an issue for you, reaching out to a lactation consultant early on is crucial. This step can pave the way for success in achieving your breastfeeding goals.

Resources:

Berebs, P., Labbok, M., & The Academy of Breastfeeding Medicine. (n.d.). ABM Clinical Protocol #13: Contraception during breastfeeding, revised 2015. https://abm.memberclicks.net/. https://www.bfmed.org/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-english.pdf

Centers for Disease Control and Prevention. (2023, July 9). Breast surgery. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/breast-surgery.html#:~:text=Breast%20implants%20below%20the%20muscle,cause%20reductions%20in%20milk%20production.

Contraceptives, oral, combined - drugs and lactation database (LactMed ... (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK501295/

Exclusive expressing. Exclusive expressing | Australian Breastfeeding Association. (n.d.). https://www.breastfeeding.asn.au/resources/exclusive-expressing

Kent, J. C., Ashton, E., Hardwick, C. M., Rea, A., Murray, K., & Geddes, D. T. (2021, January). Causes of perception of insufficient milk supply in Western Australian mothers. Maternal & child nutrition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729526/

Piccolo, O., Kinshella, M.-L. W., Salimu, S., Vidler, M., Banda, M., Dube, Q., Kawaza, K., Goldfarb, D. M., & Nyondo-Mipando, A. L. (2022, February 23). Healthcare worker perspectives on mother’s insufficient milk supply in Malawi - International Breastfeeding Journal. BioMed Central. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-022-00460-1

Walker, M. (2015, July 20). Formula supplementation of breastfed infants: - sage journals. SAGE Journals. https://journals.sagepub.com/doi/full/10.1177/1941406415591208