The Struggle is Real: Low Milk Supply

11201181_364770273720390_724628687601422601_nThe Struggle is Real: Low Milk Supply

It’s what all breastfeeding moms fear: low milk supply. Today’s blog post is the first in the series about Low Milk Supply. So what is low milk supply? Why does it happen, and what can moms do about it? Low milk supply is listed as one of the TOP reasons why mothers stop breastfeeding and is a huge topic in the breastfeeding community and lactation world. Because this topic is so important and sooo big, we are breaking it up! Today’s blog is about low milk supply in the early days after birth. The important concept that we really want moms to take from this first blog is that low supply does NOT have to mean the end of breastfeeding. We also want moms to know that if you need to give your baby formula it does NOT mean that breastfeeding is over! We support many moms that have problems with low supply continue breastfeeding with supplement 😉 Ok, so where to begin…

“No Milk!” Working with breastfeeding moms, this is a phrase that we hear often in the early days and, in many cases, is not really low milk supply, its simply small amounts of colostrum… which is normal! Before we can talk more about low milk supply, let’s talk about normal milk production or (lactogenesis).

Your body produces colostrum the first few days after birth. Colostrum is the first kind of milk that moms have and comes in small amounts. Colostrum slowly transforms to transitional milk and then what we simply call milk at days 3-6 after birth. During the first day after birth your baby’s belly is only the size of a marble! This means her belly fills after just a half-teaspoon or maybe a teaspoon of colostrum at each feeding. On day two and day three your baby gradually takes more as her belly grows. During these days she may show signs of hunger more frequently, this does NOT mean you don’t have enough milk! However, this is often the time when moms use the ‘No Milk!’ phrase. Its important to know that this period of time is normal, and babies often want to feed a lot. On day 2 and day 3 most babies have periods of marathon and cluster feeding… especially at night. This means that she wants to breastfeed for an hour or two (or three!) at a time, or she wants to breastfeed for shorter durations every 45 minutes or every hour… again at night! This marathon and cluster feeding is a good thing, as it sets moms up for a good milk supply. However, just because it’s a good thing, doesn’t mean that it’s not challenging. During this period of time it is important for moms to take naps when your baby is sleeping during the day… sleep when baby sleeps!

On day 3 to day 4 your milk ‘comes-in’. I never liked this phrase, because it makes moms think that there is no milk before this process, which just isn’t the case. This is when moms develop what they know and think of as enough milk. By day 10 babies are taking about 2-4 ounces of breastmilk from the breast at each feeding. So what happens when real life occurs and your milk takes longer to come-in or does not every really come-in?

In the early days after birth low milk supply is most commonly from a prolonged period of time before initiation of breastfeeding after birth (this is especially true for moms whose babies had to go to the NICU, for preterm babies and for babies delivered by c-section). Large blood loss during or after delivery can cause a delay in milk production and low supply, so can long periods of time between feedings (again a real issue for moms with preterm babies, babies in NICU, and babies with Jaundice) and certain medications used during labor and after delivery and a previous breast surgery (especially breast reduction surgery). The last common reason for low supply in the early days is due to a shallow latch and poor milk transfer. So what can moms do to prevent a delay in milk production and low supply in the early days?

  1. Initiate breastfeeding within an hour after birth. Make sure you tell your nurse, midwife, birth doula and other support people that you desire your baby to initiate breastfeeding right after birth… skin to skin after promotes this! If you and your baby have to be separated after birth then it is important to start breast pumping within an hour. Have someone take a picture of your baby on their phone and then use that to look at while pumping (I know this sounds strange but it has been shown to help release milk-making hormones!).
  2. Breastfeed often and Hand Express your milk if your baby is sleepy. Lots of frequent breastfeeding in the early days promotes a good supply and will help your milk come-in. Breastfeed your baby on demand (whenever she shows signs she is hungry… hand to mouth motions, rooting). If you baby is sleepy, invite her to your breast and initiate breastfeeding every 3hrs. It is common for babies to be sleepy that first day; they make up for it at night on day 2 and day 3! Your baby may be sleepier if she is premature or has higher jaundice levels. If this is the case, wake your baby to breastfeed every 3 hours by placing her skin to skin for about 20-30minutes before each feed. If your baby is too sleepy to maintain about 15 minutes of active sucking, hand express both breasts for about 10 minutes. You can collect the expressed breastmilk in a spoon or cup and then give that to your baby after feedings. Click HERE for a link on hand expression. If you are separated from your baby make sure to pump both breasts every 3 hours, even through the night.
  3. Make sure your baby is latching deeply. The importance of deep latch cannot be stressed enough. Not only will a deep latch prevent nipple soreness, it will allow your baby to transfer more milk, giving your breast the stimulation they need to ramp milk production up. Signs of a deep latch include lots of breast tissue in the baby’s mouth (all of the nipple and all or almost all of the areola – the darker part of the breast); a comfortable tugging sensation, no pinching or biting feeling; short quick sucks for the first minute followed by longer drawing sucks; audible swallows; your baby’s cheeks touching the breast while your baby’s nose just lightly touches or does not touch the breast and a cute baby double chin. Call your Lactation Consultant for help if you are having trouble with deep latch or just want a latch check! Email The Nurses for more questions on deep latch at thenurses@rnbreastfeedingsupport.com.
  4. Hold off on the Pacifier. It can be tempting to give your baby a pacifier in the early days as she seems to want to nurse constantly. We encourage you to hold off until your baby is at least 4 weeks old. The frequent breastfeeding is a good thing for your baby and for you. If your baby is marathon feeding, try side-lying position!
  5. Check with your Provider or Lactation Consultant before taking extra medication. There are some medications (including many allergy medications) that can cause delayed milk production or decrease milk production. After birth moms have a huge inflammatory response that occurs in the body. Make sure to continue your Ibuprofen and prescribed medications as directed and check with your provider or lactation consultant before using others.
  6. Supplement at the breast if your baby needs it in the early days. There are medical reasons in which babies need supplement (formula or expressed breastmilk). These include high jaundice levels, low blood sugars, large weight loss and more. If your baby needs extra, ask your Nurse or Lactation Consultant to help you give the supplement at the breast. This way your baby can get the extra she needs while still breastfeeding. Other alternate ways to give supplement include finger feeding, paced bottle feeding and a supplemental nursing system. The Supplemental Nursing System made by Medela is easy to use, able to hold a good amount of milk or formula and washes easily. Click HERE to take a look! These and more will be discussed in the next few weeks in a blog dedicated just to alternative ways to give formula or expressed breast milk!
  7. Connect with a Lactation Consultant EARLY if you have increased risks for low supply. Along with the increased risk of low supply in the early days that were listed above. Other risk factors for low supply include a history of breast reduction or breast surgery, PCOS, diabetes, obesity and infertility problems. If you have any of these risk factors, or had issues with low supply with your first, make sure your Lactation Consultant or Nurse knows. It can be beneficial for moms with these risk factors to do some pumping after each feeding to help the milk supply develop. supplemental nursing system

This introduction to low supply touched on many concerns and topics that we think are important. Like I mentioned earlier, this really is a huge topic and a real struggle for many moms! We want moms to know that low supply does not mean the end of breastfeeding; neither does giving formula! We want to support you and your breastfeeding goals. A great website that we love for information and resources for low milk supply is lowmilksuppy.org. Click HERE to browse around their website. Check in later this week and next week for information on maintaining a good milk supply after established breastfeeding, breastfeeding with formula feeding and common reasons for low supply in the later days.

References:

Spencer J. Common problems of breastfeeding and weaning. http://www.uptodate.com/index.

Hale TW. Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. 15th ed. Amarillo, Texas: Hale Publishing L.P.; 2012:1.

Effect of progestin compared with combined oral contraceptive pills on lactation. Obstetrics & Gynecology. 2012;119:5.

Younger Meek J, et al. American Academy of Pediatrics New Mother’s Guide to Breastfeeding. 2nd ed. New York, N.Y.: Bantam Books; 2011:124.

O’Connor NR, et al. Pacifiers and breastfeeding. Archives of Pediatrics & Adolescent Medicine. 2009;163:378.

Lowdermilk, D, Perry, S., Casion, K., & Rhodes, K. (2012). Maternity and Women’s Health Care. (10thed.). St: Louis, MO: Elsevier Inc.

DISCLAIMER

Please be aware that this information provided is intended solely for general informational and educational purposes and is not intended to be substituted for professional medical advice. Always see the advice of your physician or medical provider for any questions you may have regarding your or your baby’s medical condition. Never disregard professional medical advice or delay seeking it because of something you have received from this website or blog

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