The Struggle is Real: Low Milk Supply in the Later Days

slide_438772_5774040_freeThe Struggle is Real: Part 2 … Low Milk Supply in The Later Days

Last week the important topic of low milk supply was introduced. We wanted to emphasize something that we mentioned throughout last week’s blog; breastfeeding does not need to stop because of low milk supply! Even if you need to supplement with formula or donor breast milk, breastfeeding can and should continue! We want to state this clearly because low milk supply is still the number one reason moms stop breastfeeding. Moms, we support you and want you to know that just because you need to give formula due to low supply, it does not mean that breastfeeding is over. Ok, I think that’s clearer.  In our blog next week we will talk about combination feeding (formula, bottle and breastfeeding) with low supply. But, before we go there, let’s talk about causes for low milk supply in the later days.

Low milk supply in the early days is often from a prolonged period of time before initiation of breastfeeding after birth, large blood loss during or after delivery, long periods of time between feedings, certain medications used during labor and after delivery, and shallow latch with poor milk transfer.

So, what causes low milk supply in the later days? After weeks or months of breastfeeding, what causes a drop? This happens to many moms and can be due to a number of different things including external and internal factors. Common reasons for low supply in the later days include a change in routine (like going back to work), transition to pumping, using hormonal birth control, lack of nighttime feedings, maternal medical problems, and more.

A change in routine, such as returning to work causes a drop in supply for many moms. Ok, lets be real, it’s HARD to pump at work. This means that many moms are not pumping as frequently as they would be breastfeeding, and this can have an effect on supply. Milk supply is driven by how much milk is emptied. So, if moms change their routine, like returning to work, its important to pump frequently – every 3 to 4hrs for at least 15 minutes. Additionally, increased stress can cause low supply. Returning to work can be, no, IS stressful. So, make sure that you have a safe, quiet place to pump at work. Employers in the United States are required to give “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk” according to the Department of Labor (DOL). Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk” according to the DOL. Also, we have to be honest with you, the pump does not empty the breast as well as your baby does! If you experience a drop in supply after returning to work, or introducing pumping in-place or instead of breastfeeding, we suggest adding a few more pumpings during the day (if possible) or add a few pumpings after breastfeeding when you are back at home. Get more milk from pumping by doing hands on pumping- you can get 50% more pumped milk this way! Click HERE to see a video on hands on pumping! Women in the Wild

Using hormonal birth control can also decrease milk supply as it effects milk making hormones. Birth control with estrogen has been linked to low milk supply. Medications and Mothers Milk (the gold standard medication resource in the lactation world!) states that “Mothers who have problems with milk production and those who are breastfeeding an older child (one year old or more) should be especially cautious” of these types of contraceptive. If you are planning on using a hormonal birth control method, the preferred is progesterone-only. There are other types of non-hormonal contraceptives; talk with your provider to choose the best one for you and your family.

Lack of nighttime feedings can also cause a drop in supply. Although it can be challenging, night feedings help moms maintain a milk supply, especially in the first 4 months. Moms’ prolactin levels (milk making hormone levels) are higher at night, therefore, if the breasts are emptied of milk at night it stimulates the breasts to maintain a greater supply. Now, as babies grow and get older they will sleep longer throughout the night-this is a good and natural thing!  So, to avoid a drop in supply, continue to breastfeed on demand. This means that if baby wakes during the night, make sure to breastfeed and avoid bottle feeding during nighttime hours.

Maternal problems can also cause low supply issues. These problems include maternal diabetes, mammary hypoplasia (insufficient glandular tissue) and PCOS (Polycystic Ovarian Syndrome). These problems effect the amount of milk making hormones that are produced as well as the ability for the body to make milk. If you have one of these medical problems it’s important to contact your lactation consultant or provider early. This way, you and your baby can be monitored closely for possible low supply. In order to maximize your milk supply it’s important to breastfeed often and on demand. Sometimes moms like to pump after breastfeeding if they have these medical problems or increased risks for low supply. Pumping after breastfeeding increases the stimulation to the breasts to make more milk and can help increase supply. Galactogogues are substances that promote lactation and can be used to help increase supply. These include medications, herbs, and foods that will be discussed in the next few weeks as we continue this important topic of low supply.

Low supply in the later days can be caused by all of the events mentioned above and more. If you have low supply, don’t loose hope! Breastfeeding can and should continue with low supply, even with supplementation! If you experience a drop in your supply follow the above tips or email The Nurses for more information.

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.

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

USDOL. (2015). Wage and Hour Divisions. Retrieved from http://www.dol.gov/whd/nursingmothers/faqBTNM.htm

Images: Thanks for Erin White Photography and Megan Flanagan for the incredible pictures that were featured in ‘Women in The Wild’. These images were ones that were featured in the Huffpost Parents article. http://www.huffingtonpost.com/2015/07/10/breastfeeding-outside-erin-white_n_7756514.html

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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