Low Milk Supply

One of the leading causes of early breastfeeding cessation in the UK is due to true or perceived low milk supply.

It is estimated that less than 2% of the population have anatomical or hormonal imbalances that leave them unable to produce milk any milk to feed their babies. Usually this is connected with medical complexities to the pituitary gland or physical glandular tissue anomalies in the the breast.

There are however many other medical complexities that can cause true low milk supply along side many impacts from birth, breastfeeding issues, incorrect information and resources which can leave new mothers with less milk than is required to feed their babies without plans in place to help boost milk production.

The main underlying health conditions that are linked to putting some women at risk of lower milk supply are women with:

• Thyroid conditions

• PCOS

• Breast surgeries

• Previous breast cancer or cancer treatment

• Severe anemia (low iron levels)

• Insufficient Glandular Tissue of the breast/under development of breasts in puberty

• IVF pregnancy

• Gestational Diabetes

• Certain medications

Firstly, it is always recommended to talk to a breastfeeding specialist in pregnancy if you have one of these conditions who will help you to make a plan to establish your milk supply early, and navigate any potential issues in the early days to ensure there are no additional factors set against your milk supply.

It is worth noting that many women with the above complexities go on to breastfeed without concern and have plenty of milk however it is always worth ensuring support is available.

Secondly, birth and circumstances can interfere by delaying the change over from colostrum to milk in the first week postpartum. Ideally, in an uncomplicated birth where breastfeeding has gone smoothly women can expect their breasts to feel tender, firm and notice a change in the volume of milk production between the 2nd and 3rd day post birth. This corresponds to normal weigh loss/gain of the baby, increasing wet and dirty nappies and a transition of stools from meconium to soft yellow consistencies. However, many birth interventions such as the oxytocin hormone drip for inducing birth, long medicalised labour, opiates or anaesthetics, cesarean section or birth in theatre, haemorrhage after birth is known to delay milk production between 24-72 hours or longer in some cases.

Aside from birth complexities premature births, sleepy babies, jaundiced babies, babies with suspected growth restrictions, babies not achieving a deep latch in the early days, early supplementation with formula, tongue ties and feed scheduling can lead to the breasts having reduced stimulation and drainage resulting in less hormonal stimulation thus reduced milk supply levels.

Some medications and supplementations are known to reduce milk supply. Most commonly known is the active ingredient in cold/flu medications (Pseudoephedrine) which has been shown in studies to reduce milk supply by up to 25% in a 24 hour period. Other medications which impact on endocrine function or thyroid function are likely to have a knock on impact on milk supply too - do reach out if you have any specific questions on prescribed medications in pregnancy or after birth.

Finally, it is known that low maternal mood and stress can have an inhibitory effect on the oxytocin hormone that “lets down” breast milk from the milk making cells (lactocytes) into the ducts to the nipple. Research shows that women with postnatal anxiety or depression are more likely to see lower levels of milk supply. However, it is well documented that breastfeeding journeys being met can be an important protective factor in improving postnatal mental health and therefore skilled support should be offered to anyone with mood related disorders to achieve intended breastfeeding goals and combat any potential low milk supply concerns early on.

So, how can all of these risk factors be overcome?

Pre conceptual planning and good quality antenatal care is important to ensure any deficiencies in iron or hormones are discussed. Women with low thyroid levels should have regular blood tests both in pregnancy and after the birth to ensure their dose is keeping their levels stable. Any woman with a suspected low milk supply should have a blood test requested to ensure no Thyroid inconsistencies.

Early stimulation of the breasts should be commenced for all women who fit any of the risk factors for either an initial delay in milk or an ‘at risk’ baby where feeding and latch are not well established in the first 24 hours.

Breastfeeding support should be offered to achieve a deep latch first and foremost. Feeding with a shallow latch (directly latching onto the nipple rather than a wider mouth with breast tissue rather than just nipple) should prevented where possible and a deep be taught. This is both to the benefit of mother, baby and milk supply. Mothers should be supported to independently latch themselves and delatch if signs of discomfort.

If baby is not latching within the first hours of birth, hand expressing should be commenced to stimulate the prolactin and oxytocin hormones needed for milk production and release.

This should ideally be done 8x in the first 24 hours to ensure increasing levels of colostrum are fed to the baby (either by syringe/finger feeding/cup) but most importantly to give milk supply a boost and prevent a delay. Once colostrum levels are increasing or colostrum is easily hand expressed a pump should be introduced if baby is still not latching.

Often babies that are sleepy post birth are reluctant to feed. It takes time and perseverence to await them latching. But the more colotrum they receive the more eager they will be to feed eventually.

Unrestricted skin to skin access is imperative for both mothers hormones and babies eagerness to feed, temperature control and easy access to the breast. This is to be encouraged straight from birth and as much as possible over the coming days and weeks.

Once baby is latching breast compressions and switch nursing are usually beneficial if there are significant risk factors to the milk supply - it is always useful getting skilled breastfeeding support at this point to ensure good milk transfer (baby swallowing regularly).

There is good evidence to suggest that early use of breast pumps on stimulatory settings alongside hand expressing can increase breast milk volume in the long term. Caution should be taken to this approach if no risk factors to milk supply and if feeding is going well, as it could lead to future issues with oversupply (over production of breast milk).

Nipple sheilds should be used with caution in the early days, often these are given to help a baby latch but skipping many of the other support methods meaning reduced milk transfer at the breast and ultimately can lead to a low milk supply if appropriate measures are not put in place to support both mum and baby.

What if milk supply is low in the longer term?

Seeking skilled support at this stage is so important. An IBCLC will help to establish if there is a true low milk supply or if there is another explanation.

Often self doubt can creep in when it comes to milk supply when a pump is introduced and pumping volumes are significantly less than expected. Many women don’t hormonally “let down” their milk to a breast pump and get much less milk than a baby would when latching deeply at the breast. Breast pumps themselves vary dramatically and there is a huge range on the market with many claiming to be ‘hospital grade’ which is an unregulated term. Pumps that are poorly fitting can often have a reduced vaccum at the breast and ensuring the cycle speed of the pump is correct to both stimulate a let down and then draw out the milk as per a baby feeding is important.

Use of bottles can also be a confidence hit to a breastfeeding mother, it can be anxiety inducing when a baby takes a whole bottle of expressed milk or formula directly after a breastfeed and can cause a lot of self doubt about milk supply. Then a vicious cycle can occur when bottles are felt to be required thus reducing future stimulation and drainage of the breast which in turn truly does lower milk supply. A careful balance should be had when introducing bottles too early to a breastfed baby, it is always recommending latch is established and there is a confidence in milk supply before introducing supplementary feeds unless doing so under skilled support to balance milk supply.

If a pumping scheme is required to boost milk supply (alongside working on latch, breast compressions and switch nursing) an IBCLC/breastfeeding specialist will help fit the pump to you, measure flange sizes, teach pumping techniques and create a bespoke plan with a follow up of how to tailor the plan according to increase in milk supply.

On some occasions if pumping alone is not working there may be a discussion about taking a galactogogue (a medication to help boost prolactin levels) which may help to boost your milk supply but this is usually if seeing no improvement from all other interventions and after a careful discussion around risk of this method and future planning.

Please do get in touch if there are any milk supply concerns to discuss in pregnancy, for a past breastfeeding journey or currently. I’d be happy to help.