Milk supply is complicated. A mother’s body, breasts and her baby need to play their part.
The milk factory
It can help to think about the breasts as a milk factory, each part of the system needs to work well in order to make enough milk for your baby.
The controls of the milk factory are a woman’s hormones. Prolactin and oxytocin are crucial, and many more besides. A woman’s hormonal control can be affected if she has thyroid problems, pituitary issues, diabetes, polycystic ovaries or other conditions. Needing IVF can give us a clue that something hormonal might be happening, even if the cause of the infertility was not explained. Lactation consultants ask about these as part of a medical history.
A larger than average bleed (over 1L) at the time of the birth can often have a big impact on the pituitary gland and affect the amount of milk that the mother makes. Sometimes this is temporary but at other times permanent.
The milk factory itself, the breast tissue and nerves, needs to be working well for optimal milk production. Breast or spinal injuries, conditions or surgeries, even years ago, can have an impact on the complex collection of ducts, nerves and glandular tissue that are needed to make milk. A small number of women did not grow normal breasts in puberty and often do not have the tissue required to fully breastfeed a baby. Mothers in their 40s often report a lower supply than those in their 20s and 30s.
The milk factory’s feedback mechanism is supply and demand. Breasts need to be used frequently so that they “order” enough milk for the baby. If breastfeeding is not frequent – for example if mum and baby are separated, baby is not able to feed or feed effectively, baby is being fed on a strict routine, baby is only being offered one side per feed, or baby is offered formula, then the breasts make less milk. As the breasts fill up with milk, a chemical inhibiter stops more production so that they don’t carry on until they explode! If breasts are being left full the inhibitors are literally telling the body not to make more milk, so don’t believe the story that you need time for breasts to “fill up” between feeds.
When babies are growing they go through periods of feeding much more than normal – this is nature’s way of boosting milk supply for them. Genius. Offering formula at this point would stop the “more milk needed” message getting through and the breasts would not catch up.
It appears that breast milk production is most sensitive in the early days after birth, and in the first few weeks. After this, the body gets into the swing of things. Sometimes a lack of effective breastfeeding or expressing in the early days can have a permanent impact on milk supply for that child. It seems that some women’s supply is more sensitive than others, it is an under-researched area. If this applies to you then I am so sorry, please consider calling me or another professional to talk it through.
Some medicines and substances such as nicotine, certain foods, a restricted or low calorie diet can reduce milk supply. Ironically, drinking far too much water can reduce supply too – just drink to thirst rather than way beyond it.
Can baby take the milk?
If we are sure that there is milk there for the baby to drink, we need to think about whether baby can feed well at the breast.
Is your baby swallowing milk? Babies love sucking, so we need to watch to make sure that they are swallowing too. When they swallow their jaw drops and there is a little pause, and they make a tiny huff from their nose. You might even hear them gulp.
A tiny, premature, unwell or jaundiced baby, might not have the capacity or energy to breastfeed effectively for a while. For these little ones there is little point them spending energy and getting upset repeatedly trying to latch if they can’t do it. They need expressed or formula milk from a bottle, nursing system or cup until they are big and strong and well enough to feed directly at the breast. You can protect your milk supply by expressing milk frequently. Click here for more information.
If you can, give these babies lots of cuddles skin to skin and take the feeding pressure off you both. Relaxing back with your little one on your chest is a much kinder way to get feeding started than lots of hands pushing baby onto the nipple.
It is possible that a baby is healthy but unable to get milk from the breast because of problems with achieving a comfortable or effective latch. There is more information on a good latch here.
A good latch should not cause the mum pain or nipple damage. If your baby has a latch without much breast in their mouth, or they are tugging the nipple away from where it belongs, they will not be well fed. Laid back feeding positions help in a lot of cases, as can “nipple sandwich” shaping techniques for flatter nipples and sometimes nipple shields. Long term use of shields is also implicated in low supply, so use watchfully. Please contact me or another lactation professional to help to achieve the best possible latch for your baby.
Some babies have birth injuries or physical problems that make it harder for them to feed. Some, like instrumental birth bruises or sore necks, will go with time. Others need more investigation. Tongue-tied babies can face challenges with breastfeeding, and may need to be properly assessed by a specialist practitioner (see www.tongue-tie.org.uk). If you are worried that your baby is not doing well, please seek specialist support.
For information on how to boost milk supply, please click here.
Many new mothers tell me that they feel like a “failure” if they cannot breastfeed or exclusively breastfeed their baby. Nothing could be further from the truth! There are so many reasons why breastfeeding might not work out, the majority of which are not fully in the control of the mother. Many mothers do not receive the support or accurate information that they need. Some women fret about decisions they made in the past that are affecting milk supply now. Let’s turn this around. Any breastmilk that you give to your baby is to be celebrated. You and your baby are forming an ongoing loving relationship that has little to do with the way they get their milk.
You might encourage your friends and family to read the open letter I have written to them (click here). It contains some helpful hints on how they can best support you if you are working with low supply.
Be kind to yourself and enjoy this incredible journey.