Breastfeeding Problems: Milk Supply

I am not a lactation consultant.  One day I will get around to doing that course.  But I have advised many mums with low milk supply through my work as a nurse and have had to boost my own on occasions, having successfully

breastfed twins and currently feeding my 3rd baby.

Fluctuations in milk supply are perfectly normal.  It's a supply and demand thing.  When your milk first comes in, you may have too much and feel engorged, or you may need to work at building the supply.  After a few weeks the supply will settle and you will provide your baby with just the right amount.  Your body will get used to the amount being demanded by the baby and supply to meet this demand.  Give yourself time though.  When baby has a growth spurt, he may demand more frequently, suck for longer and hence build your supply himself.  It usually takes between 2-5 days of this for the supply to re-stablise.

Is your baby getting enough?

This is one of the most common questions and most stressful aspect of breastfeeding a baby (or 2).  We can look at both mum and baby to help answer this question.  Most of the time we worry without cause because baby is getting more than we realize.

Assessment of mum

~ Are the breasts firm prior to feeding and soft post feeding?  Even if the breasts feel soft before feeding, as the letdown occurs, the breasts may fill and feel firm during the feed.  I had a problem where, in the first few weeks after my 3rd was born I had A LOT of milk and felt engorged all the time.  When my supply settled I felt like I didn’t have enough because of this, but my baby was still doing well and it wasn’t something I needed to be concerned about- Just different to what I had experienced up until that point.

~ Can you feel the letdown reflex?  You should be able to feel the breasts fill once baby starts sucking.  This may take anywhere from a few seconds to a few minutes.  Breasts may feel hard, slightly uncomfortable, tingly (other sensations have also been described) and if the baby comes off, milk will spray at this point in the feed.  You may feel thirsty during a feed.

Assessment of baby

~ During a feed- baby should be relaxed, settle into a rhythmic suck swallow pattern with some pauses and you should be able to hear or see baby swallowing milk (watch the jaw and ear movements).

~ Does baby still look hungry after feeds?- If your baby is still mouthing, tongue thrusting, lip smacking, finger sucking, turning head from side to side as if searching for a feed or responding to the rooting reflex (stroke the cheek and baby’s head will turn towards it and open his mouth), then baby may still be hungry.

~ How does baby act at the end of a feed?- If your baby is still sucking ravenously at the end of a feed, then baby may not be ready to stop feeding.  Signs of being full include “suck suck pauuussse” rhythm, getting sleepy or falling asleep, pulling away from the breast.

~ Is the baby settled in between feeds?- If baby is able to have some content play time and a sleep in between feeds then he is probably getting enough.  If baby is irritable and difficult to settle between feeds, he may not be satisfied yet, of there may be some other issue, such as reflux, colic, wind or illness.

~ How often is baby demanding feeds?-  babies wanting to increase your supply may feed 2 hourly- let them.  Once the supply has settled it may be 3-5 hourly feeds, depending on the age of the baby and the time of day/night.  A baby that wants to feed every 2 hours for over a week is not only exhausting (which can also decrease your supply) but also indicates baby is not getting enough.  Even if its only for a few days- stretch out to 4 hourly feeds with bottle top ups so that you body can rest and recover and better produce milk.

~Weight gain: After the initial post birth weight loss, a healthy baby should be gaining around 30 grams per day.  This in itself fluctuates so don’t be too concerned if your baby is not gaining 30g per day every day.  Longer term weight gain is better for assessing the level of thriving in a baby.  Get a growth chart and plot baby’s weight.  The weight should stay within 2 percentile lines of the birth weigh- eg, if baby was born in the 25th percentile, then the weight should stay somewhere between the 5th and 75th percentile.  Major deviations off this weight percentile may indicate a problem.

~Tests weighs: This is a little trick we do at work to monitor failure to thrive babies.  You may do this yourself as reassurance as a one off but is intended to be used over a longer period of time.  Take your baby to a child health centre with baby scales available for use.  Weigh your baby- there is no need to remove clothing, feed your baby then weigh your baby again with the same clothing on.  The difference in between the post feed weight and the pre feed weight is approximately how much you child has drunk form you.

~ Healthy well hydrated looking baby:  If your baby looks healthy and well hydrated then you are doing a grand job at feeding him.  If you baby is not very responsive or drowsy, has sunken and dark looking eyes, sunken fontanelle, dry mouth and sticky saliva, has very few wet nappies, has problems with constipation, poor skin elasticity or just doesn’t look well: seek medical assistance.

First line treatments of low milk supply

~ ATTACHMENT: This starts in the hospital with lessons on good attachment.  Do not leave the hospital unless you are confident that your baby is attaching to the breast properly.  Each midwife has their own little something to offer when it comes to breastfeeding education.  So my main tip here is to ask for attachment advice with EVERY midwife that cares for you in the post natal ward.  What one midwife might not teach you, another will.  Baby should have a wide open mouth with flared lips, chin, cheeks and nose touching the breast.

~ FREE YOUR DUCTS: Just when you thought it was safe (and comfortable) to lay on you belly to sleep again- don’t!  When there is problems with supply, the last thing you want to do is put pressure on you breasts such as when you are sleeping on your stomach.  This has the same effect as binding (sometimes used to stop supply).  The same goes for your bras- make sure they are not too tight.

~ PUMP IT: After every feed, for a few days, express for 10 minutes after baby has fed.  You may choose to offer some expressed milk or formula from a bottle after a breastfeed (top up/comp bottle) if baby seems to be hungry still.  The extra stimulation of the milk ducts after a feed will help to remind them that their work is not yet done, and more is demanded of them, but your baby still gets fed in the meantime.  At first you may not get anything, but as the days go by and the pumped volume increases, it’s reassuring to you to see that your supply is actually improving.

~ RE-OFFER: This tip was given to me by a wonderful midwife during a home visit when I was concerned about my supply- Once you have finished feeding on both breasts, put the baby back onto the 1st offered breast.  A small second letdown may occur, promoting an increase in supply and avoiding the need for a top up bottle.

~ WHAT GOES OUT MUST GO IN FIRST: If you are dehydrated or lacking in nutrition your supply will dwindle.  You cannot make food and fluid for your baby if there is not enough in you to make it.  I had one day of not drinking enough in the early weeks, and had to spend the next 3 days trying to increase my supply.  Always take a bottle of water with you wherever you go.  Aim for 2-3 litres per day (if your baby is drinking 150mls 8 times per day, that’s 1200mls for baby, and your body still requires 2L to function properly on top of that).

~ REST: I know it’s hard, especially if you have more than one child, but producing milk takes a lot of calories, and if you are spending those calories on running around like a chook with its head chopped off, then there wont be much left over to make milk for your baby.

~ RELAX INTO THE FEED:  Find a comfortable chair……use a pillow……support your arms and back……. Relax your neck and shoulder muscles……..be conscious of relaxing your body………and when baby is attached and sucking, take a deep breath……….on exhalation imagine a strong flow of milk and let go of any tension.

Next step: GET HELP.  If you still think that your baby is not getting enough milk and your own attempts have not been successful, don’t give up, get help.  You have many options- community midwife, GP, lactation consultant, parenting helpline, Child and Youth Health (or similar service), local women’s and babies hospital, birthing centre, residential admission services such as Karitane or Torrens House.  To make my feeding successful I have used the services of home care midwives and had a day at ‘Child and Youth Health’ to help me with my twins feeding routine.  There is no shame in asking for help.

Parent helpline (Australia): 1300 364 100

Child and Youth Health appointments (Australia) 1300 733 606

Possible drug treatments.

If all of the above has not worked, then there is still no need to give up hope.  Mum’s may be prescribed Domperidone or Metoclopramide (Maxalon) (anti nausea/vomiting drugs) to help increase supply.  I believe there are other drug treatments available outside Australia as well.  There are some articles on Minti about Fenugreek and this may be effective in increasing supply but its use is over the counter, not monitored by a dr and still may have side effects, so research first. www.minti.com/parenting-advice/7016/The-Risks-of-Fenugreek/ (My article was inspired by Arna's as linked here.  Hopefully to compliment some things she was saying).

Congratulations on breastfeeding!!  I hope this helps.