When baby’s fussy or wants to nurse just an hour after eating, it’s natural to worry that you’re not producing enough milk. However, these are normal behaviours and more often than not baby’s weight gain reassures everyone that things are going well. However, for some mothers the results of baby’s weight checks aren’t as encouraging and the amount of milk they are producing isn’t always enough to meet baby’s needs. Diana West, IBCLC (International Board-Certified Lactation Consultant) and co-author of Making More Milk says that changes in breastfeeding techniques or assistance from a breastfeeding expert can help boost milk production significantly.
Here are some of the most common causes of low milk production and some strategies that may help.
1. Insufficient glandular tissue
Some women’s breasts don’t develop normally (for various reasons) and may not have enough “milk-making” ducts to meet their baby’s needs. Ducts do grow during each pregnancy and breastfeeding stimulates the growth of more ducts and tissue, so this may be less of a problem with a second or third baby. There are certainly steps you can take to maximize your milk production (these might include pumping and taking a prescription medication–talk to your doctor and a breastfeeding expert) but you may also need to supplement with formula. It’s worth the effort to continuing breastfeeding, though, as even a small amount of your milk will help support your baby’s immune system, brain development and nutritional needs.
2. Hormonal or endocrine problems
Perhaps you have polycystic ovary syndrome (PCOS), a low or high thyroid, diabetes, hypertension (high blood pressure) or hormonal problems that made it difficult for you to conceive. Any of these issues may also contribute to low milk production because making milk relies on the hormonal signals being sent to the breasts. What can you do? In some cases, treatment of your health problem will help you to boost milk production, although supplementation may be needed. A visit to a breastfeeding clinic or lactation consultant can help you find an approach that will work with your specific condition.
3. Previous breast surgery
Breast surgeries can be done for both medical and cosmetic reasons. Breast reductions or enhancements, for example, are increasingly common. Nipple piercings can also be considered a kind of breast surgery and may damage milk ducts in the nipple. How much these surgeries affect breastfeeding varies widely, depending on how the procedure was done, how much time has passed between the surgery and the birth of the baby and whether there were any complications that might have caused scarring or damage to the breasts. Some women, especially those with breast enhancements rather than reductions, may be able to exclusively breastfeed without any difficulty. Others will need extra help and may have to supplement.
4. Using hormonal birth control
Many mothers who breastfeed and take birth control pills find their milk production doesn’t change, but for some, any form of hormonal birth control (the pill, patch or injections) can cause a significant drop in their milk. This is more likely to happen if you start using these contraceptives before your baby is four months old, but it can happen later as well. The first step to increasing your milk supply again is to stop the medication, but talk to your doctor before you do and be prepared to change birth control methods. Some mothers also need extra help (such as a prescription medication, herbal supplements and/or pumping) to boost milk production.
5. Taking certain medications or herbs
Pseudoephredine (the active ingredient in Sudafed and similar cold medications), methergine, bromocriptine or large amounts of sage, parsley or peppermint can affect your milk. If you find your supply has dropped and realize you have taken one of the medications listed here, ask your doctor about an alternative treatment for your cold or health ailment. Increased breastfeeding and possibly pumping will help you build up your milk production again.
6. Sucking difficulties or anatomical issues
The problem may lie with your little one; it may be difficult for him to get the milk from your breasts. He may, for example, have a tongue-tie. That means the thin membrane of tissue at the bottom of his mouth is holding the baby’s tongue too tightly, so that he’s not able to use it properly to extract the milk. (A baby doesn’t really suck the milk out of your breast, he uses his tongue to help compress the breast and push the milk into his mouth.) In many cases this is fairly easy to see, but for some babies the restricting membrane is at the back of the tongue and harder to identify. Check to see if your baby is able to stick his tongue out (over his bottom lip) and that he touches it to the roof of his mouth when crying. If your baby is tongue-tied, the membrane can be clipped by a doctor and the baby’s ability to breastfeed will improve quickly. Other problems can also cause sucking difficulties (such as cleft lip and cleft palate), so if you suspect your baby isn’t feeding well, check with an expert or your doctor.
7. Not feeding at night
There are many books and programs that offer sleep-training methods to get babies to sleep longer at night without waking for feedings. While these techniques can work for some families, the loss of those night feedings can mean problems with weight gain for some babies. Why? Mothers vary a lot in how much milk they are able to store in their breasts between feedings. With no feedings overnight, their milk supply starts to drop. The level of prolactin (the hormone that signals the breasts to make milk) is also higher during night feedings, so the lowered overall prolactin can also contribute to a drop in milk. It’s hard to resist the lure of more sleep, but for many mothers, those nightly feedings are essential to keep milk production high. If you have started sleep training and find your milk supply going down, consider reintroducing one or two night feedings.
8. Scheduling feedings and/or using a pacifier between feedings
Your breasts make milk continuously, but the rate at which milk is made depends on how empty they are. You’ll make more milk when your breasts are close to empty and less milk when they are already filled up. When your baby is feeding infrequently, because you have put him on a three- or four-hour schedule for example, or because you are giving him a pacifier to stretch out the time between feedings, your breasts are fuller for longer periods of time. That means milk production slows down. When babies are breastfed in response to their cues, they tend to have shorter, frequent feedings and this means the breasts are emptier most of the time and so they continue to produce plenty of milk.
9. Birth medications or jaundice
Mothers don’t always realize that medications used in labour, such as epidural anaesthetic or Demerol, can affect the baby’s ability to latch on and breastfeed effectively. Some studies show these effects last as long as a month, depending on the medication used in the epidural and the length of time the mother received it. Jaundice, a common condition in newborns, can also make your baby sleepier than usual, so that he doesn’t wake up to nurse as often as he would otherwise. In both cases, you may need to pump your milk to build up a good supply. Once your baby has cleared the medications from his system and the jaundice has been treated, he will probably begin nursing well and you’ll be able to reduce and eventually stop pumping.
Especially in the first couple of weeks, supplementing with formula tricks your breasts into producing less milk. “In the early weeks, the breasts’ capacity for milk production is calibrated in response to the amount of milk that is removed,” says lactation consultant Diana West. “If less milk is removed, the breasts assume that less milk is needed, so the capacity is set at a lower point.” When your baby is given formula supplements, she naturally eats less at the breast, and the breasts respond by making less milk. If supplementation is necessary, pumping as well as breastfeeding can help to promote a higher volume of milk production.
If your baby is showing signs of not getting enough milk, don’t throw away your nursing bra just yet. Talk to a La Leche League leader, lactation consultant or other breastfeeding expert who can help you figure out and treat the cause of your low milk supply.
When You Need to Supplement
If you’re not producing enough milk, you’ll need to give your baby some formula as well. Usually this is temporary, until your own milk supply increases or until your baby starts enough solid foods that the supplement isn’t needed. But too many mothers find that once they start giving formula they’ve take the first step on a path that leads to decreasing milk production and an early end to breastfeeding. But there are ways to successfully supplement and still keep breastfeeding. Try these approaches:
Consider supplementing at the breast with a feeding tube that has one end in a container of formula and the other slipped into the baby’s mouth as he breastfeeds. Some mothers will tape the tube to their breasts, while others slide it into the corner of the baby’s mouth as he nurses. This method ensures that the baby gets both formula and breast milk at the same time and he’s encouraged to keep breastfeeding.
If you are supplementing with a bottle, give the bottle first and breastfeed second. Put a bit less formula in the bottle than you expect the baby to take. By giving the bottle first, the baby isn’t frantically hungry when he comes to the breast and may be more willing to work at learning to breastfeed well. He also gets to experience having a full tummy while he’s at the breast, which gives him positive feelings about breastfeeding. Let him nurse as long as he wants.
When you give a bottle to supplement breastfeeding, take your time. Hold the baby in a semi-upright position (not lying on his back) and keep the bottle horizontal so that he has to work to suck the milk out. If he pauses or stops sucking, you can take the nipple out of his mouth to give him a little rest. This keeps the baby from expecting milk to just pour into his mouth (as it can with a fast-flowing bottle nipple when the bottle is held in a more vertical position), so he’s more willing to work at breastfeeding.
Encourage plenty of breastfeeding times that aren’t about food. If your baby gets fussy an hour or two after formula and nursing, offer the breast again. She might only nurse for a short time, but these brief but frequent feedings actually do a lot to encourage milk production and continued breastfeeding.
This article was originally published in October 2009.