By Alex MlynekUpdated Mar 12, 2019
Photo: @littlebirddoula via Instagram, www.motherhoodrising.com
By the time Alison Lee’s son, Dexter, was three days old, he had lost 13 percent of his birth weight, and Lee’s milk supply had gone down considerably. The culprit? A poor latch, caused by tongue and lip ties (where the piece of skin under the tongue or upper lip is tight), meant that Dexter was not able to get much milk when he nursed. “For those first three days he wasn’t nursing effectively and it signalled to my breasts: ‘Clearly, you don’t need me,’” explains Lee.
According to Michelle Branco, an international board–certified lactation consultant in Mississauga, Ont., Lee experienced a common cause of low milk production: the baby not emptying the breast when he’s drinking, which, along with frequent breastfeeding, is what tells your body to make more milk.
A less common (but definitely possible) reason for low supply is a medical issue like an endocrine condition, an untreated thyroid condition, or gestational or type 2 diabetes. Women who have had chest or breast surgery before giving birth can also be at risk for supply issues. More rarely, it’s to do with the way the breasts have developed: If they’re widely spaced or very uneven or if your nipples tend to hang down instead of pointing forward (called tubular breasts, hypoplasia or insufficient glandular tissue) you may have difficulty producing milk.
Not sure if you’re making enough milk? Look to your baby for clues, says Branco. If she’s not gaining weight (your doctor or midwife will check at each visit), not producing enough wet diapers (one on the first day of life, two on day two and so on; and then six or seven per day after five days), is not easily calmed down, and always needs to be pacified or swaddled to fall asleep, she may not be getting the milk she needs.
Sound familiar? Make sure she’s swallowing and not just sucking when she’s at your breast. Look for an open mouth, a pause and then a closed mouth when nursing. Also, make sure your baby is latching properly by trying different feeding positions, and have her checked for tongue or lip ties, suggests Branco. When you’re nursing, use hand compressions to help get your milk flowing, and if that doesn’t work to get your little one eating, switch to the other breast (and back again, if needed). If these tactics don’t help and you haven’t already reached out to a lactation consultant, now’s the time, says Branco.
A lactation consultant may suggest talking to your doctor about the drug domperidone, which can boost supply by increasing the hormone prolactin. Herbs like blessed thistle and fenugreek are another option, but before taking any supplements, consult with a naturopath or a lactation consultant who understands your health situation. Just because one herb did the trick for your best friend doesn’t mean it will work for you. “Everybody is different. One person might need a herb that helps with blood sugar regulation, and another person might need herbs for hormone regulation,” says Toronto naturopathic doctor Mahalia Freed.
And although some moms feel guilty about supplementing with formula or donated breastmilk, it might be the best way to nourish your newborn if your supply is truly low. When a baby is being fed well she will eat more, the breasts will produce more and the cycle will continue, explains Branco. A lactation consultant can help you create a plan for supplementation.
For Lee, the answer was supplementing with donated breastmilk, three trips to a paediatrician to get Dexter’s ties clipped (they sometimes reconnect when they heal), and blessed thistle, fenugreek and domperidone. By the time Dexter was four months old, Lee’s breasts had caught up to his needs and, at two years old, he is still happily nursing.
Expert Tip New moms often think their babies aren’t getting enough milk because they seem to be constantly nursing. But newborns are supposed to nurse a lot, says Michelle Branco, an international board–certified lactation consultant in Mississauga, Ont.—typically eight to 12 times in 24 hours for up to 45 minutes per feeding. Also, don’t fret about your milk production if you can’t get a lot when you pump. Your body won’t react to a machine the way it does to a soft, nice-smelling baby, notes Branco.