Breast Milk Undersupply
Not everyone who breastfeeds will always have enough breast milk to feed their baby. This is called an undersupply. How can you tell that you might have an issue with low milk supply? About 3-4 days after your baby is born, your baby should come to the breast ranging from 8-12 times in a twenty-four-hour period. Your baby should stay latched for about 15-20 minutes on each breast. Your baby should appear content after the feeds. Your baby's body should be relaxed, frequently referred to as “milk drunk” and your baby should not want to come to the breast every hour on the hour all day long. A well fed baby should not be crying constantly or appear to be frustrated after coming off your breast. You may also notice your baby showing some signs of dehydration. If you are concerned about undersupply there are several steps that can be taken at any point during your lactation journey to try and increase, maintain or supplement your milk production.
The science behind milk supply:
Understanding how and why your body makes milk can also help you understand ways to change your milk supply. Your body works in what is called a positive feedback loop between your breast and brain. Stimulation to the nipple from a baby suckling or pump use or even during intimate moments, sends a signal to your brain through nerves. The signal stimulates your brain(pituitary gland) to release two very important hormones: Oxytocin and Prolactin.
Oxytocin enters your blood and when it reaches your breast, the oxytocin causes tiny little muscles around milk ducts to squeeze and release milk that has been stored there. This is called the milk let-down reflex. At the same time, prolactin has been released as well into your blood and when it reaches your breast, it signals to the milk production centers to start producing more milk that will be stored for the next feeding. The emptier the milk ducts get and the more frequently they are emptied, the more prolactin your brain is told to release. In this way, what happens at your breast during each feeding tells your body what to expect for the next feeding.
Fun fact: Oxytocin, also called the love hormone, can be triggered to release from your brain by many factors. Although not as consistent as nipple stimulation, psychological factors like emotions, mood, food, scent, and even social signals can also trigger the hormone. This explains that unexpected and sometimes embarrassing let-down with the sound of a baby cry or certain smells, or stress, etc. This response extinguishes for most as their babies get older and their body regulates.
Undersupply direct breastfeeding
Breastfeeding supply is as much about the mother infant dyad as it is about what is happening in mom’s body alone. Here are some of the most common hurdles that may be impacting your supply while direct breastfeeding.
1) Latching issues can cause incomplete breast emptying leading to a weaker milk production signaling to the brain.
2) Tongue or lip tethers can affect latching as well, leading to incomplete breast emptying and weaker milk production signaling to the brain.
3) Postpartum hemorrhage can be a risk factor in low milk supply. When there is significant enough blood loss, inadequate blood supply to the pituitary gland can decrease or delay production of prolactin leading to lower milk production.
4) Incomplete expulsion of the placenta is also another risk factor for low milk supply. Your placenta contains hormones (progesterone and estrogen) that block the action of prolactin, the milk making hormone. In this way, even a tiny bit left in the uterus can suppress milk production and cause low supply. This is why certified lactation consultants discourage consumption of placenta after delivery.
Fun Fact: Inadequate hydration or inadequate calories have not been shown to have an impact on supply. The research shows that humans make adequate milk even when mothers are suffering from starvation.
We focus fully on trying to figure out what is causing the body to not make milk or what is causing the baby to be unable to get the milk that’s there. During the consultation, we gather information to determine if the culprit is mother, baby, or both. There are some maternal issues related to thyroid levels, prolactin levels, etc that can impact supply. These issues are rare and should be addressed with a breastfeeding medicine doctor and with an IBCLC.
Undersupply pumping
A successful pumping experience is as much about your body as it is about the machinery. Here are some of the more common issues encountered leading to undersupply when pumping.
1) Check to make sure the pump is working properly. We know this is the lactation equivalent of did you unplug it and plug it back in! Most of the commercial breast pump companies have customer service numbers you can call to help determine if your pump is working properly. This is something to consider when purchasing a breast pump and we recommend researching not just the pump, but also the pump companies and selecting to purchase pumps from companies with robust customer service options (e.g. Willow and Elvie brands are great for this).
2) Check your flange size at home. Spectra has a great print out for this. https://www.spectrababyusa.com/wp-content/uploads/2022/04/Spectra-Baby-USA-Flange-Guide-2022-copy.pdf
3) Don’t skip overnight feeding or pumping sessions. People want to sleep at night (understandably) but prolactin levels are highest at night. Unless your baby is sleeping through the night, mama should be emptying her breast at night. That being said, breastfeeding doesn't have to be all or nothing. If lack of sleep is increasing symptoms of depression or anxiety for you, work with your lactation consultant to find a care plan that protects your mental health and your milk supply.
4) Your body takes time to respond to your call for milk. If you increase your pumping or feeding sessions, your body won’t immediately respond to your call for milk. Give 24-48 hours for your body to respond and don’t get discouraged while pumping.
Supplements
After correcting any mechanical issues, your consultant may recommend a supplement to help increase your milk supply. These are called Galactagogues. Galactagogues are herbal supplements that have been shown to increase milk supply in many ways, one of which is increasing prolactin production. You have likely heard of lactation cookies, mothers milk teas and other types of supplements. You will want to look at the nutritional value of those types of supplements. You’ll also want to be aware that you are getting enough of the supplement that’s part of the tea or cookie so that you are using enough to increase your supply. It’s important that before you start taking any food or herbal supplement to increase your supply that you work with your medical providers as some galactagogues may be contraindicated with certain medical conditions.
Fenugreek, blessed thistle, fennel and alfalfa possess phytoestrogens. It is believed that phytoestrogens may mimic how your body’s estrogen causes production and release of prolactin. These can be added to shakes, teas or other foods to make them easier to ingest.
Oats are an easily accessible whole grain also thought to increase milk supply although this has not been consistently supported by research. It is believed that oats help to correct maternal iron levels which have been shown to have correlation between low milk supply.
Fun fact: Although difficult, it is possible over several months to induce lactation in a person without pregnancy. This is usually accomplished with the help of galactagogues and nipple/breast stimulation. In this way many types of parents can enjoy the bond of breastfeeding with their non-birthed child.
Your milk supply or lack thereof is very time sensitive but as long as you are committed to your journey, it's never too late to try to increase it, with best results if your little one is under 4 months old. Once you realize that you have any undersupply concerns, don’t wait to start working with your chosen provider so that you can quickly get back on track with a plan that works for you and your baby.
Written by: Kiana Ayers IBCLC and Dr. Farida Kwaji
Uwa Postnatal Care
