Signs and Causes of Low Milk Supply | Tips to Increase Supply

Many mothers look forward to developing a close bond with their baby and breastfeeding is a great way to strengthen this bond. However, as with many things in life, breastfeeding can come with its own challenges. One difficulty some mothers may experience is a low milk supply which can occur due to a multitude of reasons. Since it can be difficult to figure out the exact amount of milk that your breastfed baby eats, I will discuss what exactly causes a low supply and how you can tell if your baby is getting enough milk. I will also go through some ways to help maintain a good supply of breast milk for their baby.

Possible Causes of a Low Milk Supply

So what are signs and possible causes of low milk supply? Some factors that reduce a breastfeeding mother’s milk supply include the following:

Damaged milk ducts due to previous breast surgery
Feeding problems like latch difficulties, improper breastfeeding positions or tongue/ lip tie
Supplementation after breastfeeding (donor breast milk or formula feeding)
Use of oral contraceptives
Use of nipple shields or pacifier
Scheduled feedings or cutting them short
Baby is too sleepy to feed
Smoking or alcohol intake
Medications
Mothers health condition
Complications post C-section

With a low milk supply, your baby may start to show signs that he is not getting enough milk. These include:

Poor weight gain
Reduced or insufficient urine and stool output

Can you relate to any of these factors? If so it’s important to seek professional advice from your caregiver or a lactation consultant. They will be able to advise you how to get your milk supply back to sufficient levels for your baby. If for medical reasons you are unable to increase your supply there is also the option to breastfeed your baby while supplementing with formula milk. For a clearer insight, let us first take a closer look at the mechanism of milk production and how a mother’s body delivers breast milk to her baby.

Breastfeeding and Milk Production

Did you know that your breasts start to prepare for milk production early in pregnancy? Milk is right there by the time you gave birth to your baby, even if you delivered prematurely.

For the first few days after giving birth, you will see that breast milk is a yellowish fluid and thick in consistency. This milk is known as colostrum. Colostrum is like a preparatory milk that is rich in antibodies and proteins to help protect your newborn baby from illnesses. It is more concentrated, and its small amount is just enough to meet the needs of your newborn. The slow flow of colostrum allows ample time for your baby to learn how to breastfeed which involves coordination of sucking, breathing and swallowing. It’s important for new moms to take note that the small quantity of colostrum is normal and it doesn’t mean that you have a low milk supply.

At around day 3 to 4, colostrum will have mostly disappeared. Your body will start to produce transitional and then mature breast milk. You may feel your breasts getting firmer and becoming more engorged with milk. Colostrum will gradually be replaced by a thinner, bluish-white mature milk. If you haven’t got it yet, don’t worry! You’re not alone. Some mothers have it later than the usual. Just make sure you mention it to your health care provider to check if your baby is feeding well.

Frequent breastfeeding is advised to ensure your body will produce more milk. This is also known as supply and demand. As your baby suckles at the breast, she stimulates the nerves that are present in your nipples. This stimulation sends a signal to the brain for an increase in the production of milk. The brain will tell your body to produce the hormones prolactin and oxytocin. The increase in prolactin will tell your milk-making cells to produce more milk. Oxytocin is responsible for the let-down reflex. This is where the body enables the release of milk to become more readily available to your baby. To conclude, the more frequently you nurse, the more milk your body will make.

How do I know if my baby is getting enough milk?

With frequent and effective breastfeeding, most moms will normally have a good supply of milk for their baby. However, there are also some mothers who will have a low milk supply for a variety of reasons.

Particularly as a first-time mom it can be difficult to know whether your baby is getting enough breast milk. Some mothers may perceive that they are not producing enough and this is one of the primary reasons why some mothers quit breastfeeding even before their milk comes in.

If you have doubts regarding your milk supply, the American Pregnancy Association suggest that you look for these signs to see that your baby is getting enough milk while you are breastfeeding:

Baby’s cheeks appear full while feeding.
Baby may fall asleep or release from your breast on his own.
Baby appears happy and contented after nursing.
You can see and hear that your baby is swallowing while nursing.
You may feel sleepy after breastfeeding.
Your breasts will feel softer after nursing your baby.

Sometimes, babies can behave in a way that might appear they are hungry and not satisfied with the breast milk they are receiving. It’s important to note that there are some behaviors which may have nothing to do with your milk supply. Some examples are:

Baby is fussy (may be due to a lot more reasons)
Baby wants to nurse often (every 1.5 to 2 hours is normal for breastfed babies)
Baby is increasing his frequency of nursing (may be attributed to a growth spurt)
Breasts don’t leak with milk (nothing to do with milk supply)
Breasts feel softer (normally happens once a full supply is established)

Signs of Low Milk Supply

Low milk supply means your baby is not getting enough milk. The two primary indicators that your baby is not receiving an adequate milk supply include poor weight gain and insufficient urine and stool output.

Poor weight gain

If you are not producing enough breast milk, your baby’s weight and overall growth can be compromised. Baby’s weight gain is the most reliable indicator if there is a problem with your milk supply. Here are some important considerations to take note of:

According to the American Academy of Pediatrics, most babies will lose around 1/10^th of their birth weight during the first 5 days of life. This weight loss is attributed to excess fluids in their body before birth. This weight loss will be typically regained over the next five days to one week.
After regaining their birth weight, newborns will typically have an average weight gain of 20 to 30 grams per day.
There can be many reasons why your baby is not gaining enough weight. Issues mentioned earlier such as an ineffective latch or your baby’s health condition can have an impact. This will affect the amount of breast milk he takes in and therefore, will have an effect on his weight even though you have a good milk supply.

Every baby is different and will grow at a unique rate. However, losing weight below the typical range can be a sign that your baby isn’t getting a sufficient amount of milk. If you are worried about your baby’s weight, always verbalize your concerns to your health care provider or a lactation consultant. They can help further evaluate your milk supply or assess if any other feeding problems exist.

Reduced Or Insufficient Urine and Stool Output

The number of nappy changes your baby has is a good indicator of his milk intake. A reduced or insufficient intake of milk will result in fewer wet and dirty nappies. Take note of how many wet and soiled nappies your baby will have in a 24 hour period.

So what’s the typical range among breastfed infants?

According to the AAP, a newborn who is feeding well may urinate as often as every 1 to 3 hours, or may also have it as infrequent as 4 to 6 times a day.
Urine should be light to dark yellow in color. The darker the color, the higher the possibility that your baby isn’t getting enough milk.
There should be at least 4 wet diapers a day. Getting less than that may be a cause of concern.
Breastfed babies normally pass stools that are light mustard in color, containing seed-like particles.
Stools’ consistency can range from very soft to loose and runny. Hard or very dry stools can be a sign that your baby is not getting enough milk.
The frequency of stool output may vary from one baby to another. Some may pass out stool right after feeding due to what experts call as the gastrocolic reflex. This makes the baby’s digestive system active in response to a full stomach.
Breast milk leaves very little waste products and is almost completely absorbed by the baby’s gut. Some babies in their 3^rd to 6^th week of life may only defecate once a week and would be considered normal. The consistency of stools is a more reliable indicator of your baby’s milk intake.

Causes of Low Milk Supply

Low milk supply can be a result of a variety of factors. While you might find it hard to figure out the exact root of the problem alone, you may want to be aware of certain conditions that may reduce your milk supply. With increased awareness, you can discuss these concerns with your chosen health care provider or lactation consultant. They can help evaluate your milk supply as well as assessing the breastfeeding relationship between you and your baby. The most common causes of low breast milk supply include:

Damaged milk ducts

I mentioned earlier that in order for our breasts to produce more milk, a continuous demand for milk is necessary. In the case of damaged milk ducts, the flow of breast milk can be completely or partially blocked. This can result in milk stasis. When the milk pools within the breast, the body will interpret that there is no demand for your milk. This results in the body producing less milk which will have a negative impact on your milk supply.

Your milk ducts may have been damaged following breast surgery such as breast implants, reduction or lift. Previous piercings in the nipple may also cause some damage to the milk ducts. Depending on the extent of damage, many mothers still manage to breastfeed well despite these conditions.

If your planning on having breast surgery or a nipple piercing, it is important to discuss with your surgeon or other health care provider if you’re planning to breastfeed. They can discuss with you the most suitable course of action to take in order to avoid or reduce the likelihood of having milk supply concerns.

Feeding Problems

When your baby has difficulty latching on due to conditions such as prematurity or lip/ tongue tie, your breasts may not have been emptied effectively. When milk has not been removed regularly, your breasts may start to become engorged and this might be one reason why your body will have a reduced milk supply.

Supplementation after breastfeeding ( donor breast milk or formula feeding)

Supplementation of donor breast milk or formula is recognized by many health institutions and may be recommended under certain circumstances. This includes premature infants or for mothers who will be returning back to work. However, if supplementation is given regularly and more frequent than breastfeeds, there is a greater possibility that you might breastfeed less and this will have a major impact on your milk supply.

Use of oral contraceptives

Hormonal contraceptives containing a combination of estrogen and progesterone are not indicated for breastfeeding mothers. The hormone estrogen is found to affect a mother’s lactation and will most likely reduce her milk supply. This is why if planning to breastfeed, the POP or Progestin-Only Pill is preferred. Experts suggest that if POP was started on the 6^th to 8^th week post-partum and at the recommended dose, it may not interfere with a mom’s ability to produce a sufficient amount of milk. However, it is also important to note that there are some moms who report milk supply problems even when they are having POP. Thus, those who are at increased risk of having a low milk supply may need to be extra careful. Seek a consultation with a proper explanation before taking hormonal contraceptive pills. Other forms of hormonal contraception include patches, injectables, or the vaginal ring.

Use of nipple shields or pacifier

Nipple shields are silicone breastfeeding aids which are worn on the mom’s nipple while breastfeeding. The use of nipple shields may be indicated for a variety of reasons, like for latch difficulties or to help relieve sore nipples. However, it is important to take note that the use of nipple shields comes with a variety of risks such as incomplete emptying of the breasts which can lead to blocked ducts and mastitis. These breastfeeding aids should only be used short-term and under the guidance of a skilled health practitioner.

The use of pacifiers or soothers can prolong the intervals between feeds, making the duration of breastfeeding shorter and thus, may interfere with mom’s ability to produce a sufficient milk supply. The WHO and UNICEF recommend no artificial teats or dummies for breastfed infants. The AAP suggests that soothers should not be used until your baby is around 3 to 4 weeks when breastfeeding and your milk supply has already been well established.

Conditions that reduce the frequency of feedings

Since the frequency of nursing is vital to establish a good milk supply especially in the first few weeks, any condition that may cut it short may interfere with lactation. Some examples are scheduling feedings or cutting them into shorter durations which have been recently popular in some children’s books. Similarly, a baby that is too sleepy to feed will tend to nurse less often and this may impact the mom’s milk supply. All these conditions can postpone breastfeeding and lead to engorgement, which in turn tells the body to stop producing milk.

Smoking or alcohol intake

Smoking and drinking alcohol are not recommended for lactating mothers. The nicotine content of cigarettes is thought to produce vasoconstriction on the breasts, making the smoker more prone to having a low milk supply. On the other hand, alcohol may decrease milk volume and inhibit the “let-down” reflex according to studies.

Medications

There are certain medications that may interfere with lactation and milk “let-down”. Surprisingly, these include some of your allergy meds or the anti-histamines like diphenhydramine and cetirizine as well as some cold medications that contain “pseudoephredine”.

Health condition

Lastly, the mother’s overall health condition can be a major contribution to whether she is able to produce enough milk for her baby or not. There are a few moms who might have difficulties in initiating lactation due to some health issues like:

Excessive blood loss during delivery (more than 500 ml/17.6 fl oz)
Retained placental fragments
Hormonal disorders (Polycystic ovarian syndrome/ thyroid disorders/ diabetes)
Mammary hypoplasia (condition when there is very little milk-producing glandular tissue)
Anemia
Stress

Low Milk Supply and Dehydration

If low milk supply continues for too long, dehydration will occur, which is a serious and life-threatening condition. Dehydration happens when the body is depleted of fluids and can be aggravated if your baby is experiencing fever, diarrhea, and vomiting. Dehydration can be assessed with the following signs and symptoms:

Dark-colored (concentrated) urine
Dry mouth
Poor skin turgor (skin doesn’t go back immediately when pinched)
Refuses to feed
Lethargic

Upon noticing these signs, it is important to bring your baby to the nearest clinic for prompt evaluation and treatment.

Tips to Increase Milk Supply

By knowing the signs and causes of low milk supply, you may now have some idea on how to increase it. But before that, you may first consider consultation prior to diagnosing yourself with low milk supply. Licensed practitioners can help you determine if the milk your produce isn’t enough and help you seen individualized ways on how to boost your milk supply. Nevertheless, if you’ve already been diagnosed with low milk supply, here are some things that may help:

Nurse frequently

Remember the more demand, the more supply will come! Research shows that the onset and frequency of breastfeeding within an hour after birth up to the 2^nd day of life is associated with the amount of breast milk you’ll produce on the 5^th day.

According to La Leche League, it is essential to aim to breastfeed your baby 8 to 12 times a day or even more to stimulate milk production. During the first few weeks post-partum, continue to nurse your baby as soon as he shows some signs of hunger.

Promote skin-to-skin contact

Skin-to-skin contact before and during the feeding stimulates the release of the hormone oxytocin, which helps in your milk let down. When carrying out skin-to-skin, ensure both you and your baby have skin contact as much as possible. Try the laid-down or reclining position while breastfeeding. Use a blanket to cover your baby’s back to help keep him warm.

Relaxation techniques

Stress is common among new mothers, especially when they are still in the adjustment period after giving birth. Try to breathe in fresh air and listen to your favorite calming tune while breastfeeding. Minimize distractions by keeping your cellphone away or placing a “do not disturb sign”. Relax on a comfortable chair and have a good book and a glass of water nearby.

If you’re feeling overwhelmed with your new role, talk to your partner and verbalize your concerns. You may also talk about shifting schedules on taking care of your baby to minimize stress on your part.

Express the excess milk

If the problem seems to root from the ineffective emptying of your breasts, you may need to pump any excess breast milk. You may try pumping right after or an hour after a feed which may not be easy, but can help you establish a pattern of feeding for the next day. Aim to breastfeed and pump at least 8 to 12 times a day, and at least one time overnight when the hormone prolactin is at its peak. Don’t feel discouraged if you see a small quantity of expressed milk in the first try. It will eventually increase within a couple of days.

Expressing your milk by hand is also another way to remove excess milk. This method can help stimulate the milk ejection reflex more quickly. Many moms find that skin to skin contact is more effective than using a pump. This article explains the method of hand expression and the advantages it gives.

Switch breasts

You may benefit from switching breasts if your baby is too sleepy to feed or frequently falls asleep at the breast before he finishes the feeding. You can let your baby finish one breast before switching to the other breast or switch every time you feel your baby is sucking less. Switching several times during a feed helps encourage baby to suck more and may stimulate your milk “let- down”.

Breast massage

While breastfeeding, try to gently stroke your breasts from your chest towards your nipple. This may help clear some blocked milk ducts and drain out your milk ducts. You may need to pay particular attention to the small lumps that maybe brought about by milk pooling over a milk duct. Effective draining of milk also encourages more milk supply.

Offer breast for comfort

Avoid using pacifiers or dummies and offer your breast to soothe your cranky baby. This is also called the “non-nutritive sucking”. The sensation brought about by your baby’s suckling can also help stimulate milk production.

Top-up feeding

Offer a feed to your baby more frequently than his usual routine. This could help stimulate more milk production. After your baby has finished a feed, you could try offering another quick feed even if it lasts for a couple of minutes. You might also want to offer your breast if your baby is awake but not crying. This is just like having a “snack” between feeds. Feeds need not to be very long, but more frequent.

Allow baby to decide the length of feed

If your baby is sucking for a longer period of time, you may mistakenly perceive that your baby isn’t getting enough milk. In fact, there are some babies who just love suckling at the breast for comfort. You just need to allow them to suck for as long as they like. This is of course assuming this is also comfortable for you. Doing so will help them settle as well as stimulate your milk let down.

Foods and herbs to stimulate milk production

According to the American Pregnancy Association, these food and herbs can help increase a lactating mother’s milk production:

Fenugreek
Blessed Thistle
Alfalfa
Goat’s Rue
Oatmeal
Vegetables/Leafy greens
Garlic
Sesame seeds

Be aware that some foods or herbs may alter the taste of your breast milk like garlic, so be careful in taking too much. Make sure to consult a health care professional first prior to taking any herbal supplements.

With proper attachment and positioning, most mothers are able to breastfeed well. Low milk supply might be concerning, however, it is important to take note that there are many moms who may perceive that they have low milk supply where in reality the problem may not exist. These tips can help, but if there is really an indication to increase your milk supply, your health care provider or lactation consultant will guide you in dealing with it more appropriately.