Expert tips on low milk supply by Meg Nagle, lactation consultant (IBCLC)
“Help! I think my baby is starving!”
“Do I have enough milk?”
“I think my milk has dried up”
“Is my baby getting enough?”
“I think I have to supplement”
Mums from all over the world have the same questions and concerns, and it can drive us nutso with worry! As a new mum I loved breastfeeding but with a very cranky baby (always in the evening at about the same time of day) I started to wonder what was wrong. Was he getting enough? Was he crying because he was hungry? One of the most important things for a mother to understand is how to know her baby is getting enough and what she can do if she realises he isn’t. Not only was I exhausted and probably hadn’t showered or done laundry for about a week, I also had this added pressure of not knowing whether or not I had enough milk.
How to tell if your baby is getting enough breastmilk
1. Count wet nappies
Time for a nappy count! From when your milk comes in (usually about three days after the birth of your baby) you should see 6-8 wet cloth nappies and 5-6 wet disposable per day. Your baby should also be having 2-5 poops per day (at least the size of a tablespoon or so) for the first few months. After about six weeks or so many babies will start to poop less frequently sometimes even skipping days, this is one of the easiest and best indications to see if your baby is getting enough.
2. Number of times baby breastfeeds per day
Is your baby breastfeeding 8-12 times within a 24 hour period? If yes then that is great! If your baby is not breastfeeding nearly as often or breastfeeding many more times per day it COULD be an indication that something is going on. Having said that I think my baby breastfed five MILLION times last night and I know he is getting enough so it is definitely not always an indication that your milk supply is low. This is an example of “cluster nursing” and this definitely happens at all ages and stages of a breastfed baby or toddler!
How do they look to you? Your instincts are a very important factor in determining how your baby is doing. Do they appear content? Do they look healthy, alert and hydrated? As stated in La Leche League (2003) the following are signs of dehydration in your baby, “listlessness and sleeping through feeding times, lethargy, weak cry, skin loses its resilience, dry mouth, dry eyes, less than the usual amount of tears, minimal urine output (less than two wet nappies in a twenty four hour period), the fontanel on baby’s head is sunken and fever” (p. 335).
4. Weight gain
Is your baby gaining weight? Remember that not every breastfed baby looks like a cute chunky marshmallow good enough to eat. My baby was a skinny little stick just barely on the growth chart for weight but he consistently gained weight and met all of his developmental milestones. Most importantly I knew that he was absolutely perfect…just a long, skinny noodle baby. My mother recently said to me about my third baby, “you know I think this is the cutest baby you have had! He is so chunky and adorable!” Thanks mum!
What to do when you know your milk supply is low or needs a bit of a boost…
1. You will make more milk
First and most importantly remember this…if you do not have a medical reason for low supply (hormonal, inadequate breast tissue, illness etc.) and you are patient and willing to put in the hard effort, you WILL make more milk! Women with one breast, women who have adopted and never lactated before, women who have temporarily stopped breastfeeding and then took it up again…these women have successfully breastfed their babies and you can too. Keep positive, have patience and persevere! It also helps to have lots of support; including a chef and maid if possible. In my dreams…
2. Supply and demand
The second most important thing to remember…since your body produces milk as a “supply and demand” system the most effective and important thing you can do is take the next day or two (or three!) to just “be” with your baby and simply breastfeed. Leave the washing, ask friends or your partner to cook and leave all of the various toys you might have from other children, the pile of dust under the table, cracker crumbs on the floor and go rest with your baby. I give you permission to take your IPhone with you…but only if you read all of my blog posts and tell all your friends on Facebook about them 🙂
3. Good attachment
Step two will only work if your baby is effectively and efficiently draining your breasts. If your breasts or nipples hurts (not normal) or you have any doubt about how your baby is feeding contact an International Board Certified Lactation Consultant (IBCLC), your local volunteer La Leche League (LLL) leader (breastfeeding counsellor) or volunteer Australian Breastfeeding Association (ABA) counsellor to help you out.
4. Avoid all artificial nipples.
This includes dummies (pacifiers) and bottles. This is for a few reasons; some babies have a hard time switching back and forth between a human nipple and artificial nipple. Other babies will be able to do this just fine but because they are sucking on a pacifier or bottle, they are then not stimulating your breasts to make more milk. A pump will never be as effective as your baby at increasing your milk or stimulating your breastmilk production. Remember no baby uses your breasts as a pacifier, pacifiers were invented to take the place of one of the normal natural purpose of breastfeeding which is comfort sucking. This not only stimulates your milk and keeps up your supply but it is also strengthening your babies jaw and facial structure, meeting their nutritional and comfort needs and is just a great way to mother your baby through breastfeeding 🙂 If supplementing your baby is necessary, you can do this through a different device such as a spoon, cup or a Supplemental Nursing System (SNS).
Here is a picture of a woman using an SNS (photo taken by Tracey McGrath). She has insufficient glandular breast tissue and is not able to produce enough milk to exclusively feed her baby. Here she is using donor breastmilk in the SNS. Her breasts are still being stimulated to make more milk while her daughter receives donor breastmilk through the little tube. The tube is attached to a small bag which holds the donor milk.
The World Health Organisation recommends the following for babies if their mother cannot breastfeed. The order is in preference from most preferred to least preferred;
- breastmilk from the mother that is freshly expressed
- mother’s breastmilk that has been refrigerated
- mother’s breastmilk that has been frozen and defrosted (not in a microwave)
- donated breastmilk from another mother
- banked donor milk
- artificial breastmilk.
There are many options out there before artificial breastmilk. Please contact me if you are considering artificial breastmilk but would like to continue breastfeeding if possible.
5. Switch nursing
You can try “switch nursing” which many mums find really helpful in increasing their supply. Breastfeed your baby for as long as they want but switch between each breast every few minutes (try to do each side a total of 2-3 times per feed). This way both breasts are being drained (although never “emptied” as there is always some milk hiding in there!) and stimulated every time you feed your baby. Some mums also find breast compression helpful. To do breast compression, squeeze your breast to increase your milk flow (obviously not too hard as you don’t want to injure yourself).
6. Pumping breastmilk
Pumping can be helpful for some mums as it is an added stimulation along with your baby. Try pumping right after or between breastfeeding sessions. Pump for at least 2-5 minutes after your milk has stopped flowing. You can also try, “hands on pumping” where you stop to massage your breasts and add self-expression before or during your pumping session.
Some women find that a galactogogue helps in increasing their supply. Research has found mixed results as to the effectiveness of galactogogues (whether it be prescription medication or herbal) yet there are many anecdotal reports that they are helpful, which for many women is reason enough to give it a go and see if it can help them too. The most important things to be aware of with galactogogues is that they will only help if you have effective and efficient removal of breastmilk from your breasts as well. Contact your IBCLC, LLL leader or ABA counsellor for more information on these substances.
But my breasts feel soft all of a sudden! I no longer leak! My baby wants to eat ALL the time! I must have low supply! I must! I must!
Many women are relieved to find out that what they thought were signs of a low milk supply are actually quite normal and not an indication that they are low on milk.
The following does not mean you have a low supply and can be very normal:
Once your baby has mastered breastfeeding and has regulated your supply you will no longer have your rock hard watermelon breasts! Yay!
Many babies have cranky times and this does not mean you have a low supply. Sometimes it actually means you have over supply or your baby is just simply cranky.
The frequent breastfeeder.
Many mums find that their babies cluster feed. Sometimes my babies have fed almost non-stop for days! It can be very overwhelming but is not an indication that they are not getting enough. Babies go through grow spurts or need extra cuddles and feeds or might need more when coming down with a cold or other illness. Also, as babies get older they tend to become very efficient and they finish their breastfeeding session much quicker than when they were little. This does not mean they are not getting enough, just that they are now master breastfeeders who get the job done quite quickly!
When I pump hardly anything comes out!
I remember the first time I used a breast pump. I sat there like a dairy cow and wanted to cry when I could only pump out a few drops. Is this all my baby is getting?! To answer simply, No. Pumping is never as effective as your baby breastfeeding and will never produce as much milk. It was not until my baby projectile vomited all over me a few months later that I actually saw how much he got at each feeding! Wow!
If I give my baby a bottle of expressed milk or formula, she sucks it down and falls straight to sleep! I’ve been starving her!
Almost every breastfed baby (especially those used to a bottle) will happily take a bottle that is given to them even if they are not hungry, as it freely flows into their mouths and they have no choice but to swallow it. This is not necessarily an indication that they have been starving but quite a normal response to having a bottle placed their mouth.
Most every mother out there will have enough milk for her baby. In most cases, the simple and cozy “skin to skin” will encourage your baby to breastfeed and increase your supply. Breastfeeding as often and for as long as your baby would like helps to create the perfect supply for your baby. Remember to trust your awesome and very reliable motherly instincts!
If you are still concerned after reading this please contact me. I am available for breastfeeding visits in person if you live on the Sunshine Coast or in Brisbane. I am also available for Skype consultations if you live elsewhere in the world. Contact me for more information.
La Leche League International 2003, The breastfeeding answer book, Schaumburg, Illinois.
I am a mum of three breastfed boys (still feeding my youngest!) and am passionate about helping mums who would like to breastfeed. I have been helping women and their families for eight years, first as a breastfeeding counsellor and now as an International Board Certified Lactation Consultant. Check out my website The Milk Meg. You can also find me on Facebook, Twitter, Pinterest and Instagram. To see all of Meg’s articles, click here.