Perceived Low Supply or Actual Low Supply

“Not enough milk” is one of the most common causes for stopping breastfeeding or choosing to supplement with formula. Unfortunately, often it is a perceived notion of not having enough milk which is loosely based on one or several of the following:

• feeling as if the breasts are not as full as they used to be
• baby feeding more frequently than expected
• low maternal confidence and lack of support
• misunderstanding/mismanagement of growth spurts and normal newborn behavior
• limited amounts of breast milk when pumping to assess the amount (It cannot be stressed enough that the amount of milk you pump is NOT EVER a reliable indicator of how much milk you are producing, nor how much milk baby is taking in. The healthy breastfed baby is usually much more efficient at getting milk from the breast than a pump is).

More often than not, the milk supply is adequate but is perceived as being low. Without the correct support a perceived low supply can easily become an actual low supply due to incorrect management. 

Low milk supply, whether perceived or actual, is an issue that needs to addressed and managed if you wish to exclusively breastfeed.

So let’s start with the basics.

How do breasts make milk?

When your baby suckles, it sends a message to your brain. The brain signals the release of prolactin and oxytocin. Prolactin causes the alveoli to begin making milk. Oxytocin causes muscles around the alveoli to squeeze milk out through the milk ducts.

There is also a substance thought to be contained within breast milk called FIL or Feedback Inhibitor of Lactation. FIL regulates the amount of milk you make. Each time your baby suckles and drains the breast, FIL sends a message to the brain to “fill” the breast. FIL controls the process of supply and demand.

However, if feeding is erratic or the breasts are not emptied, the breasts remain fuller and FIL sends messages to eventually reduce and then stop the cells from making more milk. After a few days, this “feed” will disappear and your milk supply will have reduced causing an actual low supply.

So a baby who is feeding frequently and effectively will be causing a constant demand that is satisfied by regular nursing sessions.

Does size matter?

The amount of fatty tissue is an inherited trait and varies among women, which is why breasts come in such a variety of sizes and shapes. The size of your breasts doesn’t determine your ability to produce milk or breastfeed. Your breasts are the “factory” for making milk and not a storage facility. It’s the ability of the factory to produce milk that determines the amount of milk and this is driven by hormones and frequent emptying. The amount and composition of breast milk changes depending on your growing baby’s needs – and even on the time of day.

How much is enough?

In the early days after the birth of your baby, your body has no idea how much milk to make. In the first weeks there is often an abundance of milk and your breasts are hard and engorged. The feeling of fullness is really not the norm at all, but means that your breasts haven’t yet adjusted to the amount of milk that baby needs. As your body regulates the supply to meet the needs of your baby your breasts may feel soft and ‘empty’. This doesn’t mean that your supply has decreased. Rather it has adjusted to meet the needs of your baby. Having the right support and advice will reassure you when this happens. You will also be reassured that frequent feeds in the first weeks are normal and expected as you and your baby find your rhythm.

What happens during growth spurts?

Growth spurts occur at around week 2, 3 and 6 weeks and are a very real cause for concern and perceived low milk supply because during a growth spurt, breastfed babies nurse more often than usual (sometimes as often as every hour) and often act fussier than usual.

The increase in baby’s milk intake during growth spurts is temporary. Physical growth is not the only reason that babies may have a temporary need for increased nursing. Babies often exhibit the same type of behavior (increased nursing with or without increased fussiness) when they are working on developmental advances such as rolling over, crawling, walking or talking. Mom’s milk is for growing the brain as well as the body!

They occur again at month 3,4, 6 and 9 so take note and do not despair. Go back to the list, meet up with other moms with babies of similar age and find support to reassure yourself. The Due Date Club is a great place to meet and chat with other moms.

Signs your baby is well attached

• Your baby has a wide mouth and a large mouthful of breast.
• Your baby’s chin is touching your breast, their lower lip is rolled down.
• You don’t feel any pain in your breasts or nipples when your baby is feeding, although the first few sucks may feel strong.
• You can see more of the dark skin around your nipple (areola) above your baby’s top lip than below their bottom lip.

Signs your baby is getting enough milk

• Your baby starts feed with a few rapid sucks followed by long, rhythmic sucks and swallows with occasional pauses. You can hear and see your baby swallowing and their cheeks stay rounded, not hollow, during sucking.
• They seem calm and relaxed during feeds and content and satisfied after most feeds.
• Your baby comes off the breast on their own at the end of feeds and their mouth looks moist after feeding.
• Your breasts feel softer after feeds and your nipple looks more or less the same after feeds – not flattened, pinched or white.

Causes of actual low supply

Insufficient removal of milk from the breasts leading to a reduction in milk production is the most likely cause of low supply. This is associated with:

• Incorrect latch and attachment to the breast
• Insufficient breastfeeding and restricting breastfeeds or scheduled feeds, especially in the first weeks
• Sleepy baby
• Separating mom and baby
• Unresolved breast engorgement
• Supplemental feeds with formula
• Tongue-tie, lip tie and other infant oral cavity abnormalities that impact latch and suck ability.

Things to do when you have perceived or actual low milk supply

• Correct positioning and attachment, and management of any nipple trauma. Wearing Silver Mama nipple cups from the first days of breastfeeding will prevent undue nipple trauma and quickly heal minor cracks so that you can continue breastfeeding uninterrupted.
• Understand and read your baby’s hunger and satiety cues and the signs of effective milk transfer.
• Avoid unnecessary use of artificial infant formula
• Increase skin-to-skin contact

I cannot stress enough the value of rest and diet when there is a perceived or actual low milk supply. Breastfeeding takes time and energy and you need to slow down and nurture yourself. Seeking support from a lactation consultant will radically improve your ability to breastfeed your baby and enjoy it.

Karen Wilmot – The Virtual Midwife RM RYT

Founder The Due Date Club