I’m Worried My Milk Supply is Drying Up, What Can I Do!?

Make sure there is truly a supply issue first! 

Before assuming that your baby’s constant desire to nurse is proof of your low supply, you may want to read about normal baby growth spurts. The first major ones often occur around 3, 6, 9 and 12 weeks of age. If your baby is growing, and meeting the goal of 5-6 wet disposable diapers, (6-8 wet cloth diapers) and you are seeing 2-3 poopy diapers the size of a half dollar per day, your baby is meeting the minimum requirements of a well hydrated baby. *Some breastfed babies start skipping a few days between poops and that can be normal, we’ll talk more about that later.

Crankiness after breastfeeding, isn’t necessarily a sign that you don’t have enough milk, it may just be that you need to nurse again. During growth spurts some babies really pack in the calories, and this can mean you end up feeding your baby very often, or in a “cluster” of back to back nursing periods. If your baby is a “snacker” or simply seems to want to nurse all the time, think about the fact that you gain weight from eating snacks, so does your baby! A baby gaining weight is a good sign!

You say your baby will still take a bottle after you nurse, so your milk supply is low? It’s pretty normal for babies to like sucking, and it meets more than just their nutritional needs. A baby has immature stomach sphincters at the top (the lower esophageal sphincter, LES) and the bottom of the stomach (called the pyloric sphincter). These are part of the reason everything that goes in can pop back up pretty easy as “spit up”. It also means that if you overfill the stomach it forces out through the pyloric sphincter and goes directly into the small intestines with little opportunity to start being properly digested. So while it seems like your baby had to be starving after you nursed your baby and then gave your baby another 4 ounces in the bottle, really there is just not that much space in the stomach!

The first step to increasing your milk supply:

Don’t give up hope! There are a series of things you can try in order to rebuild your supply. It may be helpful to remember to be kind to yourself; the chances are good that you did not know that you would be in this predicament with your milk supply. It may be a horrible shock, and you might feel really bad about it. No one wants their milk supply to dry up before they are ready!

In some cases, mothers may find that they have been prescribed medication that is not compatible with breastfeeding because the side effect is that it reduces your milk supply.  Some cold and flu medications will have Sudafed, and that is one of the culprits. There are a lot of reasons that mothers experience sizable dips in supply. Rebuilding a milk supply can take commitment and time, but it is not impossible!

There are a number of conditions that may delay or effect a woman’s ability to make milk:

• Hypothyroidism
• PCOS
• Previous infertility or hormonal conditions
• Breast augmentations, including breast reductions, injury and surgery
• Diabetes *can delay lactation 2
• Anemia, birth related hemorrhage
• Retained placenta *can delay/inhibit lactation
• Preeclampsia *can delay lactation
• Rapid weight loss after birth
• Pregnancy
• Your menstrual cycle (a temporary dip is commonly reported-not usually of critical concern)
• Obesity
• Certain types of hormonal birth control

Finding help through a free breastfeeding support organization may also be beneficial to a mother with health conditions that can make breastfeeding more challenging.

In addition to these conditions, sometimes the use of a pacifier will hide feeding cues so that the baby is nursing less often. In some families they attempt to schedule feedings, which can also limit a baby’s time at the breast. Scheduling feedings will reduce a mother’s supply, and it can be dangerous for the baby because of the risk of Failure To Thrive (FTT). If you are a pumping mother and your supply seems to be drying up because you are getting less milk, have a professional check the seals of your pump, or have a pump tune up.  An easy thing to do is to purchase new membranes or duck bills for your pump. You may also need to increase the amount of time you spend pumping, or use breast compressions. The short version of this section is that anything that inhibits your baby’s access to nursing can negatively effect your milk supply. This would include encouraging early night weaning, feeding solids, separation from your infant, or supplementing with fruit juice, water, tea, soda or formula without cause.

It will be important to remove milk frequently and watch the baby closely. In rare cases a mother may need to supplement with pumped milk, donor milk from a milk bank or some type of artificial baby milk. A baby typical needs about 25 ounces of milk per 24 hour period. This information can be helpful when assessing how much to supplement your baby with. Take your daily total average and divide it by the amount of feeds you are giving. That’s your average quantity per feeding. Older babies that are eating solids tend to get less milk, and smaller babies around 3 months old tend to have the most.

It is time to contact your HCP if :

• Your baby is failing to *regularly* meet the wet diaper goal (5-6 disposable diapers and 6-8 in cloth diapered babies)
•  Yournewborn and making less than 2-3 half dollar sized poops per day
• Your baby seems listless, limp or unresponsive
• Your baby’s urine is getting darker, and has a stronger smell
• Your baby is having thicker, harder poops, or is pooping less frequently along with having less wets.
• Your baby’s weight gain is dropping significantly, or your baby is unable to remove 45-60ml of milk at the breast during test weights.

Some steps to take to get your milk making back on track:

1. More frequent milk removal, increase your pumping or nursing! 
2. Breast massage
3. Warm the breast slightly before pumping
4. Obtain a hospital grade pump
5. Use breast compressions while nursing and pumping
6. Increase skin-to-skin contact with your baby
7. Supplement at the breast if you have to supplement
8. Consider talking to your Health Care Provider about the use of herbal supplements like Fenugreek and Blessed thistle in conjunction with more frequent milk removal
9. If you are on hormonal birth control or other medication, speak with an IBCLC or hcp about whether it is impacting your milk supply

*If you must supplement, try a Lact-Aid or a SNS (supplementary nursing system) either of which offer the supplement at the breast, instead of through a bottle.

If you haven’t heard about a breast compression yet, and you don’t know how to do one: read this over

If you decide a mother should begin some sort of at the breast supplementing temporarily, Lact-Aid is now a preferred company to recommend. http://www.lact-aid.com/

References:

Riordan, Jan and Wambach, Karen. Breastfeeding and Human Lactation, 4th edition 2010.

Flora, Becky IBCLC. The Hidden Hinderances to a Healthy Milk Supply, http://www.breastfeed-essentials.com/

(C) Serena Meyer–All Rights Reserved

5/19

You can find serena at https://www.bayareabreastfeedingsupport.com/