Ask the IBCLC: What do I need to know about my milk supply?

Advice for mothers worried about meeting their lactation goals

Supply concerns are the number one reason mothers say they aren’t reaching their personal lactation goals. There are steps women can take to improve their chances of producing a sufficient quantity of breast milk. Since breastfeeding has been proven to have significant health benefits for both mom and baby, moms are often looking for ways to improve their chances of reaching their lactation goals. For this month’s Ask the IBCLC, Katie will answers questions about moms’ top concern — milk supply.

How soon is the milk supply established?

Lactation continues to become established as the baby begins sucking more effectively and frequently at the breast. The first two weeks are a critical period in lactation. It is important to think of the first couple of weeks as a time to strive to do everything right. Breasts are being programmed during this stage. Once that window closes, it is not impossible to increase supply, but is usually exceedingly more difficult.

Once a full milk supply is established, small changes in routine should not impact supply much. Some women are more susceptible than others to low supply. If you feel you may have risk factors for low milk production, a discussion with your IBCLC—ideally in the first two weeks—is critical. These factors include, but are not limited to: Previous breast surgery or procedures, a history of milk supply problems, infertility, elevated BMI and anatomical challenges in nipples or breasts.

How does milk production change over the course of lactation?

We expect a newly-delivered mother to go from producing drops of milk during the colostrum phase after delivery to producing many ounces of milk during the next few days. Many factors can delay this transition. Once a mother has a full milk supply, emptying the breast by effective nursing and or pumping keeps the supply maintained. Several factors such as hormonal influences or changes in milk removal patterns can disrupt supply maintenance. Many factors can impact this cascade of changes.

Do some mothers have low milk supply right away, or is it something that develops over time?

Either one is possible. There are a lot of major changes that happen in a mother’s body following delivery of her baby. Although many moms notice a small amount of colostrum during pregnancy, lactation is held back during pregnancy. A sudden drop in pregnancy hormones with the delivery of the placenta allows milk-making hormones to take over. It can be frustrating to see tiny amounts of milk after delivery. Remember all that is happening inside your body, and know that this process does not happen instantly. First-time moms and moms with risk factors or complications like a postpartum hemorrhage may experience a delay in this process of milk “coming in.”. Luckily, new mothers have colostrum, which is available in the perfect quantity for a new baby’s tiny tummy.  After adjusting to life outside the womb, a newborn may nurse very frequently during the colostrum phase. This is normal, and helps the new mother transition to producing a larger volume of milk.

What are some possible reasons I am experiencing low milk supply?

  • The first few days did not go well with nursing
  • The critical first 2 weeks did not go well with nursing or pumping, and a full volume of milk was not established
  • Insufficient glandular tissue (not small breasts, but underdeveloped milk making tissue)
  • Previous or new hormonal influences or medication
  • Delivery complication such as hemorrhage
  • infrequent nursing due to separation or jaundice
  • Infrequent pumping with maternal-infant separation
  • Ineffective nursing or pumping
  • Previous breast surgery that either removed mammary tissue, left scar tissue or cut connections that allow milk to flow out

Is there anything I can do to increase my supply?

Usually there is something you can do, try or change.  This is especially true during the first couple of weeks. Start with a feeding evaluation from an IBCLC to correct any issues with breastfeeding position and latch. Although many wish there was a magic food or drink that would boost supply, for breastfeeding mothers, all evidence points toward breastfeeding more often, and emptying more effectively, as the best tactic to improve breast milk production. Pumping mothers may be able to boost supply by improving their pumping sessions. This may mean increasing the strength of pump (for example, from a personal double electric to a hospital grade rental), increasing the frequency or length of pumping sessions, or being evaluated for proper sizing of your pump flanges. All of these things can maximize chances that lactating mothers may make more milk.

There are also prescription medications, called galactogogues, that raise resting prolactin levels. Speak to your doctor if you feel you may be a candidate for one of these medications.

How can an IBCLC help increase my supply?

An IBCLC can help ensure you do everything right during the critical periods of lactation, such as the first two weeks or the transition back to work. An IBCLC can provide feedback to help get breastfeeding off to great and effective start by following the baby’s cues. She can provide you with valuable information, like the amount of milk your baby transferred at a breastfeeding session. A visit with an IBCLC can assist you with choosing the right pump for your personal situation. She can help create a pumping plan that works with your schedule, and make sure that you are using the right-sized accessories for your anatomy. She can look into your personal history to try to find the cause of your low supply, and work with you to try to correct it.

What can I do if I don’t want to give up nursing/pumping and I don’t want to use formula?

Don’t lose sight of the fact that the most important thing is a healthy baby and mom. The most important time for your baby to receive exclusively your milk is the early weeks, when your baby’s GI tract and organ systems are the most immature. If formula is determined to be medically necessary for nourishing your baby, perhaps even temporarily, remember breastfeeding or providing milk does not have to be all-or-nothing. There is significant evidence to suggest that some breastmilk is better for your baby than none at all.  Plus, just ask any breastfeeding mom—the breastfeeding relationship is about much more than just nutrition: it is much more than a way to feed your baby.