A Lactation Consultant's Guide To Low Milk Supply And Insufficient Glandular Tissue
Updated: Feb 3
Low milk supply is one of the most common reasons to reach out for lactation help. Within the population of lactating parents there are fewer than 2 % who are actually diagnosed with insufficient glandular tissue (IGT).
Low milk supply can be complicated and multifaceted. It takes a thorough history taking by a trained professional to help navigate the potential causes of a low supply of milk and to come up with a plan of care to address the situation.
Lactogenesis is a fancy word for milk making. After the placenta is delivered, there is a cascade of hormones that drives milk production and starts the process of increasing milk supply also know as Lactogenesis II. Milk production continues to be driven by those postpartum hormones for those first couple of weeks after baby is born until they shut off and milk supply is driven by supply and demand. This can be as early as 6 weeks for some and up to 12 weeks for others. We call this milk regulation. The excess milk volume we had seen in the beginning if any is typically gone at this point, and your milk supply is regulated to exactly what you baby needs.
Driving Milk Volume And Supply Longterm:
When babies are newborns, we need to feed them on-demand with at least 8 feeds in 24 hours. We feed babies frequently in the first couple of weeks because babies are growing and gaining at an astonishing rate and also because we are establishing our milk supply long-term. Think about this as an order at a restaurant: we are putting in our order for our longer term milk supply and establishing that in the first couple weeks of life.
If milk removal is limited or breasts aren't stimulated correctly in the first couple weeks, we can actually see milk supply start to down regulate overtime and ultimately decrease. Without the proper guidance from a lactation professional, you can find yourself feeling discouraged with a low milk supply and not knowing why.
Insufficient Glandular Tissue (IGT)
There are many reasons lactating parents can experience a low milk supply. Insufficient glandular tissue, although rare, can be one of these reasons. As stated above, it is estimated that fewer than 2% of the population have IGT. Some indicators that we look for with IGT are widely spaced breasts, tubular shaped breasts, asymmetry, missing quadrants of breast tissue, decreased glandular tissue, and lack of breast growth or changes during pregnancy. This is significantly rarer than the number of people who report low milk supply. If you notice any of these symptoms in your own anatomy, working with an IBCLC prenatally to have a plan in place can help to maximize your milk output and establish that professional as a person of support after baby is born.
Other reasons that we can see a low milk supply are a traumatic birth, c-section, postpartum hemorrhage, maternal elevated blood glucose, HELLP syndrome, improper latching and milk drainage from the breast or hormonal issues such as a history of PCOS and hypothyroidism.
What Can We Do?
You can meet with an IBCLC prenatally, have a plan in place for when baby arrives, and discuss questions and concerns.
Next, you make sure baby is latching properly and a tongue tie has been ruled out with a functional oral exam. This will help ensure that the baby is draining the breast efficiently.
Also, lactating parents in the first couple weeks of life will need to remove milk frequently from their breasts, whether that be by using a pump or baby depending on the situation and maximizing skin-to-skin contact as this helps to release milk producing hormones and helps babies feed more reflexively.
Herbs And Medications:
In some cases, the lactating parent may also need to take certain medications or supplements to help increase milk production. Herbal supplements such as Moringa, Torbangun or goat’s rue can be beneficial as well as prescription medications such as Reglan or Domperidone depending on where you live in the world. Always reach out to your healthcare provider before starting a new medication or supplement.
Finally, it is important for the lactating parent to reach out to lactation professionals who are savvy in low milk supply. If you suspect IGT or have a history of low milk supply, meet with an IBCLC prenatally.
With the right guidance and support, lactating parents can maximize their milk volume and work toward their feeding goals. Those goals may change over time or look different than what you had initially hoped for, but having support through the process will make the biggest difference.
Kelsey RN, BSN, IBCLC