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Low milk supply: It's complicated



Did you know that a low milk supply whether perceived or actual is one of the top reasons for breastfeeding cessation? And it doesn't always have to mean that you can't breastfeed. What it does mean is that we need to get to the root cause so we can treat it and work on maximizing your milk volume. Below we will talk about the simple fixes as well as the more complex cases of low milk supply. No matter what situation you are in, the most important thing is that your baby is getting fed (gaining and growing) while trying to decipher the reason for low supply.


Simple fixes:

Simple fixes for low supply can look like increasing feeding frequency for those moms with a lower milk storage capacity.


A lower milk storage capacity means two things:

1. That your breasts store a smaller amount of milk and

2. Babies may need to feed more frequently for growth.


We can sometimes try to increase storage capacity by supplements that target glandular tissue (milk producing tissue inside the breasts) growth such as Goats Rue because the more glandular tissue we have, the more milk we can store.


Letting baby feed on-demand versus on a schedule can also help to increase milk supply and make sure baby is getting what they need. As wonderful as it can be to have a schedule and know what to expect, babies cannot tell time and are hungry at different times throughout the day and night. Just as we sometimes have a snack versus a meal and feel hungrier at certain times during the day, babies do this as well. During the nighttime (about 1-5 am) your hormone prolactin is at its peak for the day meaning that your milk volume is also at its peak. This is a great time to help baby to get volume to gain and grow as well as stimulate your milk supply by taking advantage of the peak prolactin. Letting your baby tell you when they want to eat may be just enough to increase your supply and get baby growing appropriately.


Extra breast stimulation. This can be from feeding your baby or from pumping and hand expression. Our breasts make milk based on supply and demand after our postpartum hormones have dropped off. If we aren't demanding enough milk with schedules or decreased oral function, your supply can slowly decrease.

**See my blog on tongue ties if you are concerned your baby may have one.


If you're pumping, make sure that your flange fits correctly! I prefer a hard flange versus a silicone insert whenever available. Your flange should be a tight fit before pumping to the base of your nipple-and we aren't adding any mm on to that number anymore. Also make sure that you are changing out pump parts every 4-6 weeks depending on your pumping frequency as the parts will start to lose suction over time.


More complex cases:

The more complex cases can be complicated. If a mom has markings for insufficient glandular tissue, history of PCOS, insulin resistance, gestational diabetes, infertility, thyroid problems, postpartum hemorrhage or autoimmune disease, I consider these a pink flag. To me a pink flag is something to keep in the back of my mind if we run into milk supply issues after baby is born.


There are many hormones and minerals in the body that need to all work together functionally so that we can produce breastmilk. These hormones also need to be functioning properly prenatal as well. If hormones are off during pregnancy, this can limit the amount of glandular tissue you produce prenatally which can limit milk volume when baby arrives.


So what do we do?

First off, we take a full assessment of mom and baby. This includes: medical history, growth during pregnancy, breastfeeding history and complications this far in pregnancy. If baby is born, this also includes an assessment on baby, an oral exam as well as a breastfeeding and latch assessment. We need to first figure out if it's actually a milk supply issue or if it's a baby who isn't emptying the breasts appropriately. Once we have confirmed a supply issue, we can talk about appropriate lab work based on your medical history. This looks at hormone labs as well as blood panels and nutrients in your body that help hormones to work efficiently. Once the labs come back we can discuss them and talk about supplements or refer out either to a functional medicine practitioner or to a naturopath who can better assist with specific hormones.


To wrap it up:

We can try all of the herbs and cookies and drinks on the market for milk production, but if we aren't truly treating the actual problem, you may not notice a difference. I always recommend that, if you have a history of low milk supply or any of the above diagnosis, you meet with a skilled lactation provider prenatally to make sure things are on track. Some labs can be drawn prenatally and then also drawn in the postpartum period if there are supply concerns. Labs should be looked at from a functional standpoint versus a traditional range, and we should always be looking for the root cause of the problem.


Have any questions or want to schedule a consult?

Send me an email at kelsey@loveatfirstlatch.com


And you can also check your insurance benefits here:

**If you have Aetna please email your benefits


XO,


Kelsey RN, BSN, IBCLC

@loveatfirstlatch



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