Tag Archives : human milk

Momblog: when your breasts don’t work & low supply

breastfeeding_symbolIt is estimated that 95% of women who conceived naturally are physiologically able to breastfeed.  This means that, so long as the mothers nurse the baby(ies) on cue, their bodies will be able to produce the right amount of milk.   But this means that 5% of women cannot physiologically produce milk, cannot produce enough milk, or can produce milk but something impedes the milk from reaching the baby.   That’s 5 women out of every 100 who cannot nourish their babies 100%, no matter how much determination they have and no matter their desire to breastfeed.

The reasons are myriad, but reasons are both maternal and neonatal.  Let’s focus on the maternal side.  For the birth mother, they include long words such as:

  1. mammary hypoplasia
  2. insufficient glandular tissue
  3. breast reduction or augmentation
  4. breast injury damaging glandular tissue
  5. breast removal (mastectomy)
  6. thyroid or other hormonal imbalances
  7. PCOS or other auto-immune issues
  8. retained placental fragments
  9. late onset lactogenesis
  10. more…

When these mothers hear “I stopped breastfeeding because I didn’t have enough milk”, their hearts often break.   They may have tried and tried and tried.  But their bodies just didn’t produce or wasn’t able to provide what their baby needed.   And by no fault of their own. With accurate diagnosis, whether or not a mother is able to provide 100% of the baby’s needs for milk, even with intervention, cannot be estimated, each mother and each set of circumstances play a role.

For those who cannot feed 100%, they can seek out donor milk or use formula.  This milk can be offered in bottles using paced-feeding methods or in supplemental nursers such as the SNS or Lact-Aid.   The latter is particularly appealing to mothers as it promotes the intimacy of breastfeeding as the supplement is given at the breast.  In fact, with supplemental nursers, it’s even possible to “breastfeed” 100% of the time, even if you do not feed human milk 100% of the time.

No matter the method to offer supplements, many times these mothers are judged when they are seen to not be breastfeeding their children.  No mother should be judged.  Most mothers try the best they can with the information they have at the time. It’s especially hurtful, however, when the mother wanted to nurse but could not.

Low Supply & the Mother

In my work as a breastfeeding counsellor, I’ve met many women who said “I didn’t have enough”.   And probably 5% of these women had one of the above issues.   The other 95% had either “perceived low supply” or actual low supply, but low supply not based on a physiological inability to produce milk.   It was another issue.  Let me explain.

Perceived low supply often manifests itself from lack of confidence in one’s ability to nourish a child, from misinformation about normal infant behaviour & nursing patterns (see this blog about the 3-8 week crisis), and/or from cultural booby traps that set mothers up for failure, before they have even given birth.   In these cases, the mother’s supply is often fine, but circumstances lead her to believe she doesn’t have enough milk.  Without receiving accurate information & support at this time, parents often supplement their babies, the supplementation then reducing the baby’s time breastfeeding, thus interfering with supply & demand, ultimately resulting in actual low production and eventually early cessation of breastfeeding.

In other cases, breastfeeding gets off to a rocky start and low supply ensues due to misinformation or poor support.  For example, many parents have been taught that babies breastfeed every 4 hours, this idea repeated by family & friends (feeding “again”?) and even by health care professionals.  So they try to feed every four hours, even though they hear their babies asking for more before that time period (often forcing themselves to ignore their maternal instincts, which can dull that instinct long term).  Infants, however, don’t read watches.   If we try to manage breastfeeding by limiting a baby’s access to the breast (his all-in-one source of water, food, antibodies, comfort & love), the mother’s body will react by producing less.  And the fewer times baby nurses, the less milk the mother’s body will make.   If there is very early management of breastfeeding, the mother’s body may not reach its full production potential.

Low Supply & the Baby

Sometimes the baby isn’t able to “transfer milk” effectively, either due to an easily corrected latch or due to a physiologic issue, such as a high palate, tongue-tie, and/or lip tie.   If the latch isn’t fixed or the baby’s issue not corrected (with a tongue or lip tie release or cranial sacral therapy to work on the palate), the milk that is there won’t reach the baby, meaning the mother’s body will think the baby does not need the milk, so will respond by producing less, ultimately leading to low supply as well.

So what’s the point of this blog?   There are several:

  • Breastfeeding isn’t just about the milk!
  • Learn about breastfeeding & infant behaviour BEFORE the baby is born.   The production of milk is innate, the act of breastfeeding & babycare is learned.
    If you learn BEFORE (by reading and by attending mother’s groups where you can SEE mothers breastfeeding), when baby is here you’ll have a better idea of what’s normal & what’s not.  If something’s “not normal” you can get early help.
  • Get to know your body and breasts/nipples!
    Did your breasts grow during pregnancy?  Do you have hormonal issues?  PCOS? Thyroid?   Knowing about these things in advance mean that you can be prepared for a possible effect on supply.  You may also be able to act DURING pregnancy.
  • If you feel like you have low supply but wish to continue breastfeeding ASK a breastfeeding counsellor or lactation consultant or both!  They can help you figure things out and can suggest tips to up low supply IF this is the issue.
  • Some mothers truly cannot breastfeed 100%.  Know that paced-bottled feeding & supplemental nursers are an option.
  • If you want to stop breastfeeding as it’s not working for you (for whatever reason), think about how you talk about this choice.  Instead of perpetuating the idea that many mothers are not able to produce enough milk by saying “I couldn’t make enough” take ownership of your choice and give the true answer.

Comments?   Experience with low supply?   We’d love your comments below.

Need support?   Follow the facebook page “Supportive Community when breastfeeding doesn’t work out


BabyBlog: Breastfed babies at 3-8 weeks 3

You’ve gotten through the first couple of weeks with your new baby and you think you’ve figured things out and then WHAM!  Something changes.   We often forget this, but our children are constantly growing, maturing, changing (and so are we), so this is only the first change we’ll face as new parents.  And they happen weekly, if not daily!  Unfortunately, if we aren’t used to babies and are getting used to parenting on our own, with only our partner…. (and many fewer people to turn to for guidance, especially as expatriates), well, the numerous changes that occur in the initial weeks are often tricky to comprehend.  And, we’re recovering from pregnancy and childbirth too.   So, to help the new parent, let’s talk about some of the changes that occur in the baby in the first two months.

There are several growth / developmental spurts that occur one after the other starting around 2-3 weeks and lasting until about 4 months (with another at about 6 months).  Lots of things are going on during these spurts, not just growth in length and weight, but also in abilities and understanding, i.e. the brain and muscles are developing too (see publications like The Baby Book or Your Amazing Newborn to learn more). In other words, newborn babies are growing, learning and developing at a fast pace.  When these spurts occur, babies need additional nourishment (water, food, immune support, suckling, affection), so want to be at the breast more often.  And as a result a mother’s milk supply fluctuates up and down.

So long as you let baby stay at the breast as he/she seems to want and there are no issues with latch or tongue or lip ties, nor any physiologic issues in your ability to make milk (e.g. hormonal imbalance, thyroid issue, hypoplasia) your supply will keep up!  This said, in addition to often feeling like you don’t have enough milk (because you are unused to newborn behaviour and/or you hear comments around you like “feeding AGAIN?” or “you are going to spoil her if you keep picking her up”), you might feel like you have too much!  The latter is because milk supply fluctuation can often result in fast let-down (with babies sometimes pulling off or spitting up more, which is not fun for the mother, but it means they are naturally managing this stage of breastfeeding).

Sometimes the fluctuations also result in a higher amount of lactose in the milk (as the mother’s body has adjusted to make more milk, but with more milk there is also more lactose). Lactose is simply milk sugar so it’s always there, but when there is a lot of it, babies sometimes get unsettled tummies, can seem fussy, and as lactose is digested differently their stools can turn green and frothy/mucousy (or like algae).

The green stools can worry many a new parent, but in general, if green or changed texture stools are the only thing going on and the baby seems otherwise content (even if fussy), has enough wet and poopy diapers, has periods of alertness, etc., then a parent can just think of this as a normal stage of infant development.  If, on the other hand the fussiness is making the days harder or making the baby not only fussy but apparently uncomfortable (or the mother is getting a lot less sleep as a result), then a mother can “manage” breastfeeding by doing things like:

  • Feeding against gravity (so leaning back more, using laid-back positions)
  • Letting the first flow (let-down) of milk go into a towel/diaper (or bottle to freeze for another purpose) and then re-latching baby to breast afterwards (or hand-expressing off a bit and then latching baby)
  • Feeding with shorter intervals between feeds
  • Increasing time at the breast (& using breast compression to stimulate additional let-downs) and using only one breast at a time
  • etc.

Often mothers will do these things automatically and won’t realise it until later.   But these are NOT things that must be tried or that all new mothers try.  They’re just things to think about “in case” of need.  And they are short term fixes, think days & weeks.   Anything longer than that and you can end up with the opposite problem: slow flow & lower supply!

Parents must also remember that stools can also be green (and also smelly) from allergies (to cow’s milk protein, gluten, etc.) and in these cases in addition to the stronger smell, there can be traces of blood.  Whenever there is blood in a baby’s stools, a quick call to the baby’s paediatrician or other health care provider can provide guidance, but in general blood simply means that there is a broken blood vessel in the bum or that mother has a few cracks on her nipples (check baby’s tongue and latch and think about silverettes for healing) and baby has swallowed some blood himself.  If the latter two are ruled out and it’s not a normal fluctuation of milk supply, then mothers look into eliminating common culprits from their diets (milk, gluten, eggs). Unfortunately it takes around 3 weeks for things like cow’s milk protein (casein) to totally leave the system, but a marked improvement should already be felt about a week after elimination.   Allergies often show up around the same time as the first growth spurt, i.e. ~4 weeks.  Other mothers ADD things to their diets, such as probiotics, to ensure their own physical well-being.

Now let’s go back to the changes in baby:  her eyesight is improving, she’s starting to recognise patterns and people, her muscles are developing, including stronger head control, stronger abdomen, etc.  (see The Baby Book for more ideas).   This means that from around 2-3 weeks of age, baby is transitioning out of the “newborn” phase.  Every day, every week, parents will notice things that baby wasn’t able to do before.   And all these changes mean that every day a baby’s active alert time, sleep time, and overnight time will also change.   There’s just too much going on developmentally in baby’s brain for patterns to last more than a few days/weeks. In fact, it’s VERY common for babies to wake 4-5 times overnight in these 6-7 weeks (not every day, but 2-4 nights in a row repeatedly is common and physiologically expected).  This is because not only do they need to be at the breast more, which satisfies:

  • Thirst
  • Hunger
  • Development & Immune-Defense
  • Need to suckle
  • Need for affection

But also she may wake more because she wants to communicate with her parents about her day, relay information, etc.    A baby’s evening might be between 11-14 hours long, but overnight wakings are expected to continue during this time and for the first few YEARS of a baby’s life.  With 1-3 wakings a common pattern (more during spurts), usually with a long overnight period of sleep of 5-6 hours (either at the beginning of the night or later, if at the beginning, you’ll want to go to bed early!).  A baby’s sleep is quite easy to understand, once you know why it is the way it is.  To learn more about baby’s sleep, read Nighttime Parenting or visit the Ask Dr. Sears web pages about sleep.

What changes did YOU notice in your newborn in the first three months?  Comment below!