What you can do if you're not producing enough breast milk.
Even before her baby arrived, Lindsay Miller was planning to breastfeed. After her son was born, the first-time mom was thrilled when he latched on quickly and easily. But he cried so much in the first few days that she suspected something might be wrong.
"I realized after several phone calls to fellow moms and the hospital nurses that he wasn't getting enough milk from me," she says. "We gave him a bottle of formula and he sucked it down."
Despite the early setback, the Chicago-based mom was determined to keep nursing, but "after a consultation with a lactation consultant, weeks of pumping or nursing every 30 minutes around the clock and every supplement and home remedy I could get my hands on, I was still only able to produce 3 to 5 ounces a day," she says.
At 10 weeks, Miller's milk supply had dwindled to less than 2 ounces and she made the very difficult decision to stop. "I had hoped to nurse my son for 12 months like all the books said I should," she says. "When I wasn't able to go 12 weeks, I felt like a failure."
Miller's story isn't unique. Not only is low milk supply now recognized as a valid concern, it may even be on the rise, as more women choose to breastfeed. and women, like Miller, who expect nursing to come easily are blindsided when it doesn't, leading to feelings of failure and inadequacy.
"Not being able to breastfeed, or breastfeed exclusively, when you really want to can feel devastating," says pediatrician Marianne Neifert, M.D., co-founder of the Academy of Breastfeeding Medicine and author of Great Expectations: The Essential Guide to Breastfeeding (Sterling). "Women often end up feeling it's their fault."
A study that evaluated breastfeeding success at three weeks postpartum found that approximately 15 percent of women experience inadequate milk supply—even when given close follow-ups and support. So, it pays to be on the lookout. "It's much easier to prevent low milk, when possible, than to try to remedy it," Neifert says.
Keep Reading: The most common causes of low milk supply
Management problems, which Neifert says are the most likely and treatable causes of low milk supply, often involve having an abundant supply at the outset that then dwindles.
"The most common scenario is that the milk comes in but doesn't get well drained," she says. "If milk isn't removed from a woman's breasts frequently and effectively, she's already behind the eight ball by the end of the first week." Even with a well-established supply, milk production can decrease later if a mother goes long intervals without draining her breasts (such as not pumping regularly during the work day). reasons for incomplete drainage include:
An ineffective latch. If a baby doesn't have a good "docking" with the breast, he may not be able to stimulate and drain the breast effectively. (For tips and video on how to latch on your baby properly, click here)
A premature baby. Preemies can be particularly ineffective at removing enough milk when breastfeeding because they tire easily and have immature feeding skills.
A mom's lifestyle. "Many women want to schedule feedings and stretch out the nighttime interval, which throws a wrench in the supply-and- demand of breastfeeding," says Nancy Hurst, Ph.d., R.N., I.B.C.L.C., director of women's support services at Texas Children's Hospital in Houston. "If the breasts aren't well emptied early on—and often—a woman can really take a hit in terms of her potential ability to produce milk."
A mom's breast capacity. "A woman's storage capacity isn't related to her breast size, but to the amount of functional glandular tissue she has," Hurst says. Some women have greater milk-storage capacity, and their babies may be able to go longer between feedings without affecting the volume of milk; women with smaller "containers" may suffer in terms of supply if their breasts aren't emptied more often.
Rare but Stubborn Causes
Approximately 4 percent of women have primary causes of low milk supply that are more difficult to treat, including such medical issues as breast and hormonal problems. "Previous breast surgeries, insufficient mammary tissue and thyroid or other hormonal disorders are some of the more common causes," Neifert says. "A woman who has difficulties during delivery, such as very heavy bleeding, can also have problems." So may a woman with a severe infection or high blood pressure.
Keep Reading: What to do when you have a problem
Other causes of low milk supply:
Environmental toxin. A woman's surroundings may affect her milk supply. A small study conducted in 2006 found that daughters of women who grew up in a pesticide-contaminated agricultural valley of Mexico had a much higher incidence of insufficient mammary tissue than those living on a hilltop in the same area."We're seeing a dramatic increase in the number of women who have primary problems, possibly because of environmental contaminants," says Diana West, I.B.C.L.C., a co-author of The Breastfeeding Mother's Guide to Making More Milk (McGraw-hill). "Lactation consultants around the world are reporting increases in the numbers of women who can't produce full milk supplies."
Underlying fertility problems. "Interventions are allowing people to get pregnant when they wouldn't otherwise, causing babies to be born to women who might not have fully functional reproductive systems," West says. "For example, many women with PCoS [polycystic ovary syndrome, a condition that can cause ovulation problems] have less functional milk-making tissue."
When You Have a Problem
If you suspect you have low milk supply, see a lactation consultant as soon as possible. (To find one, visit the International Lactation Consultant association at ilca.org.) She can identify risk factors, evaluate how much your infant drinks during a breastfeeding session and start you on a pumping regimen to improve milk drainage. there's no blanket fix; treatment must be individualized.
That said, many lactation consultants follow a typical course of action. The first step is to increase milk removal, which often involves a combination of nursing and pumping.
Next, a lactation consultant might recommend herbs, such as fenugreek, malunggay, goat's rue or shatavari, to help boost your supply. Some might also recommend prescription medications, such as domperidone. Says West, "Domperidone has been shown to be highly safe for long- term use at the levels we recommend for nursing mothers and is used throughout the world to effectively and safely increase milk production."
Experts say that with the right approach, you should be able to boost your milk supply—especially if you catch the problem early. "Almost everyone can make more milk," West says. "It may not be enough to sustain your baby, so you might still need to supplement, but that's OK. You need to celebrate what you can do and see your breasts as being half full."