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.