“I didn’t have enough milk”. As a well-baby clinic sister, I hear this phrase literally every day. It evokes feelings of sympathy because I know that I’m simply hearing a mommy who was feeling anxious about her breastmilk supply and scared that her baby was going hungry.
Occasionally I recognise a mom who found the demands of breastfeeding a newborn baby to be more than she bargained for. Mostly though, it simply leaves me frustrated with a society whose faulty believes and unrealistic expectations have led to women completely doubting their bodies’ ability to make enough breastmilk for their babies.
The majority of women that stop breastfeeding do so because they believe that they do not have enough breastmilk, or that their milk isn’t nutritious enough. Medically speaking, only a very small percentage of these women truly didn’t have enough milk. The rest simply had the wrong information and not enough support.
So what should you know about milk production and supply? If you are pregnant and concerned about this topic, or if you currently have a small breastfeeding baby, read on as this information is key to breastfeeding success.
Milk-supply – a misleading term
The term ‘milk supply’ in itself carries a very negative association, as the supply is something that can become depleted.
Breastmilk is a bodily fluid, like tears or sweat. You don’t worry about running out of those, do you?
You know that your body will make the amount that you need. The same goes for breastmilk. You should rather see it as your breasts milk-producing capacity.
There are some factors that can reduce this capacity and others that can boost it. In most cases though, the body is able to produce a sufficient amount of milk.
Understanding breast milk production
Lactogenesis, or the making of milk, is a complex process with different stages. In short, the following three facts are a summary of what you need to know about breastmilk production.
Firstly, towards the end of pregnancy and in the first 3-4 days after birth your breasts contain colostrum, a concentrated form of breastmilk meant to nurture baby until a mom’s body starts producing her ‘normal’ milk. Colostrum is there, whether you see it or not.
While some women leak colostrum in the pregnancy and early days, others see no sign of this super-substance. Many women become stressed in those first few days as they feel that their breasts are empty. But if a baby latches and sucks well, he will definitely get colostrum out, even if mom can’t see it. And a few millilitres of colostrum equals a full feed of normal breastmilk. It is like an espresso compared to a latte – a small amount packs an amazing punch.
Secondly, you can expect your ‘normal’ breastmilk to come in 3-4 days after your baby’s birth. This ‘coming in’ of milk is a physiological process that happens in response to the detachment of the placenta after birth.
During pregnancy, the placenta produces high levels of the hormones progesterone and oestrogen. With the placenta out of the way these hormone levels fall, allowing the hormone prolactin to increase. Prolactin is responsible for making milk.
So between day 3 and 4, you will suddenly feel your breasts becoming fuller and harder, and you may now experience milk leaking. This initial fullness lasts around 12-48 hours.
Finally, after this initial physiological ‘coming in’ of milk, your body switches to a demand-supply system for making milk. This means that your body will use the amount of stimulation on the nipples (thus how often and how long your baby latches and sucks) to determine how much milk it should produce.
So amazing is this system that one mom can feed a 2,5kg baby, another a 4.5kg baby and yet another one twins! You literally make the amount of milk that your baby orders you to make…or you do, if your baby latches well and if you feed on demand.
READ MORE: Five basic tips for breastfeeding
Legitimate causes of reduced milk production
I firstly want to acknowledge that there are a few medical factors that can most certainly affect milk supply, and if any of these apply to you it would be worthwhile to speak to a lactation consultant:
- Medical conditions
An underactive thyroid, certain congenital breast abnormalities, and occasionally PCOS can affect milk supply. The good news is that these can often be treated.
- Previous breast surgery
Previous breast reductions and augmentations can influence milk supply. I usually suggest meeting with a lactation consultant in your pregnancy already and having her help you to monitor breastfeeding after the birth to determine if and to what extent this is affecting your baby.
- The use of certain medication
Some drugs can affect your supply, including contraceptives and common over-the-counter cold-and-flu medications. If you are not sure, ask a lactation consultant to assist.
I would have loved to say ask your pharmacist or GP, but the sad fact is that most healthcare professionals are not up-to-date on medication in mothers milk, and more often than not women receive wrong information.
- Complications during the birth
Complications like a retained placenta and postpartum haemorrhage (excessive bleeding after the birth) have the potential to influence milk supply.
An elective caesarean section or early induction of labour can also play a role, as a mom’s own hormone levels are affected; however, most women’s bodies catch-up fairly quickly and these interventions are unlikely to cause long-term problems if dealt with correctly.
- Severe stress and anxiety
Severe emotional distress (for example losing a loved one) can definitely influence milk supply. The common day-to-day stressors that we all cope with are unlikely to play a significant role.
- Latching troubles
If a baby is not latching and sucking well for any reason, there will be reduced stimulation and subsequently lower milk supply. A lactation consultant can evaluate the latch and help you with any corrective measures.
Practices that can lower milk production
Sadly, most cases of low milk supply are not caused by the above medical conditions, but by a few bad practices that mothers choose to implement, often on advice from healthcare professionals and mostly without knowing that it may be harmful to breastfeeding.
- Failing to feed on demand
Your body makes milk in response to how often and long your baby breastfeeds. Feeding on demand means feeding whenever your baby wants to, for as long as he wants to. It is normal for breastfed babies to feed every 1,5-2 hours in the early months of breastfeeding. While some feed for shorter periods, many will spend significant amounts of time on the breast. Trying to stretch baby’s feeds will negatively influence your milk supply and your baby’s growth.
- Not allowing baby to empty your breasts
Mothers are often told to limit the time that a baby feeds to e.g. 20 minutes per breast, in order to prevent overfeeding and to prevent baby from just using mom as a dummy.
The truth is that proper breast emptying is needed to ensure good milk supply. If the breasts are not emptied well the body will tone down breastmilk supply to prevent engorgement. Always allow baby to drink until he comes off on his own.
- Formula top-up feeds
This practice is most harmful of all. Your breasts make milk on demand; if part of the demand comes from elsewhere your body is simply going to end up making less milk. If a baby truly need top-up feeds it would be better to express breastmilk to give to baby as at least you will be supplying extra stimulation as well.
- The use of dummies
A dummy can be a great tool to help mom cope. However, you should never use a dummy to stretch the time between a baby’s feeds, and baby shouldn’t spend time on the dummy that should have been spent on the breast. Comfort sucking on the breast also counts as stimulation and can boost breastmilk supply.
Keep in mind that dummies may add to latching difficulties, so wait until latching is established before introducing one.
How do you know that your baby is getting enough milk?
Before you implement techniques to boost your breastmilk supply, remember that it’s simple – if your baby has 5-6 wet and/or dirty nappies in 24 hours, and if baby’s weight gain is adequate you can know that your baby is getting enough and that your supply is sufficient.
So you can stop trying to fix what is not broken, simply trust a system which was specially designed to perfectly fulfil your baby’s nutritional needs, and just enjoy your breastfeeding journey.
