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Understanding Low Milk Supply

By May 8, 2024May 14th, 2024No Comments11 min read

Low milk supply is considered an under production of milk during breastfeeding. It can be a temporary occurrence, or it can persist as a long-term issue. Concern around low milk supply affects many families and is one of the biggest contributing factors to stopping breastfeeding early.

Below we discuss the indications, causes and treatments for low milk supply based on current evidence and best practice. We also discuss how Coro can help with concerns around low milk supply.


Indications of low milk supply

Listed below are indications of low milk supply, alongside examples that are NOT indicative of low milk supply. 

When the indications listed on the left are present, breastfeeding must be assessed. Reach out to a health professional or lactation consultant if you notice any of these signs.

Signs of low milk supply NOT signs of low milk supply
  • Baby losing weight or weight remaining static (some weight loss is expected in the first week of life, most hospitals treat this as normal if it is within 10% of baby’s birth weight. Baby’s weight should increase in line with the WHO growth charts).
  • Baby having signs of dehydration, including dark coloured urine and persistent jaundice.
  • Low urine/stool output (For young babies, expect 1 wet nappy for each day since birth, e.g. on day 4, baby should have 4 wet nappies.
    After this, breastfed babies should have at least 6 wet nappies and at least 3 dirty nappies per day from 6 days of age.
    For breastfed babies over 5 weeks, focus on wet nappies as stool output can be an unreliable measure).
  • Breasts not feeling full, sore or heavy (this often happens when milk supply has been established and your breasts have ‘learned’ how much milk to produce).
  • Breasts remaining hard or full after feeds.
  • Small breasts.
  • Not feeling the let-down reflex.
  • Wakeful babies or babies that want to be held often.
  • Upset babies, crying is not always a sign of hunger.
  • Not being able to express a large amount of milk.
  • Breasts not leaking.
  • Baby still seems hungry/happy to feed from a bottle after a breast feed.
  • Changes in babies’ feeding patterns, or patterns that include cluster feeding, spending a long time at the breast, feeding frequently or fussing at the breast (breastfeeding should be baby led, if baby is suddenly wanting to feed more it is OK and simply reflects baby’s appetite for milk and/or comfort).

 

Potential causes for low milk supply

There are many behavioural factors that impact milk supply and these can lead to false perceptions around an individuals ability to make enough milk. For many cases of low milk supply, behavioural factors are the cause and the solution.
Chronic low milk supply, that persists beyond changes in behaviours around breastfeeding, usually arises from a physiological issue. We explore both causes of low milk supply below. 

A research paper collating data from 27 studies found that 50% of mothers who had stopped breastfeeding did so due to concerns about low supply. In mothers who were still breastfeeding, 10-25% of them felt concerned about low supply. These studies showed that low supply concerns were influenced by behavioural factors such as breastfeeding initiation and breastfeeding knowledge. 

Rates of physiological milk supply are more difficult to measure due to the many individual and behavioural influencing factors. Some studies estimate rates of 10-15%, however, sufficient supporting evidence for this is limited. More research is needed to determine the actual prevalence of chronic low milk supply.

Behavioural:

Behavioural causes for low or declining milk supply come from breastfeeding practices and patterns. Examples of these include:

  • Not initiating breastfeeding early enough.
  • Irregular feeding patterns, leaving long periods of time between feeds.
  • Stopping breastfeeding sessions early.
  • Replacing breastfeeds with formula and thereby reducing milk removal and breast stimulation.
  • Breastfeeding with poor attachment and positioning of baby at the breast.
  • Breastfeeding when latch or suck problems are present. 

Each of these behaviours are known to negatively impact breast milk supply over time. The good news is that they can be rectified with the support of a qualified health professional. If you feel any of these behaviours describe part of your breastfeeding journey, reach out to a lactation consultant for support.

Physiological:

If all of the above factors have been considered but the indications of low supply persist, then physiological issues may be the cause. Physiological reasons for low supply might come from hormonal issues that impact breast tissue or they might arise from the physical capacity or nature of the breast tissue. Some of these issues can cause a delay in milk ‘coming in’ that evens out over time, whilst others can impact supply throughout breastfeeding.

Below are some examples of conditions/circumstances that can impact breast milk supply:

  • Polycystic Ovary Syndrome (PCOS).
  • Diabetes (including Gestational Diabetes), Obesity and insulin resistance.
  • Thyroid conditions.
  • Other conditions that might influence hormones: e.g. retained placenta after delivery, theca lutein cysts or being pregnant.
  • Extensive blood loss during birth.
  • Smoking and drinking alcohol can negatively impact breastfeeding hormones.
  • Breast injury or previous surgery can sometimes impact milk supply.
  • Insufficient breast glandular tissue, also known as hypoplasia.

 

Treatment options 

When low milk supply is a result of a physiological issue:
It is important to access a health professional who can help you address the problem. Sometimes lifestyle changes or medications can help and physiological reasons can be treated. However, low supply can be some mums’ ‘normal’, and this is okay, it does not reflect on your worth as a mother and many work around solutions are available.  Reach out to a lactation consultant to determine a feeding plan that works for you and your baby. 

When low milk supply is likely due to behavioural factors:
Reach out to a lactation consultant to identify and address the behavioural factors related to your supply concerns.
Below are some tips that can help to maximise milk production at home, ask your lactation consultant to support you with these methods. 

  1. Feed or express regularly. Aim for at least 8 feeds in 24 hours. Regularly feed from both breasts and try to drain breasts thoroughly at least once a day as empty breasts will trigger more milk production.
  2. Perfect the latch at every feed. Even small adjustments to positioning and attachment of baby at the breast can make a big difference. 
  3. Do lots of skin to skin. Having baby close will trigger the release of the hormones required for milk production. It also allows babies to feed on demand which is essential for establishing supply.
  4. Try using  breast massage or warm compress before/during feeds, this can also work wonders during pumping sessions.
  5. Nutrition and hydration. Regular healthy and nutritious meals plus snacks and staying hydrated is key. 
  6. Don’t avoid the early morning feeds (2-5am). Prolactin is the hormone that governs milk production, and it naturally peaks between 2am and 5am. To make the most of this, allow baby to feed throughout this time.
  7. Reduce stress where possible. Stress hormones can interfere with the hormones that support breastfeeding. Creating a calm environment, asking for support and getting as much sleep as possible will help while you work to rectify supply issues.
  8. You can introduce an expressing schedule to boost milk production and supply. Using your hands or a breast pump, introduce expressing sessions after or between feeds for 10-15 minutes on each breast. Breast pumps may be more effective due to the suction they can create and double pumping with a hospital grade pump often works best, but some women find hand expression just as useful. Adding 2-3 pumping sessions per day for a few days consistently may help to boost your supply. 
  9. Consider ceasing use of your hormonal contraceptives. These hormones may influence breastfeeding.

 

How Coro can help with concerns about low supply

Coro is a nipple shield with a highly advanced flow sensor that allows us to quantify milk flow during feeds. 

As discussed above, the indicators of low milk supply show up only when supply issues have started to impact baby. With Coro, earlier identification of supply issues is possible, without the need to wait for potentially severe symptoms in baby.

Coro has been designed to give parents peace of mind when supply or feeding issues are interfering with breastfeeding. With the information Coro provides on feed volumes Coro can reassure families that baby is getting enough and that mum’s milk supply is perfectly adequate to meet baby’s needs.

Coro can also provide the information required for health professionals and lactation consultants to confirm the presence of low milk supply. With this, treatments and/or suitable feeding plans can be established. 

 

References

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