Ask the Experts: Insufficient Supply of Breastmilk

by Cynthia Good Mojab,

Maternal Mental Health, International Board Certified Lactation Consultant, Clinical Counselor

Should I be concerned about not having enough breastmilk to nourish my baby?

Many mothers are concerned about not having enough milk. Yet the likelihood that a woman will be physically unable to produce sufficient milk for her nursling is actually low. So why is this such a common concern? Part of the answer lies in our loss of the art of breastfeeding. Many mothers have grown up in families where they are the first women in generations to breastfeed. These mothers are pioneers, doing the best they can with the information and support available to them. Unfortunately, because they are breastfeeding in a formula-feeding culture, the information they receive may be inaccurate and the support they have may be inadequate-which can undermine their efforts to breastfeed. In addition, exposure to formula advertising and being given free formula in the hospital after birth can decrease the confidence of mothers in their ability to breastfeed.

Milk supply is dynamic. It follows the law of supply and demand. The more frequently and effectively a nursling breastfeeds, the more milk the mother's breasts make. That's why recommendations to rigidly schedule and limit feedings or to never breastfeed at night (instead of responding to a nursling's cues for frequent, flexible feedings) can result in a reduced milk supply. It's also why nursing more frequently and ensuring that a nursling is effectively draining the breast are good first steps toward increasing milk supply.

Sometimes the misinterpretation of a nursling's behavior can lead mothers to think they don't have enough milk even though they actually do. Let's say a baby seems fussy after a feeding. The mother-or someone around her-may interpret the baby's behavior to mean that the mother doesn't have enough milk. A mother can have plenty of milk, but if she is engorged, the baby isn't positioned and latched on well, or the baby is using an incorrect suckling pattern because of exposure to artificial nipples, then the baby may not nurse effectively. (Such problems have solutions: they do not have to result in low milk supply or weight loss in a baby.) Or perhaps the mother has plenty of milk and the fussy baby is nursing effectively, but has thrush (an oral yeast infection) or is teething or needs to have a bowel movement. Fussiness can even be due to an ample milk supply that flows so quickly the baby has difficulty managing its abundance! These are just a few of the many reasons a baby might be fussy at the breast and that might lead to someone suggesting that a mother supplement with formula. Regardless of what leads to supplementation with formula, it is a very effective way of decreasing a mother's milk supply if her breasts are emptied less frequently and thoroughly because of it. Remember: milk supply follows the law of supply and demand.

Before or after the birth of a baby, International Board Certified Lactation Consultants and La Leche League Leaders can help mothers sort through breastfeeding advice to identify what is helpful and what might get in the way of building and maintaining a good milk supply. They can help mothers learn about positioning and latch-on so that nurslings can effectively obtain milk, how to tell a nursling is getting enough milk, and how to increase milk supply, if needed. They can also refer mothers to healthcare providers to evaluate a nursling's weight gain and development or to determine if there are any physiological causes of low milk supply in mother (e.g., a hormonal imbalance, retained placenta, previous breast surgery) or nursling (e.g., tongue-tie, low muscle tone, respiratory problems)-many of which are treatable.