Causes of Low Milk Supply in Breastfeeding Mothers
When initiating breastfeeding, certain natural changes occur. In the first few weeks, particularly during the first month after childbirth, mothers may notice that their breasts feel softer and appear smaller. This does not indicate insufficient milk levels for the baby’s needs; rather, it is a typical occurrence. Additionally, infants may sometimes increase their feeding frequency as a way to stimulate milk flow, which is known as cluster feeding. It’s important to highlight that low milk supply can sometimes be attributed to delayed milk let-down, which might gradually or suddenly decrease milk production. If a genuine issue with milk supply exists, signs of hunger and discomfort may appear in the infant, alongside insufficient weight gain.
It is essential to understand that several factors contribute to low milk supply in breastfeeding mothers, some being related to the mother and others to the infant. Occasionally, causes may involve both parties, necessitating a thorough evaluation. Implementing a remedy requires following professional guidelines to address these concerns. Regardless of the cause, it is crucial to ensure that the infant receives adequate nourishment throughout the treatment of low milk supply, as they require frequent feedings.
Maternal-Related Factors
Incomplete Latching
One of the most common reasons for low milk flow is improper latching during breastfeeding. The suckling action stimulates the breast to produce more milk, thus an ineffective latch may prevent the infant from drawing milk efficiently from the breast, leading to a decrease in the mother’s milk levels. It is advisable to assess the infant’s positioning on the breast to ensure a proper latch, and mothers may benefit from consulting a doctor, nurse, or local breastfeeding support group.
Short or Infrequent Feedings
Milk production in the breast is continuous, relying heavily on how well the breast is emptied during feedings. Milk supply increases when the breast is drained and decreases when it is full. Therefore, frequent breastfeeding, especially during the initial weeks, promotes healthy milk flow and adequate supply for the infant. Inconsistent feeding can be a common reason for reduced milk levels, as repeated breastfeeding stimulates the body’s milk production. Most newborns require feeding every 2-3 hours day and night. Establishing a feeding schedule that allows prolonged sleep for the infant or using pacifiers between feedings can limit the opportunities for natural stimulation of milk production. Additionally, offering formula between breastfeeding can prevent the infant from getting sufficient milk. Ideally, breastfeeding should occur on-demand, responding to cues of hunger, and if the infant is very sleepy, waking them every three hours for feeding is recommended.
It is essential to note that short feeding periods may not allow the breast to evacuate milk adequately, which, in turn, fails to stimulate further milk production. For instance, if an infant is on each breast for only five minutes, they may not receive adequate nutrition from the available milk. Furthermore, time spent using a pacifier can reduce the duration of breastfeeding, subsequently affecting milk production, although this may not apply to every infant.
Early Introduction of Formula
A lack of understanding regarding the importance of colostrum produced in the initial days postpartum can lead many mothers to erroneously believe that they possess insufficient milk for their babies, resulting in premature and unnecessary formula use. Mothers often misinterpret the stages of cluster feeding in later developmental phases, leading to earlier reliance on formula and supplements. This early use can cause the infant to spend less time nursing, hence reducing the hormonal stimulation responsible for milk production. This reduction sends feedback to the body to decrease milk supply, creating a negative feedback loop between formula use and decreased breastfeeding. If there is a medical need for formula supplementation, mothers should begin pumping breast milk to enhance overall production.
Stress in Breastfeeding Mothers
Separation from the infant can trigger emotional and physiological stress in the mother. For example, if the infant is admitted to a neonatal intensive care unit, it is vital for the mother to visit frequently and make physical contact if medically permissible. To avoid delayed milk let-down or decreased supply, mothers must pump as soon as possible. Increased stress levels can lead to a sudden decrease in milk supply.
Hormonal or Endocrine Issues
Certain conditions, such as diabetes, hypertension, thyroid hormone imbalances, and polycystic ovary syndrome, can contribute to low milk supply due to their impact on hormonal signals necessary for milk production. Addressing these health issues can sometimes improve milk production, and mothers may need to consider dietary supplements.
Use of Certain Medications
Some medications are known to diminish milk production. If a decline in milk flow coincides with the introduction of these medications, an evaluation of the mother’s health is warranted. It is important for mothers to inform their healthcare provider of their breastfeeding status, enabling recommendations for safer alternatives. Medications that may affect milk production include:
- Decongestants containing pseudoephedrine.
- Fertility medications like clomiphene.
- Antihistamines such as cetirizine and diphenhydramine.
- Birth control pills that contain estrogen; progestin-only contraceptives are advised for postpartum breastfeeding periods.
Insufficient Glandular Tissue
Glandular tissue in the breast is responsible for milk production. A reduction in this tissue can result in insufficient milk supply, a condition that affects a small percentage of women. Despite the inability to produce enough milk to fully nourish the baby, many of these mothers can still breastfeed successfully. It’s noteworthy that the milk ducts expand with each pregnancy and that breastfeeding promotes further duct and tissue growth; hence, this issue may diminish with subsequent children.
Other Contributing Factors
Additional causes for low milk supply in breastfeeding mothers may include:
- Excessive alcohol consumption: This can lower milk supply, so it is advisable to limit intake.
- Missed night feedings: Failing to empty the breast during the night reduces levels of prolactin, the hormone that is typically elevated at that time, subsequently decreasing milk supply.
- Certain herbs and spices: Consuming large amounts of specific herbs like sage, thyme, mint, marjoram, parsley, and lemon balm can reduce milk production, although small amounts usually do not pose an issue. Large quantities of sweets and acidic foods can also affect supply; most mothers can tolerate them but should consider dietary adjustments if they experience challenges with milk production.
- Previous breast surgeries: The impact of surgical procedures on breastfeeding can vary significantly, depending on how the surgery was performed, any complications that caused scarring or damage, and the time elapsed between the procedure and childbirth. Many women, especially those who undergo breast augmentation, can breastfeed without significant difficulties, while others may require additional assistance and supplementation.
Infant-Related Factors
Factors causing low milk supply related to the infant include:
- Premature birth: Premature infants may have underdeveloped sucking and swallowing processes, requiring more time to grow instead of expending energy on breastfeeding. They may need assistance in learning how to breastfeed effectively.
- Food allergies or sensitivities: If an infant suffers from food allergies, they may exhibit fussy behavior while nursing.
- Oral health issues: Some oral conditions such as a high palate may hinder effective breastfeeding.
- Congenital anomalies: Conditions such as cleft lip and palate can prevent proper latching, which inhibits the infant’s ability to suckle correctly.
- Neurological conditions: Certain neural problems may disrupt abilities related to swallowing and sucking, necessitating nutritional intervention.
- Down syndrome: Infants with Down syndrome may experience muscular weaknesses and other issues requiring specific support for feeding challenges.
- Gastroesophageal reflux or acid reflux: The pain from these conditions can lead to poor nursing and inadequate weight gain while displaying colicky behaviors.
- Inadequate milk transfer: Mothers may perceive low supply despite normal milk production if their infant is not effectively transferring milk over time. Conditions like tongue-tie or lip-tie are common reasons for this issue and can often be resolved with help from a pediatrician or lactation consultant.
When to See a Doctor
If the aforementioned causes have been ruled out—meaning the infant is latching and nursing effectively every two to three hours throughout the day—yet milk supply remains low without noticeable improvement, it is advisable for the mother to consult a healthcare provider. There may be underlying health issues contributing to inadequate milk production. Fortunately, many causes of low milk supply can be effectively treated, although in rare cases, there are factors that may not be reversible, necessitating some supplementation to ensure the infant receives adequate nutrition, all while continuing to breastfeed.