Avoid Booby Traps! Milk supply sabotages
I often get lactation consult requests or just questions at support group about milk supply dips.
It can be very scary when your supply takes an unexpected plunge. Especially if things were going well or if you need to go on a trip or back to work soon.
There are a few milk supply sabotages that can be remedied. Your milk supply will more than likely come right back once you get to the culprit. Don't panic, stay calm, let's fix it!
Here's a list of things that can cause your milk supply to take a hit and halt or slow down production:
Decongestants - sudafed / pseudoephedrine
Hormonal birth control
Hormonal Imbalances
Missed feeds/pumps
Oral restrictions undiagnosed
Ineffective pump or incorrect flange size
Pregnancy
Period
Increased Solids
Extreme dieting
Alcohol
Medications - bromocriptine, ergotamine, cabergoline
Let's review the most common reasons and remedies:
Period - I get this one more than you know and it almost always coincides with a return back to work for a double whammy! Yes, you can have a period while breastfeeding and it can come anytime postpartum. Exclusive breastfeeding folks with a period might not see their period return for longer. If not using any artificial teats/bottles, pacifiers, etc. Only feeding at breast under 6 months old, it can stay away for a while, like a year. This is the LAM method we will talk about this more with birth control.
For some, the drop in milk supply and nipple tenderness associated with menstruation becomes more of a challenge. An effective treatment for these symptoms associated with the return of periods is to add a calcium/magnesium supplement to the diet upon ovulation and continue it through the second or third day of a period.
The remedy:
The supplement should be 1500 calcium/750 magnesium but can be as low as 500 calcium/250 magnesium (the higher the dosage the more effective and quicker the results). It should be a combination pill. This much calcium should never be taken alone.
If your cycles are not regular and you do not know when you ovulate, you can take the supplement the entire month until you begin to see a pattern to your flow.
This type of supplement seems to work as it prevents the drop in blood calcium levels which occurs mid-cycle and continues through the second to third day of a period. It is this drop which is associated with the nipple tenderness and drop in milk supply as well as the uterine cramping so often experienced with menstruation.
Hormonal Birth Control - This is the second most common reason I hear in my practice. After a little bit of chatting, we usually get to what type of birth control are you using if any? As soon as I hear some hormonal method not compatible with breastfeeding, I let them know to find a different method temporarily like condoms as they get off the current birth control to and talk to their doctor about switching to something non hormonal.
The remedy: Tell your doctor your are breastfeeding when you discuss birth control.
Use bedsider.org or plannedparenthood.org to find a birth control comparison chart to make the best decision for you.
Breastfeeding is not a 100% proof form of birth control. Many think it is and get pregnant that way.
LAM (lactation amenorrhea method) is a birth control method that requires you to be exclusively breastfeeding a baby under 6 months, your period cannot have returned and you must not be offering any other foods, bottles, pacifiers of any kind for any time. This is the ONLY way this method works. It's not easy for everyone but it is a natural family planning option. This works by preventing ovulation.
Missed feeds / pumps - Sometimes this happens when you travel, move or start school or working again. Stress and overload at work can lead you to forget your pump session. It's ok, it happens.
The remedy:
The key is to just get back on schedule. Add yourself an extra session in the day and be sure to feed or pump often, aim for every 2-3 hours or 8x or more in 24 hours. Power pumping might help. Travel with a hand pump or wearable. You just put the wearable pump in a checked bag. Try a wearable for work meetings or school. Some are quiet enough to wear discreetly and not have to miss your session due to work.
Oral restrictions or tongue tie - It's always a good idea to rule out or in any oral restrictions / tethered oral tissues with supply issues. It that may be limiting range of movement and motion of the tongue or oral cavity.
The remedy:
If you suspect it due to pain, slow weight gain or poor latch skills, and baby has not been seen by a lactation consultant, have them see one for an oral assessment.
Infant bodywork (pediatric chiropractic or craniosacral therapy) can be done in the meantime as well. It can cause low supply if baby isn't transferring well. They will guide you on next steps whether they find one or not.
Quick notes on these:
Alcohol - In excess amounts, you could dehydrate yourself causing milk to "shrivel up" and be gone. I've not seen it in practice, but I would imagine if you are suffering with alcoholism breastfeeding would be contraindicated for you. Too much alcohol in the blood means too much in the milk. Keep it to 1-2 drinks every 2-3 hours. I wouldn't binge or get drunk while feeding even if you can pump and dump. Pumping and dumping is not necessary for casual drinking. You should just allow the alcohol to clear your bloodstream and then it's cleared your milk. More on this here.
Dieting - Work with a nutrionist and let them know you are breastfeeding. They will be able to help you with your weight loss goals and eating habits in a healthy way. They might alert you to lactogenic foods to continue to promote good production. It's best to not go under 1700 calories a day. Try not to lose more than one pound a week for healthy weight loss that doesn't impact supply.
Increased Solids - Babies naturally decrease their milk intake over time after beginning solids. You can add a pump session into your day when they eat if you desire to produce more. Always offer the breast before solids.
Hormonal imbalances - seek help or a doctor or naturopathic doctor to run necessary blood tests
Pregnancy - Usually doesn't cause a drop until you are around 16-20 weeks when your milk composition changes back to colostrum if you are still nursing.
Decongestants - Try nasal saline spray, neti-pot or other holistic remedy. Decongestant medications like sudafed / pseudoephedrine, work by drying up the mucus and all other liquid in your body. This includes your milk. This is also why you have to stay well hydrated with these medications. We even recommend them for abrupt weaning solutions, that lets you know how powerful it is. Avoid if you don't wanna lose supply. If you've taken it, do not panic. Stop taking it and ask your doctor for something else. Being stuffy is miserable but so is having no milk when you need it. 😖
Ineffective pump or incorrect flange size - I have a whole blog on this. Basically, if you have a pump that your body isn't responding to, you'll want to try something else. Doesn't mean more expensive and doesn't mean higher suction. You may just need a hand pump or a hospital grade pump instead of a wearable. Wrong size flange will give you poor output, period. It's amazing to see the milk spray vs the drip with the proper size!
Medications - Ask you doctor to review LactMed before starting a new drug to ensure it's compatible with breastfeeding. Tell them you are nursing. Most drugs are compatible but some are not. Some doctors are not familiar with lactation. If they aren't ask an IBCLC to help you find a doctor who is breastfeeding friendly.
That's all I have for you on this one, whew we covered a lot!
Hope you feel educated and empowered on how to self troubleshoot ways to increase your supply if it has dipped. If you can't figure it out ask an IBCLC.