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  • Writer's pictureChardá Bell, IBCLC, CBE, CD

Do I Have Low Milk Supply?

Several common misconceptions often lead people to believe they have insufficient milk when they are in fact producing enough. A few of those misconceptions come from more frequent demands by the infant to feed, feeds becoming shorter over time, colic, the perception that the baby is more satisfied after being fed formula and a slowdown in growth after three months.

This is what we call PIMS (perceived insufficient milk supply). This is common amongst new mothers, experienced ones, even partners and dads, grandmas and aunties. Everyone has an opinion when it comes to your new baby and your ways of caring for that baby, including feeding choices. Guess what, only your opinion and thoughts matter!

To evaluate whether milk supply is actually insufficient, qualitative parameters should be used such as the following:
  • By 3–5 days, of age, the infant should be stooling 3–4 times per day and urinating 3–5 times per day. By 5–7 days of age, there should be 3–6 stools per day and 4–6 urines.

  • The infant should be alert, have good muscle tone, and show no signs of dehydration.

  • The infant should be consistently gaining weight and growing. In newborns, a loss of more than 5 to 7 percent of birth weight warrants investigation.

  • Gaining 4-7oz a week and back to birth weight within 2 weeks of birth. The use of IV fluids in labour tends to artificially increase the birth weight of the baby, and subsequently inflate the baby's weight loss.

If an infant is not showing these signs of growing well, other possible causes include:
  • Poor milk transfer due to tongue-tie, or cleft palate.

  • Medical conditions in the infant, such as malabsorption of nutrients.

Low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

Low milk supply is often caused by allowing milk to remain in the breasts for long periods of time, or insufficiently draining the breasts during feeds. It is usually preventable, unless caused by medical conditions which counts for only about 5 - 15% of lactating women.

Low milk supply is producing less breastmilk than the infant requires. Milk increases in volume or "comes in" around 30–40 hours after delivery of a full-term infant.

Low milk supply is different from delayed onset of lactation or delayed lactogenesis stage II. This is when the milk comes in later than normal but when it does it produced in sufficient quantities. Sometimes this is due to excess IV fluids and medications, traumatic birth or c-section.

Concerns for low milk supply would be If your baby is not growing well or is showing signs of dehydration or malnutrition, and does not have a medical condition that would explain the lack of growth.

The best way to increase milk supply is improved breastfeeding practices (positioning and latch) and/or expressing milk through pumping or hand expression. If you are truly experiencing low milk supply, a prescription medication called Domperidone increases milk supply for some people.

There are two forms of low milk supply:

Primary (caused by medical conditions or anatomical issues in the lactating person), Secondary (caused by not thoroughly and regularly removing milk from the breasts) or it can be both.

Secondary causes are far more common than primary ones.

The main reasons for secondary low milk supply would be:
  • Poor Latch

  • Unnecessary non-medical use of supplemental formula

  • Timed or scheduled feedings (as opposed to on-demand feedings)

  • Overuse of pacifiers

Medical conditions in the infant that result in weak or unco-ordinated sucking can cause low milk supply by inhibiting the transfer of milk to the baby.

These conditions include:

  • Tongue Tie

  • Congenital heart defects

  • Prematurity

  • Down Syndrome

Primary causes of low milk supply include:
  • Insufficient glandular tissue, also known as primary lactation failure. Breasts with insufficient glandular tissue often have a tubular shape, with a large space between the breasts, and often do not grow during pregnancy.

  • Retained placenta (Results in high levels of progesterone, a hormone that inhibits lactation.

  • Sheehan's syndrome

  • Prior breast surgery (especially breast reduction - Surgery or injury to the breast can decrease supply by disrupting milk ducts that carry milk from the alveoli where milk is produced, to the nipple.)

  • Polycystic ovary syndrome (PCOS)

  • Hypothyroidism

  • Hypoprolactinemia

  • Theca lutein cysts

  • Hypertension

  • Pregnancy

FYI - Smoking more than 15 cigarettes per day is also associated with reduced milk production. Have not seen enough research on cannabis and human milk to confirm or deny it drastically lowers or alters milk supply.

Some medications are known to significantly suppress milk production, including:
  • Pseudoephedrine & phenylephrine

  • Diuretics

  • Contraceptives (that contain estrogen)

Some herbs including Sage & Peppermint in large doses may suppress milk production. Cabbage does the same thing.

Learn more in the next blog on how to prevent & manage low milk supply.
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