Updated article : October, 2023.
Hello Parents,
You now have a new baby at home and you’re breastfeeding them. You might be wondering if you’ll have enough milk to meet your little baby’s needs. Growth spurts at different times in a baby’s life give parents the impression that mom’s milk isn’t rich enough. Or maybe she doesn’t have enough. But never worry about the quality of your milk. And a minority of mothers won’t be able to provide the necessary amount due to insufficient milk production. In this entry, I will talk about the circumstances that might lead to low milk production.
In this article:
- Low milk production causes due to the baby
- Low milk production causes due to the mother and breastfeeding practices
- Practical advice to avoid low breast milk production
When a health care professional sees you for a postnatal follow-up, they will gather information about your pregnancy and childbirth, and how your breastfeeding is going. They do this to better understand and advise you.
When milk production problems occur during the 3- or 4-week follow-up visit, parents will often say:
- That their baby is unsatisfied when breastfeeding, agitated, lets go of the breast, cries while feeding or even refuses to feed, bite the nipple or pull it when they throw their head back;
- They feed often;
- That the length and frequency of feeding increases, leading to nipple wounds;
- That the baby falls asleep due to fatigue. They will wake up a couple of minutes later and ask for more.
The caregiver needs to examine your baby to check their growth and development. Before assuming low breast milk production, they have to examine the whole situation before making conclusions and providing advice.
According to podiatrist Jack Newman, the mother is responsible for the milk transfer to her baby, and the baby reacts to the milk flow. They may fall asleep. Not because they’re tired but because the milk flow is slow. Too slow to encourage them to continue feeding. The baby stimulates the nipple when they latch on to it, but if they don’t suck strongly, it sends a signal to the mother’s brain to promote milk ejection. The baby isn’t a passive participant!
Breastfeeding isn’t really physically difficult for a baby. However, if they’re not properly latched on to the nipple, aligned properly, the milk flow might be negatively influenced, and this will indirectly affect the quality and satisfaction of the baby’s feeding. The moral of the story is that you have to PROMOTE GOOD MILK FLOW, as the baby reacts to the milk flow in their mouth.
Different causes can lead to low milk production in a new mother. These can be associated with her, her baby or poor breastfeeding practices.
Causes of Low Milk Production Due to the Baby
- Take the situation where a baby has very weak sucking capacity or a baby who is very sleepy. For example s premature baby who has difficulty latching on the breast for sufficient time. As quickly as possible after childbirth, you have to promote the mother’s satisfactory milk production and flow. This will keep them awake and increase the quality of their feeding. If the flow is slow and difficult to obtain, their sucking efforts and their response to low milk flow will make them disinterested doing it. They will prefer falling asleep.
- The baby can’t latch on to the base of the nipple. Why the base of the nipple? Because that is where the neurotransmitters are. If they baby only latches on to the nipple, the stimulation isn’t the same. The message sent to the brain to stimulate production isn’t the same either. This can lead to low milk production. You have to re-evaluate the baby’s position on the breast. Simply changing the alignment can make a difference for latching.
- A baby with severe jaundice or hypotonia (lack of tone).
- Mechanical causes include a baby with torticollis, plagiocephaly, cleft lip and/or palate or a short tongue frenelum.
- A particular health condition, such as a muscular or skeletal problem (mobility disorder) or a cardiac, neurological or infectious problem.
Many low breast milk causes are due to the mother and breastfeeding practices exist.
- Pacifier: Parents use a pacifier instead of breastfeeding the baby. Breastfeeding stimulates production. The pacifier interferes with milk production. (Decreased frequency of feedings.)
- Latching: there are mothers with flat or very large nipples. Based on the baby’s mouth and morphology, it’s difficult to fully latch on to the nipple and this incorrectly stimulates the neurotransmitters at the base of the nipple.
Baby positioning: it’s important to position the baby properly for breastfeeding. This provides better stimulation, and sometimes you just have to shift the baby’s alignment towards the breast to improve latching.- You have to stimulate both breasts when breastfeeding. This promotes milk production and milk flow for the baby. Avoid feeding from one breast at a time because it can diminish milk production over time.
- Medication: if the mother is taking medication, it can indirectly affect their production (for example certain decongestants containing pseudoephedrine). Hormones are sensitive, even when using medications that are theoretically compatible with breastfeeding. It will be different for each woman, so remain watchful.
- Hypothyroidism: if the mother has hypothyroidism (a lowering of the thyroid gland function which influences other organs in the body), it can impact production.
- Hypoplasia: a mother might have hypoplasia (fewer mammary glands in her breasts) unilaterally (one breast) or bilaterally (both breasts). Your caregiver can examine your breasts for this. If you note that your breasts didn’t really change during pregnancy, this can be an indicator.
- Breast reduction surgery: if a mother had breast reduction surgery to remove mammary glands for back pain or other issues, their nipple might have been moved. If so, the nerve endings to the nipple were cut along with milk production signals to the brain.
- Breast implant surgery: we see many more mothers with breast implants. If the nipple wasn’t moved and the implant was inserted under the breast, milk production should be fine. But any surgery should be considered, as the targeted structures go through trauma. But generally, there should be no problem breastfeeding a baby after breast implant surgery.
- Polycystic ovaries: if the mother has been diagnosed with polycystic ovaries, this can influence their milk production.
- Placental retention.
- Post-partum hemorrhage.
- Hypertension and preeclampsia.
- Pregnancy diabetes, with insulin.
- Mastitis.
- Fatigue, stress, and pain felt elsewhere in the body can negatively impact milk production.
- Caffeine and tobacco use can also influence production.
- A new pregnancy.
The caregiver will advise you when the potential causes have been identified. They will know your pregnancy and childbirth history and observe your breastfeeding. They will weigh the baby and ensure they gain between 25 g and 30 g a day. A first step could be the use of non-pharmacological measures to improve the situation.
- Examine breastfeeding positions;
- Examine your medication (ex.: contraception, Synthroid for hypothyroidism, iron for anemia);
- Carefully use material to help breastfeeding, depending on the situation, such as a nipple shield (ex.: flat nipples) or an electric breast pump (increase stimulation);
- Will they provide supplemental milk to the baby for weight gain? If yes, how, to avoid confusing the baby and harming your breastfeeding? With a cup? Lact-Aid (little tube)? Spoon?
