I Don't Have Enough Breast Milk. Why?

When your baby is anxious or wants to breastfeed just an hour after feeding, it's natural to worry that you don't have enough milk. But this is normal behavior and if it increases its weight there is no reason to worry.

For some mothers, however, the results of the baby's weight are not so encouraging and they believe that the amount of milk they produce is not always enough to meet the needs of the baby. Diana West of the International Board of Lactation Consultant and co-author of Getting More Milk says changes in breastfeeding techniques or the help of a breastfeeding expert can significantly boost milk production.

How to find out if breast milk is declining

First, there are several no reliable ways to determine whether your milk supply is adequate, including the way you feel your chest (full or empty); the frequency and / or duration of breastfeeding; the fact that your baby can take a full bottle of formula after breastfeeding; absence of leaking milk or lack of breast milk when trying to express. None of these indicators are reliable. Fortunately, there are many signs that will give you guidance on whether your baby is getting enough milk:

• the baby actively hugs during feeding;
• the diaper is wet with each shift (8 to 10 times a day);
• urine is straw yellow or colorless;
• the baby defecates about five times a day;
• gain weight.

Most mothers can breastfeed their babies effectively. So before you start thinking about formula and give up breastfeeding, ask the following questions:

• Does the baby hold the breast properly?
• Do you breastfeed often enough?
• Does the baby suckle long enough with each feeding?
• Does the baby go through a period of growth?

The answer to these questions can give you guidance on whether a problem you are having with breastfeeding can be resolved quickly and easily or the cause is more serious.

More information can be found in the topic " Is breast milk enough for your baby ".

A very small percentage of women have really low milk production. However, the problems in some cases can be fixed again.

The most common causes of poor milk production and strategies that can help

In some women, the breasts do not develop normally (for various reasons) and may not have enough milk ducts to meet the baby's needs. The ducts grow during each pregnancy, in addition, breastfeeding stimulates the growth of more ducts and tissues, this prevents problems in the second or third baby. There are certainly steps you can take to maximize milk production (this may include expressing breast milk and taking medication, which you must consult your doctor for), but it may also be necessary to resort to adapted milk. It is worth the effort to continue breastfeeding, as it will help build your baby's immunity, brain development and nutritional needs.

Additional information on expressing breast milk can be found in the topics " Expressing and storing breast milk " and " Manual expressing of breast milk ".

Such problems can be: polycystic ovary syndrome, decreased or increased thyroid function, diabetes, hypertension (high blood pressure) or hormonal problems that make it difficult to conceive. Each of them can contribute to the low supply of milk, because it is formed as a result of hormonal signals that are sent to the breast.

What could you do? In some cases, treating the health problem will help stimulate milk production, although additional nutrition may be needed. Meeting with a breastfeeding counselor can help you find an approach that will work well for your specific condition.

Breast surgeries can be performed for both medical and cosmetic reasons. Breast augmentation and reduction, for example, are some of the most common surgeries. Nipple piercing is also considered a type of breast surgery and can damage the milk ducts in the nipple.

The extent to which these surgeries affect breastfeeding depends on how the procedure is performed, the time elapsed between surgery and the birth of the baby, and whether there are any complications that have caused scarring or damage to the breasts. Some women, especially those who have improvements (enlargement) of the breasts rather than a reduction in breast circumference, can breastfeed without any difficulty. Others will need extra help and may need supplementation.

For many mothers who breastfeed and take birth control medications, milk production does not change, but for some, any form of hormonal control can lead to a significant drop in milk. This is more likely to happen if you start using contraceptives before your baby is four months old, but it is also possible at a later stage.

The first step to increasing breast milk is to stop taking contraceptives, but before doing so you need to consult your doctor and be prepared to change the methods of birth control. Some mothers will also need extra help (such as prescription drugs, herbal supplements and / or more frequent pumping stimulation) to stimulate milk production.

Pseudoephedrine (the active ingredient in cold medicines), metherin, bromocriptine or large amounts of sage, parsley or mint can affect breast milk production. If you find that your breast milk is declining and you need to take a prescription, then see your doctor for a consultation. You can also discuss alternative health treatments with him. More frequent breastfeeding and possible pumping of breast milk will help you to resume milk production.

The problem may be that your nipples are flat or sunken. Then the intake of breast milk is difficult.

Another possible reason is the presence of a short bridle on the baby's tongue. This means that the lining connecting the lower part of the tongue and the floor of the mouth is very short, which disrupts the normal movement of the tongue and makes it difficult to suck (the baby does not actually suck the milk from the breast, but uses his tongue to press the breast and milk to fall into his mouth). In many cases, this is quite easy, but for some babies, the restrictive mucosal connection is a huge difficulty. The solution to this problem is with a light surgical intervention (frenotomy). It provides full mobility of the tongue and is painless.

Another problem that can also cause breastfeeding difficulties is a rabbit's mouth or a cleft palate.

There are many books and programs that offer sleep methods to get babies to sleep longer at night without waking up to eat. Although these techniques work very well in some families, lack of night feedings can lead to weight gain problems in some babies.

In addition, the lack of breastfeeding at night leads to a decrease in milk production, as the level of prolactin (the hormone that signals the breast to produce milk) is higher during night feedings. It is difficult to resist the irresistible desire for restful sleep, but for many mothers these night feedings are essential for maintaining milk production. If you are trying to stop night feedings, but find that your milk is declining, it is a good idea to consider reintroducing them.

Meal planning and/or use of a pacifier in between

Breasts produce milk continuously, but the rate at which it is formed depends on how empty they are. The more empty they are, the more milk is produced. When the baby is scheduled, every three hours, or you are offered a pacifier to prolong the time between feedings, the breasts remain fuller for longer periods of time. This means that milk production is reduced. When babies are breastfed in response to their needs rather than a schedule, feeding periods are shorter. Frequent feedings lead to correspondingly frequent emptying of the breasts, which stimulates the production of breast milk.

Mothers do not always realize that medications used during childbirth (such as epidural anesthesia) can affect the ability to breastfeed effectively. Some studies show that these effects last for different times depending on the medicine used and the duration of administration.

Jaundice is a common disease in newborns. In this condition, babies are more sleepy than usual and do not wake up to breastfeed as often as healthy babies would.

In both cases, you may need to express breast milk to stimulate its production. Once the medication is released from the baby's body and the jaundice is cured, it will probably start to suck well. Then you could reduce and possibly stop pumping.

Especially in the first few weeks, formula supplementation may be a major reason for lower breast milk production.

"In the first few weeks, the capacity of the breast to produce milk is calibrated depending on the amount of milk that is removed," says breastfeeding consultant Diana West. "If less milk is removed (drained or squeezed), the breasts suggest less production is needed, so the capacity is set at a lower point." When the baby receives formula, it is natural for him to suckle less and, accordingly, the breasts produce less milk.

If supplementation is necessary, it is best followed by an attempt at breastfeeding and breastfeeding. In this way you will stimulate the formation of breast milk.

If you suspect that you do not have enough milk, do not rush to stop breastfeeding. Contact a consultant or doctor who can help you understand and treat the cause of the problem.

When supplementation is necessary

If you do not produce the amount of milk you need for your baby, you will need to offer formula. This is usually temporary - until you stimulate lactation again or until the baby starts eating solid foods.

You can read more about breast milk augmentation in the topic " How to increase and maintain lactation ".

Many mothers find that once they start supplementation, they take the first step on the road to weaning. However, there are ways to successfully supplement and still breastfeed. You can try some of these approaches:

• attach a feeding tube to the breast, which has a container of formula at one end , and the baby takes the other with the breast when it suckles. This method ensures that the baby receives both formula and breast milk.
• offer formula first and then breastfeed the baby. Put less formula than you expect your baby to take. When the baby drinks it, put it to the breast, this way he will have positive emotions for satiety related to breastfeeding. Let the baby suckle as much as he wants.
• if the baby is fasting again an hour or two after receiving formula, offer the breast. These short but frequent breastfeedings stimulate lactation.