9 Things Your Lactation Consultant Desperately Wants You To Know About Low Milk Supply

Danielle Downs Spradlin, a Certified Lactation Counselor and the founder of Oasis Lactation Services, tells me in an interview that moms need to know that the production capacity of the breasts is not fixed. "In a physiologically normal breastfeeding relationship, the volume of milk produced can vary daily." Maryanne Higgins, IBCLC, a childbirth educator, doula, and founder of Barefoot Baby's Birth Services, suggests that most women self-diagnose under false assumptions, believing, at one point or another, that they do not have enough milk. Moms should become educated the variations of milk supply in the early days of breastfeeding before assuming that they have a supply issue.

According to Spradlin, the first six weeks of a baby's life include many variations to "normal" supply. Higgins agrees, noting that when a mother's milk comes in at around the fourth day, her body produces enough milk to feed two babies. The milk will regulate according to the baby's needs, and this is when a woman's breasts soften and lose the extra volume. "Most women expect to stay that enormously large, and get worried when they don’t," Higgins says of the early days of engorgement.

Additionally, a baby will go through a growth spurt around seven to 10 days after birth, which will cause the infant to eat every one to two hours for 48 hours. Some moms take this as a sign that their baby is still hungry and that they must not be producing enough milk. "That’s when we lose a lot of women," Higgins says. "They don’t understand (this) normal infant behavior."

After six weeks of breastfeeding, Spradlin says moms should begin seeing signs of normal milk production. You are producing an adequate supply of milk if your exclusively breastfed baby nurses eight to 12 times in a 24 hour period, makes six or more wet diapers in a 24 hour period, stools with many feeds, gains five to eight ounces per week for the first three months, and you are able to collect two to four ounces of milk when using a properly fitting pump to replace a nursing session.

"When a mom complains of low milk production, she deserves competent medical care," Spradlin says, warning that poor milk supply is not random and most likely a symptom of an underlying health condition or sub-optimal feeding. Common causes of low milk production include endocrine conditions in the mother such hypothyroidism, diabetes, insulin resistance, or polycystic ovary syndrome (PCOS). Other causes are poor feeding patterns, extended mother-baby separation, breast reduction surgery, hormone regulating medications, medications that decrease milk production, and alcoholism.

Jennie Rae Lanziero, Certified Lactation Counselor for the Florida Department of Health and the Pasco Hernando Breastfeeding Task Force tells me that it's important for lactation consultants to learn the history of the mother and baby, and it starts with the baby’s latch. When a baby has a good latch, he or she can transfer milk well, has a good suck and swallow patterns, and there is no pain to the mother. "If mother is experiencing pain with latch," Lanziero warns, "it is likely that the baby has not been removing milk to the fullest potential. This can cause a mother, over time, to have a decrease in her supply."

Breast milk production is based on supply and demand. "If a supplement or a pacifier is started, or you miss a feeding, then the breasts don’t get the message to make more milk and you have begun the weaning process," Higgins says. But that's not to say that you should never supplement.

Lanziero says a baby who is not able to transfer milk from the breast should be supplemented. This doesn't necessarily mean moms should automatically opt for formula. Today's mothers have choices including the mother's own pumped milk and donor milk. "If the mother chooses to supplement with formula that is OK," says Lanziero. Lactation consultants are trained to work with moms to increase their supply while decreasing the supplement.

Poor feeding patterns such as scheduled feeds or restricting minutes at the breast can be a culprit to your supply issues, warns Spradlin. Babies should nurse as needed while you're trying to build your milk supply. Higgins notes that some moms start pumping early on, which may not be necessary. "It is just one more thing to take up your time," Higgins says. "Learn about your baby before you start pumping." In short, get comfortable with nursing and learn your baby's feeding cues before trying to build up an expressed milk supply.

Lanziero wants mothers to know that what you are able to pump is not a good indicator of how much milk you make. She sees many moms who join Facebook pages and are exposed to other mothers posting pictures of their freezers full of breast milk bags. The new mother feels as though she, too, should be pumping tons of extra milk. "There’s no question that having a freezer full of frozen breast milk is a wonderful accomplishment for a mother and something to be incredibly proud of," Lanziero says. "However, what I think is truly important for a mother to understand is how milk production works, and that it’s not expected of her to have a freezer full of frozen breast milk."

A baby with a good latch is able to remove more milk than a pump can. Just because you don't pump a ton of extra milk doesn't mean that your baby is getting short-changed. Don't forget that nursing is based on supply and demand.

Not all moms are going to have the perfect breastfeeding experience right off the bat. But according to Higgins, those who stick out the tough parts will be rewarded in in the end. "You have to be committed to work through the kinks," she says. "You will make it to the other side, you’ll get it. Like anything good in life you must work for it and have someone who is supportive and believes in you."

"Low milk supply is a common worry among mothers, and one I hear every week in my practice," Mary Unangst, and IBCLC from Sweet Songs Breastfeeding says. "The reality (is that) it is actually quite rare. This is where working with a trained lactation professional like an IBCLC is very important. The thorough assessment is needed to really address the issues and potentially find resolution."

Unangst and her colleagues use very sensitive scales to weigh a baby before and after he or she eats to determine exactly how much is being transferred from the breast. They assess for maternal risk factors that might cause low supply and perform a suck assessment of baby. Babies who do not have an adequate latch or suck, could have a medical condition such as ankyloglossia, also known as "tongue tie" that can be corrected through minor surgery.