Breastfeeding/Lactation Consultant

Another common cause of low supply is supplementation with formula or solids, since that will cause the baby to take less bresast milk from the breast and ultimately the breast will produce less.

Sometimes babies are too sleepy, though this usually only occurs in the beginning or if the baby is ill, and don't take enough milk, leading to low supply.

Sometimes there is something dysfunctional about the baby's suck, such as a short frenulum that restricts the baby 's ability to suck and therefore take milk from the breast though suck and tongue problems are usually accompanied by nipple soreness.

Most of the common causes of low supply can be fixed easily by fixing the cause such as improving the latch or increasing the frequency of bf.

True low milk supply, where the mom is truely unable to produce adequate milk even though all the management issues of bf are going well is pretty rare. One cause is retained placenta, which can be corrected by taking the retained placenta usually. Retained placenta generally occurs in the early weeks. Hypothyroidism (low thyroid hormone), which can be corrected with medication, is another potential cause of low milk supply. Excessive loss of blood during the birth can cause low supply. And very rarely inadequate breast tissue. Polycystic ovarian syndrome can also create low supply.

Low milk supply is also a problem that many moms think they have when they don't. *Perceived* low supply is a very common problem. Many moms think they have low supply when they actually do not b/c they are using the wrong signs to judge milk supply. Here is a post on how to assess milk supply:

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=63037.3

If someone thinks they have low supply the first thing they should do is contact a lactation consultant to evaluate the bf and figure out what exactly is causing the problem and offer suggestions to correct it. Here's how to find one:

http://www.ilca.org/find/index.php

But, the most basic concept to increase milk supply is to increase the amount of milk taken from the breasts. Usually effective breastfeeding is the best way to do that. The second best way is to pump with a high quality pump, such as a rental. If the baby is reluctant to bf more try pumping after each feeding even if you don't get results.

Hope this answered your question. If you need more specifics please get back.

Warmly Kathy

Hi Melissa. Wow, you found a post from 2003! I’m so sorry you had such a difficult time with your delivery. My goodness, how scary! I’m so glad you are doing well now.

No you are not doomed with regard to milk supply! It’s usually possible to increase milk supply. It does get harder the older the baby is but usually not impossible.

Many things have potentially impacted your supply. Certainly the tough birth probably delayed your ability to pump. There seems to be a vulnerable period in the first few weeks where the milk supply is set. The best way to set the supply high is via frequent, effective breastfeeding or if you can’t bf frequent effective pumping. Your breasts are growing more milk making cells in the early weeks and if you have enough stimulation your supply will be set nice and high. That is not to say however, that if you miss out on bf or pumping early you can’t increase supply. It’s just harder.

I work in a large hospital with a NICU. When I’m working with NICU moms I recommend they use a rental pump with double kit and pump every 2 hours during the day and evening and once overnight when they wake up ‘naturally’ (usually when they feed the baby or wake to use the bathroom). This gets you about 9-10 pumping sessions per 24 hours. So timing of the pumping sessions might be something like this.7am, 9am, 11am, 1pm, 3pm, 5pm, 7pm, 9pm, 11pm and then set up the pump at bedside and pump when you wake overnight one time.

Each time you pump use your double kit. Pump AT LEAST 10 minutes even if no milk is flowing for part of that time. IF you are still flowing at 10 minutes continue to pump until it looks like there is little or no flow and then add another 2-5 minutes after that. This usually means pumping sessions last from about 15-20 minutes with your double kit. In general more frequent pumping sessions are more productive than longer sessions. So for example; you’d get more benefit from two 15 minutes sessions over one 30 minute session.

The main way to increase milk supply is to take more from the breast. In general the more you pump the more milk you will make. If you have not been pumping this much and you begin to pump more, it can take a few days to a week until you notice an increase in the amount you pump so hang in there a bit, your body will respond.

How often are you pumping? Are you using the double kit? How long do you pump each time? Was your baby premature, if so how early? How many weeks old is your baby?

Most moms don’t respond to pumps as well as a baby who is bf effectively so pump volumes are harder to increase than bf volumes. Often mothers with babies in the NICU find that they pump larger volumes right after holding the baby or kangarooing (holding the baby skin to skin). Ask your NICU nurses if that’s possible for you to do when you visit your baby. Some hospitals allow or promote pumping at the baby’s bedside and find that works better to increase supply. Some moms find that as they are able to put the baby to breast their supply gets a boost.

Does your hospital have a lactation consultant? If so, contact her for help as well, especially as you begin to breastfeed the baby. As soon as the baby is able to take food by mouth you should be able to breastfeed directly. As you begin breastfeeding you may find that the baby doesn’t breastfeed well enough to depend just on breastfeeding. Most NICU babies need to have breast milk supplements as they learn to breastfeed effectively. The breast milk and any formula supplements will need to be weaned off gradually as the baby grows in her ability to breastfeed effectively. But the sooner you and she begin to practice breastfeeding the sooner she’ll learn how to do it effectively and putting the baby to breast may also help with supply. When you begin to breastfeed her be sure you continue to pump even after you breastfeed the baby and/or every 2 hours. Sometimes mothers are told they don’t need to pump if they breastfed the baby at a feeding. I feel that it’s very important to continue to pump, even after feedings to give the breasts adequate stimulation to produce milk. Often breastfeeding sessions in the nicu are not the most effective b/c the babies aren’t feeling well or may be to immature to do a good job of it.

Just do your best and try not to worry. You may find that as the baby gets healthier and you are able to breastfeed that your supply adjusts just fine. Are you doing ok at this point? Are there any residual health issues for you? Are you on any medications, including any birth control medications or over the counter medications? Do you smoke or drink alcohol?

Also Melissa I didn't see if Kathy asked (might have missed it) but did you stop the reglan pretty abruptly or did you wean off it?

Hi Kathy:

Thanks for all of the great info.  Yes, my baby was premature 29.3 weeks.  Her lungs are/were more premature than they were expecting at her age and so they aren't nipple feeding her every time because her numbers usually drop or she just poops out and falls asleep in the middle of her feeding.  I am using a hospital grade pump but I have only been pumping every 3 hours.  Thank you for letting me know that 2, 15 min. pumpings are better than 1, 30 min. pump.  My doctor authorized a refill on the Reglan and my milk has increased a little since I have started taking it again but I'm afraid when I run out of this refill I will go back down again.  Have you ever heard of women just staying on Reglan?? 

I am going to try your suggestions about pumping every 2 hours and see how this works.  I don't smoke or drink and the only medication that I am taking is for my blood pressure since it was so high during my pregnancy but my blood pressure seems to be fine now that I am no longer pregnant.  Am I just crazy or is pumping this often difficult?  How do you leave the house?  Especially right now with Christmas shopping and the hospital is a 45 min. drive.  It seems like this is all I do.  :0)  I will let you know in about a week or so what my results are.  I had dropped down to approx. 15-20ml per pump out of BOTH breasts but I am back up to about 35-40 right now since the Reglan and pumping more often but I am going to try the every 2 hours.  My health is great, I just need to try and lose more weight - I have lost the weight that I gained during my pregnancy but I was a little overweight to begin with.  I have a doctors appt. this week to find out if I can have more children and not worry about complications.  I am hoping that if I lose about 40 pounds more it will help.  Thanks for responding to my email.  I was hoping that you would still be able to receive it.  - Melissa