Low Milk Supply? Don’t Give Up Breastfeeding Just Yet

If you’re breastfeeding a baby and worried that you aren’t making enough milk, there’s something you need to know: You may not actually have a problem with your milk supply — and if you do, there are better solutions out there than the quick fixes that friends and family might offer.

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According to a study in Pediatrics, 60% of women give up breastfeeding earlier than they want to. The most common reason named by the mums in that study: “I didn’t have enough milk.”

There are two reasons that’s sad: one is that we (as human beings) aren’t good at telling whether we’re making enough milk or not; and the other is that if you do have a low milk supply, it’s usually fixable, as long as you catch it early.

A baby that’s getting enough milk will be gaining weight steadily, and making lots of wet diapers — six per day is the benchmark. Here are some completely normal things that breastfeeding mums sometimes misinterpret as signs of a low milk supply:

• The baby nurses, then acts fussy and shortly afterwards wants to nurse again. This is part of a normal pattern known as cluster feeding, and typically occurs in the evening.
• Frequent nursing at any time of day is normal. Babies that drink formula can usually go longer between feedings than a breastfed baby, which sometimes leads breastfeeding mums to think that there’s something wrong with their milk. Meanwhile, if a baby does need more milk than what you can make, the act of nursing frequently is what tells your body to make more milk. It’s a self-fixing problem.
• Nursing feels different. In the first few weeks after birth, it’s normal for your breasts to feel full in between feedings, and to feel a tingling sensation when the milk “lets down.” By the time the baby is a few months old, you may not feel the fullness or the tingling, and some mums interpret this as a drop in milk supply. It’s not.
• You don’t pump “enough.“ Almost everyone gets less from pumping than their baby gets from nursing. This can definitely be a problem if your goal is to pump a lot (say, if you’re at work and pumping for your kid’s day care bottles the next day), but it doesn’t tell you anything about how much the baby actually gets when she nurses.

Even though they’re completely normal, these things can be frustrating or problematic, so it’s worth seeking help if they bother you. But they’re not necessarily signs of low milk supply. A woman’s body makes milk on a supply-and-demand basis: the more the baby nurses (or the more you pump), the more messages your body gets saying Make more milk.

This is where worrying about your supply can backfire: if you think the baby isn’t getting enough, and decide to give him a bottle (either formula or your own milk from your freezer stash), your body is missing out on some of those signals, so the next day you’ll make just a little bit less. This is how a perceived low supply can turn into an actual low supply.

Supplements Aren’t The Answer

Well-meaning friends, family members, and internet strangers may respond to breastfeeding concerns with a suggestion that you try a milk-boosting supplement — usually something “natural” like a food or herb.

For example, you might be tempted to pick up some Mother’s Milk Tea, containing herbs that “have been traditionally used to help mothers support their production of breast milk and to promote healthy lactation.” Just because something is traditional, of course, doesn’t mean that it works.

Fenugreek is one of the ingredients in that tea, and you can also purchase it in pill form. It’s widely rumoured to be effective and mostly safe (side effects include upset stomach, low blood sugar, and your sweat smelling like maple syrup), but the Academy of Breastfeeding Medicine could only dredge up one report that supported it as effective in increasing milk supply — and that wasn’t a clinical trial, but a collection of anecdotes from women who said it worked for them. More recently, a small study published in Clinical Lactation tested fenugreek supplements against placebo, and found no difference in milk output between women who did and didn’t take the herb.

There are “lactation cookies” that you can make or buy; you’ll find them on lists of milk-boosting suggestions alongside herbal teas and pills (but more about those later). The typical lactation cookie is oatmeal based, perhaps with chocolate chips, and always with flax seeds and brewer’s yeast. Here’s a typical recipe, and if you want to eat one I won’t stop you. They sound tasty. But the reasoning behind their ingredients is based on a combination of anecdotes and scientific hypotheses that never panned. out. For example, brewer’s yeast is in there because beer seems to increase blood levels of prolactin, a hormone involved in making milk. It’s a nice theory, but according to a review by the Academy of Breastfeeding Medicine, more prolactin doesn’t translate into more milk.

Despite the lack of evidence, some women swear by the cookies (or tea or oatmeal or beer), but this is anecdotal evidence at its finest: we may only be hearing from the few people who think it works, and not from others who had the opposite experience. We also can’t separate the effects of the cookie from the effects of other things that people may have been doing at the same time: for example, if somebody ate lactation cookies and started nursing or pumping more often, they might credit the cookies with the improvement.

Does it hurt to try a few cookies or a cup of tea? Not literally, but there are costs to attempting a solution to a problem when it’s unlikely to help. You’re either spending money or time to obtain the cookies that could be spent looking into better, more effective solutions to the problem — or questioning whether you actually have a problem at all.

What You Can Do (Besides Eating Cookies)

Look, I’m all for cookies, but they don’t have to be the oatmeal-and-yeast variety. If you think you really do have a problem making milk, kick back with a pizzelle or a macaron and call a pro (ideally an International Board Certified Lactation Consultant) who can work with you to figure out what went wrong and how to fix it.

Under the Affordable Care Act, your health insurance should provide coverage for lactation help. If you don’t know where to look, ask around: the hospital where you gave birth, your pediatrician, and your local La Leche League can usually all point you toward a qualified professional.

An estimated 5 to 15 per cent of new mothers have trouble getting breastfeeding started, either because there is something physically wrong or because they didn’t begin breastfeeding right away. Some, but not all, of these women can still manage to breastfeed if they get help.

If you managed to get breastfeeding started, and your baby gained weight and had lots of wet diapers, that’s a good sign: it means your body knows how to make milk. The challenge, then, is making sure it gets enough of the signals to make more.

The lactation consultant’s advice and problem-solving will likely focus on:

• Nursing the baby as much as possible (more demand improves your supply)
• Making sure the baby “latches” correctly, so that he gets plenty of milk without causing you any pain or soreness
• Pumping more effectively, if your problem includes low output when pumping. This may include upgrading to a stronger pump, and pumping more often.

They might suggest galactagogues — drugs or foods to increase your supply, but only as a last resort. The Academy of Breastfeeding Medicine’s protocol for galactagogues is full of cautions: They aren’t a substitute for frequent nursing or pumping, they don’t work very well, and the prescription-strength ones that may be effective — domperidone and metclopramide — have rare but scary side effects.

So even if the cookies worked (and you will find people who swear they do), they still wouldn’t be a great option: you’re better off finding a pro to help you diagnose and fix the underlying problem.