Low milk supply
The medical reasons behind low milk supply
Perceived low milk supply is a common concern for many women and is a significant contributor to women in the UK stopping breastfeeding before they wanted to. This stems predominantly from lack of understanding about normal infant feeding behaviour such as cluster feeding or frequency of feeds.
It is difficult to get accurate data for the UK but it is though that between 95-97% of mothers can make enough milk for their babies. But what if you’re in the small percentage who is struggling with physiological low milk supply?
Let’s think about how breastfeeding works…
Milk production is complex and involves many factors. To make enough milk, you need to have:
Glandular tissue (milk making tissue)
Adequate hormone functioning
Functioning nerve pathways and ducts to carry milk from the glandular tissue to the nipple
Regular and effective milk removal (by your baby or by hand expression/pumping)
If low milk supply occurs due to issues with regular and effective milk removal it can in most cases be reversed. However, in some situations, your body just may not be able to make enough milk.
What are the red flags?
previous breast/chest surgery, injury or trauma
damage to your nerves or spinal cord
unusual breast or nipple features
few or no changes to the breast during pregnancy
radiation
certain chronic illnesses or conditions
hormone-related conditions
low milk supply despite frequent and effective milk removal
significant blood loss at birth (over 2 litres)
retained placental fragments
Previous breast/chest surgery, injury or trauma
Breast injury or trauma surgery can affect the ducts and the nerves in the breasts. There are many factors to consider, including the type of surgery or injury, the amount of damage to your ducts and nerves, scarring, how long ago it took place, your previous breastfeeding experience and your baby! In the majority of cases lactating people will be able to produce some milk, rather than none at all, so combination feeding will likely be an option for you if you are affected. You can find out more about breastfeeding after injury or surgery here.
Damage to the nerves or a spinal cord injury
Nerves carry messages from the breast to the brain, to tell your body to make milk. Spinal cord injuries or nerve damage above T6 vertebrae can interfere with these messages, resulting in less milk being made for your baby.
Unusual breast or nipple features
Many women assume those with larger breasts can make more milk, while those with smaller breasts make less milk…. well, this is not true. Your breast size is determined by the amount of fat in the breast, while milk production is all about the glandular tissue (milk- making tissue) inside! Insufficient Glandular Tissue (IGT) means that you don’t have enough milk-making tissue before pregnancy. Your breasts may lack fullness, look as if they haven’t completely developed in puberty or appear long, tubular or bow shaped. With larger breasts, the nipples may face away from the body. One breast may be a lot larger than the other. Usually, mothers with IGT would experience few changes to their breasts during pregnancy. With frequent milk removal, it is possible to increase growth of glandular tissue. Like with many of the other conditions mentioned here the amount of milk making tissue present will vary from mother to mother with this condition and some breastfeeding is usually possible alongside formula feeding. Maximising the potential of the milk making tissue available using galactagogues may also help increase supply.
Hormone-related breastfeeding difficulties
There are a number of different hormones involved in breastfeeding. Below is just a selection of the most common hormone-related conditions that may affect breastfeeding.
Polycystic Ovarian Syndrome (PCOS): The hormones affected in this condition can impact on milk supply. The set of symptoms each woman with PCOS may experience will be unique to them based on their hormone function. This means for some women (reports suggest up to 20%) they may struggle to make enough milk to exclusively breastfeed, however many will not and there will be women at the other end of the spectrum who may struggle with an oversupply.
Sheehans Syndrome: This is a condition that that can affect women who have lost a significant amount of blood during childbirth, depriving the body of oxygen and causing damage to the pituitary gland. This gland releases the hormone prolactin, which plays a significant role in milk production. If there is damage to the pituitary gland, your body may struggle to produce milk.
Diabetes or gestational diabetes: This is a condition in which the body does not make enough insulin or the insulin made cannot be used by the body. Insulin plays an important part in breast development and milk production. You may notice that your milk comes in a day or so later when you have this condition.
Hyperthyroidism and Hypothyroidism: Your thyroid gland plays an important part in regulating your hormones for making milk. If your thyroid is not functioning adequately, as is the case with these conditions, your milk supply may be affected.
Will I ever be able to breastfeed if I fall into any of these categories?
The first thing to remember is that every drop of breastmilk that your baby receives counts! Mothers with the above conditions may not be able to make all the milk their baby needs, but will still be able to breastfeed! Any breastmilk that your baby receives is beneficial. Your breastfeeding experience may change from one baby to the next so if breastfeeding wasn’t successful the first time, it doesn’t mean you won’t be able to feed a subsequent infant. The only real way to find out your potential is to start to breastfeed and to identify support that you can reach out to early if needed.
If you are unable to provide your baby with all of your own milk, there are plenty of options available to you to still breastfeed alongside other options. Combination feeding at the breast and supplementing with donated breast milk or formula would be required. You can choose to bottle feed your baby the supplemental milk feeds but you may also want to consider using an at breast supplementer otherwise known as a supplemental nursing system. This is a container attached to a thin plastic tube which is placed at the breast. The end of the tube is placed near the nipple so your baby can get extra milk by sucking from the tube while latched and sucking from the breast. This gives the added bonus of providing additional stimulation to your breasts at the same time.
Low milk supply can be daunting and difficult to navigate. If you are unsure about your supply and have concerns, please contact a lactation consultant for support. Contact me here for support