Welcome to part one of our series on Top 5 Breastfeeding Issues! We are excited to start our series off with LOW MILK SUPPLY! This is something that many women go into breastfeeding concerned about, so we wanted to start off our series with a BANG!
Maybe you struggle with low milk supply or maybe you know someone that has, so you are afraid of experiencing it yourself...
If so, this post will go over EVERYTHING from pumping, formula, frequency, and galactagogues (supplements to increase supply)--SO keep reading!
The first thing to do in order to combat low milk supply is by breastfeeding and/or pumping often! Your baby should be feeding 10-12 times in a day which means you should be emptying your breasts just as frequently. If you have struggled with a low milk supply -- I am sure you are sick of hearing the phrase 'supply and demand' as it relates to breastfeeding... But it is the best aid to remind yourself that the more you pump or breastfeed, the more milk your body will make. It may not happen overnight, but consistent and frequent stimulation will be your best way to increase your milk supply and meet your baby's needs!
Action Item: Even if your baby doesn't meet the 10-12 times/day feeding goal, you should still pump that many times! Pump at least 1 session more than you think you need. Even if barely anything comes out! The stimulation and having an empty breast will stimulate more milk production.
The first hour of life...
In the first hours of life, your baby goes through 9 different stages in preparation for the first breastfeed. Unfortunately, not every woman has been given the chance to be skin to skin, uninterrupted, for a full hour after birth to help complete these 9 different stages.
Many women and baby dyads face complications, such as preterm birth, or hospitals that don't follow this policy (skin to skin for the first hour after birth). BUT, the more you know, the better able you will be to request your first uninterrupted hour with your baby.
Getting to be skin to skin with your baby, even if the first breastfeeding session doesn't produce any milk, is the first response your body has to shift from 'pregnancy' hormones to 'breastfeeding' hormones. This hormone shift is the exact reason that milk is produced-- SO the sooner the shift, the more time you have to start producing milk. The later you start, the less intense your hormones will be because they may be worn off after a bit of time and it may be harder to increase overall milk supply.
Latch:
All of the aspects of breastfeeding are tied together, which is why we are going to cross into different categories during each of the posts in this series. Your baby's latch can have an indirect effect on your milk supply when it relates to milk transfer. If no milk is being transferred due to a less than optimal latch, then your supply will not increase and may even potentially decrease-- remember the supply and demand concept...
The pressure from the milk in the breasts will tell your body that the milk isn't being used and therefore, the volume is not needed. As a result, this may decrease the supply ever time.
Action Item: If you think this may be an issue for you and your little one, working with a lactation specialist may help to optimize your baby's latch with little adjustments which can help to increase milk transfer and increase milk supply! (Hint-hint Mamas Maternal Health)
Pressure:
Something as simple as too much pressure can decrease a milk supply. Just as we talked about having too much pressure inside the breast can have an affect on milk supply, the pressure outside can also effect supply. Wearing tight clothes or bras such as sports bras puts pressure on the breasts and will cause milk supply to decrease over time. Similarly, if a woman has had breast implants there may be less space to hold milk in her breasts and may need to empty her breasts even more frequently to make up for volume needs for her baby.
Your anatomy:
Unfortunately, a woman's anatomy may affect her milk supply. Although rare, some women have hormone imbalances or too little glandular tissues which affect the ability to produce milk. In these cases, she will still be able to produce milk and may have to supplement with formula. However, again, this is not very common...
Other times, women may have had breast enhancement, or reduction surgery which could have interfered with nerve endings and her anatomy, causing her body to have a more difficult time producing milk.
Pumping:
Pumping can be easier for some women that struggle with milk transfer because the sucking effect helps to draw the milk out. Other times, women struggle to produce milk from pumping sessions because of the different and sometimes uncomfortable feelings that is less of a baby and more of a machine, which makes it hard to relax.
As we discussed previously, make sure if your baby misses a session of breastfeeding, that you pump to maintain their normal schedule. Alternatively, if you want to increase supply, adding in an extra session of pumping will help to tell your body that your baby needs more!
Another strategy that some mothers find helpful is a method called 'Power Pumping' which mimics cluster feeding. This is essentially telling your body that your baby is HUNGRY, they may potentially be going through a growth spurt, and that you need to produce more milk! There are different recommendations, however, one of the most common routines is as follows: pump for 20 minutes, rest for 10, pump for 10, rest for 10, and pump for a final 10 minutes; totaling 60 minutes.
Action Item: If you want to learn more reach out to a lactation specialist to help you create a pumping/breastfeeding schedule that works for you and your baby!
Unequal Production:
Sometimes, our bodies are different and that can be a really good thing! However, it can definitely be frustrating when it comes to breastfeeding... Sometimes we have one breast that produces WAY more while the other is a little... well, lazy. It can be so frustrating because if the one side just produced as much as the other you wouldn't be dealing with low supply, right?
One of the first things that we need to remember is to NOT get discouraged and blame ourselves! It is incredible that you are producing milk at all and you can make that work!
One of the best ways to combat this is really utilizing the side that produces a lot. Make sure it empties and gets lots of stimulation, and always start on that side. The fuller side will have the most milk and your baby may prefer that side because they will feel more easily satisfied from the feed.
Save the other breast for the end as a 'just in case' your baby isn't full, your baby may get frustrated with the one side not having much or having to work really hard for less. They might become frustrated and not want the other breast at all, which is not only frustrating for you, it brings on feelings of rejection and not being enough, WHICH IS NOT TRUE! If your baby doesn't take the other breast after the fuller one then try to pump so that side still gets the stimulation.
Essentially, what may end up happening is the 'lazier' side may start to produce more from either the stimulation increase or the need for a higher volume than the left can produce on its own.
Galactagogues:
Galactagogues, or supplements used to increase milk supply, have been around for centuries, each culture has their own spin or version. However, the majority of women may not actually need these supplements and should be considered supplemental instead of a first resort action to increase supply. However, some may be safe and others not so much.
Some medications and herbs actually decrease milk supply such as some birth controls, cabbage leaves, sage, oregano, and peppermint. The medications will have a stronger effect, and, don't worry, having oregano in your food when you want won't make your supply diminish.
Medications such as Reglan or Motilium, typically used to increase gut motility, have been prescribed by doctors to increase milk supply. However, they may not be as effective as once thought and may put the mother at risk of developing cardiac issues and other risks.
Safe herbs for tea are: chickory, orange spice, peppermint, raspberry, red bush tea, rose hips
Fenugreek, a very popular galactagogue, has actually not been proven to increase milk production or the corresponding hormone, prolactin. It may also interfere with medication effectiveness for moms.
Foods that have been typically used as galactagogues are oats, nuts/seeds such as flax. These foods have high amounts of fiber, which has been shown to aid in increasing milk supply. And herbs such as ginger or garlic, spices such as cumin, chickpeas, and dark leafy greens.
Brewers yeast is another item seen in lactation cookies and other lactation snacks that have been thought to increase milk supply, however, there is not a lot of evidence that proves so.
Don't beat yourself up about formula supplementation:
Breastmilk contents are so unique, they cannot all be copied and made into infant formula. It provides immunities and micro/macronutrients specific to the mother/baby dyad. It's really a win-win for both mother and baby.
We also understand that for many women, breastfeeding is not easy. They face impossible roadblocks such as preterm infants staying in the NICU, minimal to no maternity leave that creates difficulty with milk supply, lack of family support, lack of support from health care providers, a latch that leaves them in pain with no one to turn to, etc. These are only a FEW instances of many that would lead to the possible use of formula.
When giving formula, it is important to note that when bottle-feeding milk comes out faster than breastfeeding and often infant might become frustrated with breastfeeding after being fed with a bottle. Try to pace the feedings in a bottle whether its breastmilk or formula. Also, note the number of ounces that your baby is taking in. If they take a lot of formula, they may not be hungry for the next breastfeeding session.
After formula supplementation, women often feel discouraged, like they failed. But Mama, that is not the case at all. If you had to give formula for the first couple days, but then were able to breastfeed, you succeeded. If you were never able to breastfeed but pumped and gave them breastmilk anyway, you succeeded. If you were able to give your baby any breastmilk you succeeded. If you did what you could, you succeeded, and that is enough to make you the best mom in the world.
We want to say that if there is or was a time during your breastfeeding journey where you had to or will have to supplement with formula, that is okay. That does not mean you are done breastfeeding if you still want to. You were courageous enough to make a decision that you may have not wanted in order to give your baby nourishment (even if it isn't your milk). Again, this supplementation isn't game over. On the contrary, its just a little needed break that is necessary to complete your next steps. Many women have given infant formula for a couple of days, like we said, to get over a rough patch or hump in their journey. BUT if willing, most are able to keep on breastfeeding either by themselves or with a little help from a lactation specialist. There is no shame in this, in fact, it shows how strong you are that you chose to keep going even when times got tough.
At Mamas Maternal Health, we know it can be difficult. If no women ever had issues breastfeeding there would be no such thing as a lactation specialist. And these issues are very common!
What frustrates us the most is that many women are unsupported during this time and therefore give up breastfeeding. That is why we became a company-- to support mamas and show them just how powerful and capable they are.
Dirty/Wet Diapers as an indicator:
The number of diapers a baby goes through can be daunting, but it can also be an indicator of proper milk transfer and nourishment. Women fear having a low milk supply when in reality, they might be doing well! Here is the amount of diapers your baby should be soiling for each stage after birth to help you track intake...
(Cool, right?)
Your baby should have their first urination within the first 8-24 hours of life. They will have 2-6 wet diapers per day for the first 2 days and can be up to 20 times per day after those 2 days. This is because infant's kidneys during this time are unable to concentrate urine and therefore excrete a lot of fluids.
After the first week of life, your baby will be putting out 200-300ml every 24 hours. Some infants may have red or pink stains in the urine, which may be attributed to uric acid crystals. Although most likely normal, this should still be checked out for possible blood in the urine and hydration status.
Since stool coloring and texture are relatively related to the maturation of both the infant gut and breastmilk composition, the progression is easier to follow than urine.
First, your baby will have what is called meconium (black tarry stools) within the first 24 hours. What is mainly in the stool is secretions from the intestine, mucosal cells, and other bodily fluids that your baby is excreting.
After 2-3 days, your baby's stools will transition through a few stages. This is also when more mature milk begins. They will turn to a more greenish-black color and transition to a greenish-brown, then more of a yellow color. The texture does vary more from watery to thick---this is not a concern as it is normal, however, they will have less of an odor and will be less 'sticky' than the previous meconium.
Eventually, once solid foods are introduced, stools will become more brown and solid as added fiber and solids are incorporated.
Breastfed babies will pass stools up to four times a day, but can vary. Formula-fed babies are less frequent and can be as little as twice a day or even every couple of days. So it's important to keep those differences in mind!
Donor Milk Options:
Within the last few years, donor breastmilk banks have become increasingly more accessible. But what exactly do they do?
In general, the idea behind donor milk is to provide milk to infants whose parent's cannot provide milk themselves. It is considered similar to blood banks because they test and treat the milk through the pasteurization process to make sure it is sterile for the infant.
Although this may alter the milk in some ways, the protective elements as well as other important components--- that formula does not have-- are kept intact. For premature infants (with or without other medical conditions), breast milk is viewed as medicine do its healthful properties.
It also gives women who may otherwise be unable to provide their own breastmilk (due to specific medications or diagnoses) a 'loop hole' in the system ---
...with a fee of course. UGH.
Some insurance companies may or may not pay for the costs of obtaining donor breast milk. This may be a turn off for some women because costs are significantly higher than that of formula. Why? This is due to increasing demand as well as a shortage of breastmilk donors. But just a reminder, as we look at breastmilk vs formula, we know that breastmilk straight from the mother's breast is the best option, then donor breastmilk, and then formula.
Many women feel that the cost of donor breastmilk is worth the extra dollar due to the protective properties of breastmilk that come with its unique composition. Others may not feel this way or may not be able to afford it. Feeding your baby PERIOD is ultimately the most important --- no woman should feel guilty about the way she chooses to feed.
Action Item: Keep a journal or a log where you track time and length of feedings, times you pump and the amounts, and when you supplement and how much. This will help you to get a better picture of how much your baby is eating and when, while giving you answers as to where you can make adjustments.
If you found this information helpful or it resonated with you and your struggles with breastfeeding, know that you aren't alone! Women all over struggle not only with breastfeeding but the EMOTIONS behind breastfeeding. It is a rollercoaster ride and you should not have to feel isolated because it's not a perfect journey. Just know that we are here for you and we are SO proud of you for all you have and will accomplish as a mother... YOU are enough and don't let anyone try to tell you otherwise!
References:
The Lactation Counselor Training Course Notebook (2018)., Healthy Children Project, Center for Breastfeeding
Lawrence, M., (2016)., Jaundice and the Breastfed Baby., Breastfeeding and Human Lactation.,
Photo by Rainier Ridao on Unsplash