How Will I Know If I Have A Low Milk Supply?

If you’re a breastfeeding mum, you may worry that your baby isn’t getting enough milk from you or that you’re actually not making enough.  It’s totally natural to feel this way, especially at the start of your breastfeeding journey, but rest assured that in most cases your baby WILL be getting enough milk from you to satisfy their hunger.

So, lets firstly look at how milk supply works and what is normal newborn behaviour for a breastfeeding baby, this will not only be reassuring but help you to Identify If you are one of the few that have low milk supply, be aware of what you can do and when you need to get help and support.

How Does Milk Supply Actually Work?

Milk production is automatically controlled by hormones until around day 3 after birth, with the process changing when you notice your ‘milk has come in’. Your breasts then start to produce milk through a process of supply and demand. So every time milk is removed, whether by your baby feeding at the breasts, or by you expressing milk, your breasts make more – clever, eh!?

That’s why the way your baby nurses will affect your milk supply. The more frequently and effectively your baby breastfeeds, the more milk you’ll make. This is also why it’s so important to let your baby feed on demand when you’re breastfeeding. Most babies need to feed between 8-12 times a day in the early weeks, to get enough milk and really stimulate the supply. We totally understand that this can be tough in the early days (you might be feeling like all you do is breastfeed 24/7!) but rest assured the number of feeds will decrease over time as your baby grows and it won’t feel like this forever.

Is This Normal For My Baby Or Signs Of Low Milk Supply?

Your baby shouldn’t go too long in between feeds. A normal healthy baby might go 30 minutes between feeds or for some 2 hours. They may cluster feed with them feeding continuously, or feed hourly when having a growth spurt. Remember that just as you’re individual, so is your baby and this is all perfectly normal.

It’s also normal for Babies to feed for differing amounts of time too and they can generally get everything they need from a 10-minute feed. They can start feeding for longer in the early days with feed times reducing as they get older. Why is this? Well babies just get better at feeding more effectively…and sometimes they actually like second helpings too, so again this Is to be expected.

Your breasts won’t always feel engorged and full like they do at day 3 when your ‘milk comes In’. Having softer breasts Is not a concern, or an Indication that you’re not producing enough. Your breasts just become better at storing milk as time goes on. And good here’s some good news…you won’t always leak!

Not All Mums Can Pump Milk.

Just because you can’t pump milk doesn’t mean you have a low supply. The 2 are not comparable….and baby removes milk more effectively and In a very different way to a pump, and it certainly can’t replicate the let-down reflex.

Babies have a sucking reflex which will automatically trigger If you put a bottle into its mouth. They will drink past the point of being hungry and so giving a baby a bottle after a breastfeed doesn’t mean your baby Is still hungry.

Babies love being close to you and near your breast, they feel safe, warm, and secure, just as they have for the last 9 months when they’ve been with you constantly. So, when you put your baby down, don’t be surprised when they start looking for the breast or start to cry, it’s an instinctive response and doesn’t mean they’ve not had enough milk.  Baby’s you see, don’t just breastfeed for hunger but for comfort too! Keep them close for at least the first 12 weeks giving them time to adjust, and remember you can't spoil a baby or breastfeed them too much.

So What Are The Signs Of Low Milk Supply?

In the early days of breastfeeding there are only two key signs that could Indicate your baby may not be getting enough milk

• Poor weight gain – It is completely normal for newborns to lose weight, but they usually regain it by around 14 days. If your newborn loses 10% of their birth weight in the first few days, or they haven’t started gaining weight by days five to six, breastfeeding support from a midwife, doctor or lactation consultant should be called upon. Now everything might be fine, with no milk supply issues being present, but because a baby’s weight is a good indication of when something may not be as it should, getting it checked out it something we always advise.
• Nappies - from when your milk comes in to around 4 weeks you should expect to see 6 wet nappies with the pee a pale yellow colour, and 2 dirty nappies around the size of a 50p piece in 24 hours. If you are concerned about the amount and/or colour of what’s in your baby’s nappies, have a chat to your midwife, lactation consultant or health care provider. After 4 weeks the number of soiled nappies can slow right down and isn’t related to milk supply.

What Can Cause Low Milk Supply?

The most common cause of low milk supply is a slow or difficult start to breastfeeding, resulting in not enough milk being removed from the breast in the early days. This can be caused by one (or a combination of) the following:-

• A poor l this is where your baby doesn’t attach correctly to the breast and therefore cannot drink their milk effectively. It often causes sore & cracked nipples, which may make it painful to breastfeed, further exacerbating the problem.
• Your baby does not feed often enough – newborn babies should be fed on demand 8-12 times in 24 hours. They don’t need a schedule or routine at this age – just feed as often as they want to. If you have a sleepy baby, you may need to wake them initially to feed more often, at least every 2-3 hours.
• Your baby does not feed for long enough – you should feed your baby for as long as they want to feed for in the early days. This may be for 5 minutes or 30 minutes…be led by them.
• You’re using a combination of breast milk and formula. Introducing any formula will reduce the amount of breast feeds the baby has, and in turn will tell the body not as much breast milk Is needed.
• Jaundice babies can be quite sleepy and they may not feed as often or for as long as they should. As long as baby is well seek help from a lactation consultant, breastfeeding counsellor or your midwife. However, If your baby is jaundice and lethargic, as well as having fewer wet nappies, and the whites of the eyes are yellow, seek immediate help from your midwife so that baby’s bilirubin* levels can be checked.

There are other reasons why breastfeeding mums have a low milk supply including complications during birth, previous breast surgery, thyroid, and other hormonal conditions as well as some pre-existing medical Issues.  In some cases, this may mean there is a limit to how much milk you can produce, so it is likely that you will be referred to an infant feeding specialist.  Some of these conditions are treatable and even if you have underlying factors that can’t be treated, you may still be able to make more milk than you are currently making.

What Can I Do To Help Increase My Milk Supply?

The first thing Is to find the right support. Find someone who knows about breastfeeding and lactation, and who fully understands it. You need someone who can tell you how to protect and develop your milk supply, even if in some cases they will recommend formula too. Look for friends and family that understand you and what your breastfeeding journey means and can support you practically and emotionally.

• Check your and attachment whilst breastfeeding as this may be affecting how effectively your baby can remove milk from your breasts. Get some breastfeeding support to help with this and to oversee your breastfeeding management, looking at frequency and how quickly you’re changing sides.
• Once you’ve mastered attachment, it’s all about finding time to feed…and lots of it, just you and your baby with no disturbances. Sleep when they sleep so you get lots of rest, and if baby Is sleepy wake every 2 hours to feed.
• Hold your baby skin to skin – this is great for your milk-making hormones, keeps your baby relaxed and encourages them to feed (a lovely excuse for lots of cuddles too!)
• Use breast compressions to give a last boost of fatty milk, helping to keep your baby actively feeding for longer.
  • Support your breast with one hand – thumb on one side, fingers on the other.
  • Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.
  • Rotate your hand around the breast and repeat step 2 on different areas of the breast.
• Try ‘switch nursing’ which means going back to the first and second side for 3rd and 4th feed. There will definitely be milk there and it may be richer, sending the message to your breasts to produce more.
• We know sometimes dummies can be a huge help to a busy mum, but if you can avoid using a dummy as it’s hard to recognise your baby’s feeding cues, if a dummy is used.

Baby feeding at the breast is always the first choice when looking to increase your milk supply and the most effective,  but if the above steps don’t help, it is worth trying to express breast milk to increase stimulation of your breasts.

How Do I Express Breastmilk?

You can express breast milk either by hand or by using a breast pump depending on the stage of your breastfeeding journey and what works for you, but pumping can increase milk supply and stimulate production.

Before pumping, prepare the breasts with warm cloths and a gentle massage then follow with hand expressing. Make sure your flange Is the correct size as this can make a difference to the effectiveness. Oh, and don’t think that putting the pump on the highest suction Is going to mean you pump more, it doesn't!

You don’t need to pump at specific times or intervals, just as often as you feel able to. You may need to experiment as to what times are best for you and whether more frequent, shorter pumps are better than a few longer ones. You can pump on an empty breast which can help send milk production signals or imitate a cluster feed, but don’t take baby off the breast mid-feed to pump.

For individualised support and planning reach out to a breastfeeding specialist and for further tips and advice on expressing milk and storing breast milk visit:

https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/expressing-breast-milk/

Should I Switch To Formula Milk If My Milk Supply Is Low?

Please don’t be tempted to top up your baby’s feeds with formula, this will only further reduce your milk supply, and whilst switching or mixed feeding is always an option, persevering with breastfeeding in the early days really should pay off. Your milk supply will increase, so try to take things one day at a time and keep reviewing.

You should NEVER suddenly stop breastfeeding and switch completely to formula feeding at any point in your breastfeeding journey, it could lead to breast engorgement, blocked ducts or even mastitis. If you want to stop breastfeeding this should be done gradually over a few days or even weeks!

Finally, we 100% agree that there is no “right way” to feed your baby. It has to be what works for you, your baby and your family. Any amount of breastmilk you give to your baby will be beneficial and please don’t be too hard on yourself if you choose to give formula milk, either temporarily or long-term.  Your breastfeeding journey may not have been as smooth as you’d hoped but having support really can make the biggest difference, so the best advice we can give? Reach out and ask for help, regardless of your feeding plan.

 For support from trained breastfeeding counsellors contact the National breastfeeding helpline on 0300 100 0212

For online support, resources and to find a local support group go to Association of breastfeeding mothers www.abm.me.uk

https://laleche.org.uk/my-baby-needs-more-milk/