Breastfeeding

Reasons for low milk supply

Time to read: 3 min.

Insufficient milk supply is one of the most commonly cited reasons for ceasing breastfeeding early. Reasons for low milk supply include medical conditions that affect the baby's ability to breastfeed effectively, such as ankyloglossia, cleft palate or neurological issues, malabsorption of nutrients, and metabolic issues. If baby health problems have been excluded, maternal factors are likely to be the cause of low milk supply.

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Primary Lactation Insufficiency occurs in five per cent of mums, and occurs due to inadequate glandular tissue as a result of breast abnormalities, breast or nipple surgery (which may be medically indicated or cosmetic), or other issues. Secondary Lactation Insufficiency, which occurs more commonly, is usually a result of inappropriate feeding routines or use of supplements resulting in diminished milk synthesis and eventually an insufficient supply.

Signs of low milk supply

Babies may experience delayed bowel movements, decreased urinary output, jaundice, weight loss from birth and lethargy. During breastfeeding the baby may exhibit sleepiness or frustration at the breast, or only short periods of continuous sucking.

Evaluation of breast milk production

Consultation with a lactation consultant or healthcare professional is a necessary first step. To diagnose insufficient milk supply, a mum, with instruction from a healthcare professional, can measure her milk production by test-weighing her baby before and after each breastfeed (without changing their clothes or accessories) for 24 hours. Average normal milk production for healthy term babies is considered to be between 750 and 800 ml/day (range 478 to 1356 ml/day).

Management

A management plan should be implemented and monitored with a lactation consultant or healthcare professional. The key to increasing milk supply is frequent and effective milk removal. Since most babies take about 67 per cent of the available milk from the breast, greater breast drainage with more frequent and efficient milk removal should help the mum synthesise milk more quickly.

In conjunction with a health professional's advice, evidence-based strategies that may be implemented to increase milk supply include:

Help with positioning and attachment
Unrestricted skin-to-skin contact during breastfeeding and promotion of comfortable feeding both physically and psychologically
Increased frequency of breastfeeding, with no more than three hours between breastfeeds and feeding 8-12 times a day
Temporarily expressing after every feed; double pumping (simultaneous pumping) both breasts results in increased milk removal and better breast drainage
Breast massage during pumping
Using breast shields that fit correctly during pumping: they should not compress the breasts or damage the nipples. A range of breast shield sizes are available if the tunnel is too tight
The use of relaxation techniques while expressing, such as music or deep breathing
A medical professional may consider prescribing a galactogogue, a medication that stimulates milk production.

Study abstracts

Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants

Breastmilk remains the optimal form of enteral nutrition for term and preterm infants until up to six months postnatal age. Mothers of preterm infants who ...

Donovan TJ, Buchanan K (2012)

Cochrane Database Syst Rev. 14;3:CD005544

Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants

The duration of exclusive breastfeeding is affected by maternal confidence and perception of milk supply, but objective measurement of milk supply is rarely used. ...

Kent JC, Hepworth AR1, Langton DB2, Hartmann PE (2015)

Breastfeed Med. 10:318-25

References

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians 2006).

Donovan, T.J. & Buchanan, K. Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants. Cochrane. Database. Syst. Rev 3, CD005544 (2012).

Hill, P.D., Aldag, J.C., Chatterton RT. Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants. J Hum Lact. 2001;17(1):9-13

Hill, P.D., Aldag J.C., Chatterton RT, Zinaman M. Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth. J Hum Lact. 2005 February 1, 2005;21(1):22-30.

Kent, J.C. et al. Importance of vacuum for breastmilk expression. Breastfeed Med 3, 11-19 (2008).

Kent, J.C. et al. Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 8, 401-407 (2013).

Kent, J.C., Hepworth, A.R., Langton, D.B. & Hartmann, P.E. Impact of Measuring Milk Production by Test Weighing on Breastfeeding Confidence in Mothers of Term Infants. Breastfeed Med (2015).

Morton, J., Hall, J.Y., Wong, R.J., Benitz, W.E. & Rhine, W.D. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 29, 757-764 (2009).

Parker, L.A., Sullivan, S., Krueger, C. & Mueller, M. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med (2015).

Prime, D.K., Garbin, C.P., Hartmann, P.E. & Kent, J.C. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med 7, 442-447 (2012).

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