Worried About Low Milk Supply? This is What a Lactation Consultant Says

I see so many moms use formula before they need to because they think they have low supply when that's not really the case. As a pediatric nurse practitioner and lactation counselor, I am here to tell you exactly what I talk to families about all the time in clinic. That is whether to tell you actually have low supply, what actually works to help boost your supply, questions to ask yourself if your supply is good, and then it starts to dip, and what the research actually says versus what's just touted as a really good solution on the internet when it's not actually. I want to start with something that matters a lot and that is when you think you have low milk supply but you actually don't versus when you actually have low milk supply and the way that you handle both of these situations is completely different. There are a few common concerns that I hear about all the time from moms in clinic thinking that they have low milk supply when they actually don't and that is that their breasts were feeling sort of full and firm before and then now they're just soft all the time. The second is that babies are seeming a little bit more uncomfortable or wiggly or squirmy or fussy around feeds or after feeds. And then the last one is that babies might seem hungry right after they finished eating. These concerns on their own are not necessarily indicative of low milk supply. So your breasts start feeling less firm and less full once your supply starts to regulate. So that usually happens sometime between six and 12 weeks, it is normal to not get that like kind of rock hard and engorged feeling. That doesn't necessarily mean the supply is low. It just means it's more of the supply and demand versus the hormonal push that you have after you deliver your baby. Fussy babies, it's just really hard to tell if that is related to feeding or if there's something else going on. There are many, many reasons why a baby is fussy. So if you're not seeing any of the warning signs we'll talk about in just a second. A fussy baby or a baby that is even feeding or wanting to feed right after you finish feeding doesn't necessarily mean that your supply is low. And cluster feeding is very normal in babies. And sometimes they're going through growth spurts. Sometimes their feeding patterns are changing for a few days and then it'll go back to what it is. It doesn't necessarily mean low supply, but we will talk about what would make me sort of pause and question is it low supply or not? These are the things that would make me wonder like, okay, maybe there is some something going on that needs further investigation. So if your baby is not gaining weight appropriate for their age, that would give me a little bit of pause. If they're dropping percentiles, I know percentiles aren't the end all be all, but if your baby is dropping significant percentiles between weight checks, I would want to investigate a little bit further. If your baby isn't having like good saturated wet diapers, at least six every day. They don't need to be like the fullest, but they need to be a little bit more than just like a little bit of the blue line, or they should have some weight to them every time you're changing them. If there's just like a little bit of a tinkle, even if you're changing five or six wet diapers, I want to make sure that they're like good appropriate diapers. Other things that I ask myself is that did you have breast changes in pregnancy? Did they start feeling fuller or more tender? Did you have any breast changes in the first week postpartum? So did you ever feel like your milk was coming in? And if not, then why not? So if you were pumping or breastfeeding, removing milk effectively, but you didn't have any breast changes or you never felt like your milk came in. I also sometimes ask questions about what are the breasts shaped like? If the breasts are spread further or they're kind of like longer and more tubular, that could indicate that there's something going on with the tissue. So all important questions to ask. I like to know what your pumping output is. Is it consistently lower than you would expect? And then also when we would anticipate your milk supply to be the highest, maybe early in the morning, the wee hours of the morning, if you're pumping at that time, how much are you actually getting? Along the same lines, if your baby's at the breast, do they ever actually suck and swallow? Can you hear those soft k? Are you ever seeing them swallow? Do they ever seem satisfied after a feed? All important questions to ask. Here are the things that the evidence supports to actually build supply. So if there are no underlying conditions causing low milk supply, this is what we can actually do to build milk supply. Number one, milk removal frequency and effectiveness. This is the most important one because your body works on supply and demand. So the more you demand from your body, either by breastfeeding or by pumping, the more it's going to tell your body to make. Now, if your baby is very, very tired in the early days when they're newborn and they're on the breast, but they're not actually removing milk, this will tell the body to make less milk. So if they're not actively eating, then it's not going to tell the body to make more. If your pump is not working, even if you are pumping and you're not getting anything out, it's not going to tell the body to make more. And then as your baby gets older, if they are doing some alligator rolls or they're getting more distracted, you can't get them to actually focus on removing milk. That'll tell the body to make less milk. It can also happen that they're filling up on solids. They're not interested in eating as much anymore at the breast. And then it tells your body to make less milk. So what if you are removing milk effectively, but your supply is still not increasing. So the next thing that you can do is try power pumping. I always love power pumping. It sounds like you're like, oh, I'm gonna get swole. Try power pumping, which is a way to mimic cluster feeding by using the pump. So what you're doing is you're pumping for a certain period of time. Usually you start with around 20 minutes, then you give your body a little bit of break for maybe 10 minutes, and then you pump for 10 minutes, give your body a break for 10 minutes, and then you pump for 10 minutes. and then you take a break. So what it does is it is telling the body, okay, my baby needs more, more, more. We're getting these little pauses in between, and then the demand is there again. So you can do this every day. If you can do it at the same time, that's great. If you can do it whenever you can fit it in a baby's nap or after bedtime, that's okay too. The most important thing is to keep doing it because we're not trying to get milk immediately. So on day one or day two or even day three, we're not expecting the supply to increase. But by day five, day seven, we're expecting there to be some levels of increase in your milk supply. Last thing I want to make sure you have is an effective latch and good transfer. Like I touched on before, if your baby is not able to get the milk out of the breast, it's not going to tell the body to make more milk. If you are always uncomfortable, if the latch is really just not great, if it's very, very shallow, this can make it so it's a little bit harder for your baby to get the milk. And if they're not able to get the milk, then it's not going to tell the body to make more. One thing that you can do to help improve milk transfer, especially for the little babies who might have a harder time pulling all of the milk, is doing some gentle massage up in your armpit while your baby is eating or before your baby's eating. You can move your breasts around before your baby's eating, help loosen up the milk. You can also do compressions when your baby or newborn is kind of slowing down. We want to give them little pauses, but we don't need them to pause for, you know, 30 seconds. When you're like, are you awake? Are you awake? Like the minute period, you can give them little compressions and that will help loosen the milk and get more for your baby to improve milk transfer and then improve your supply. I want to address a few things that I hear about all the time on social media and online that say this will definitely boost your supply. And when you are feeling desperate or it's the middle of the night and you feel like you have low supply, you know we do all of these things because we want to try to do everything. But these are not necessarily research-backed. The first one is the oatmeals, the teas, the lactation cookies. They're often very expensive, not backed by research, but you know, are they harmful? Probably not. Are they going to help boost your supply? Potentially. Are they going to treat the underlying cause of why you have low supply in the first place? No. So once you stop using the teas or the cookies, they're probably, it's just going to go back to where it was before. Does it hurt? Probably not. There are milk boosting supplements that people really love and swear by. A lot of them are very expensive. The most popular active ingredient that we hear about a lot is fenugreek. I have seen personally moms whose supply dips with fenugreek. I'm just very, very cautious to use any supplements with that. And then always make sure to talk to your medical providers before starting on any supplements to boost supply. The last is drinking something like BodyArmor or coconut milk. Now, if you're dehydrated, it is never going to hurt to hydrate yourself better. The nutrients from breast milk are coming from what you eat and your body. So making sure you're hydrated, that's great. Is it going to be the thing that boosts your supply? Probably not. And if you're not treating the underlying cause, it's going to go back where it was. I want to talk about something that I hear all the time in moms clinic and online and that is when milk supply was really really good and then all of a sudden it drops. Usually there's a trigger and when the trigger is taken away things start to improve. So the first set of questions that I always ask is what's going on with your body? So did you start your period where you can sometimes see a temporary dip in supply right before. Are you pregnant? That is a common reason for supply to dip. Or are you feeling sick? Are you feeling really crummy? Are you very stressed out? All of these things can inhibit your letdown reflex, which means that sometimes it can decrease your supply temporarily. Next, I always ask about medications. So were you recently sick? Did you take any kind of decongestants? Have you started any new medications? Did you start birth control? Sometimes these can affect hormones and sometimes these can decrease your milk supply. Next is about your feeding patterns. Is your baby sleeping through the night now when they weren't before? Sometimes moms can't go longer than five to maybe six hours without milk removal and keeping up their milk supply. That was the reason that my milk supply dipped with my first, but I had no idea. Now, is your baby getting more distracted? Are they filling up on solids and they're not really taking milk much anymore? Both of those could be reasons why there's less demand and then less supply. The last thing is about your pump parts. Are you pumping a lot and your parts haven't been changed? Do they still feel effective or are you getting less with your pumping sessions? If you haven't changed your parts, probably time to start doing that. So when is it time to get help? It is never the wrong idea to bring your baby into their pediatric provider, get them weighed, and see a lactation professional. It is never the wrong idea and much rather have you do that earlier versus have these suspicions and then have your baby lose a lot of weight. That was the case with me. There was a lot that I was kind of questioning. I didn't know I went from oversupply to undersupply when my baby started sleeping through the night and he did not gain any weight between four and six months, but I was confused. I was trying to figure it out on my own and I didn't have a lot of lactation experience. So just know that if you're seeing any of the red flags, they're not having good saturated wet diapers. They don't seem like they're gaining weight. If you're feeling like they're not actually effectively removing milk from the breast or your supply has really decreased, those are all reasons to go and see somebody, whether that's your pediatric provider or seeing lactation and your pediatric provider. If you have an older baby and you've been working on your milk supply for five to seven days, but you are not seeing any increase in output, that is also a good reason to seek some medical help. Don't feel like you have to have it figured out all by yourself. And sometimes seeing a professional versus getting all of your information from ChatGPT or whoever you're asking your questions to, seeing a professional can really help. Now make sure to hit subscribe for all of your bite-sized pieces of feeding information. Bye-bye.