Breastfeeding is a supply-and-demand system. The more demand on the system through breastfeeding the baby, the more milk the body makes.
Occasionally, nature’s system is imperfect. Sometimes the body takes a day or two to catch up to a baby’s increased breastfeeding demand during a growth spurt. And while a mother sometimes can make that extra milk, sometimes she can’t.
Women who can’t produce enough milk to satisfy their babies may have physiological problems, such as breast injury or surgery, polycystic ovarian syndrome (PCOS), thyroid or other hormonal imbalances, or underdeveloped milk-producing glands, says Emily Healy, lactation consultant with Puget Sound Breastfeeding Services.
Other issues that interfere with a mother’s milk production include the infant’s separation from the mother or from the breast, no assistance for initial feeds and interruption of breastfeeding efforts, says Barbara Orcutt, R.N., a lactation consultant for Birth and Beyond in Seattle. Introducing formula or exclusively expressing milk by pumping instead of nursing can also reduce the amount of milk a mother is able to produce while breastfeeding, she says.
Milk supply problems
If milk supply is an issue, try skin-to-skin contact between mom and baby, says Healy. “Holding your baby directly on your bare chest keeps your baby healthy and stable, and triggers hormones that help with breastfeeding."
Jack Newman, M.D., author of The Ultimate Breastfeeding Book of Answers, says an inefficient breastfeeding “latch” may not sufficiently stimulate milk supply or adequately feed the baby. Consult lactation consultants to evaluate and improve latch or seek an assessment from breastfeeding experts at Seattle Children’s Hospital.
Pumping can also help increase milk supply. After breastfeeding, some extra time with the breast pump will provide that extra “demand” to increase “supply,” say lactation experts.
If your baby is losing too much weight, you may have to consider supplementing your milk supply, although supplementing can be a slippery slope. The more the baby’s needs are satisfied by a bottle, the less likely the baby is to breastfeed and encourage the milk supply.
To both supplement and protect the breastfeeding relationship, consider supplementing at the breast by using a supplemental nursing system (SNS). An SNS is taped to the mother’s nipple, encouraging the baby to suck vigorously. This helps the mother make milk and the baby learn the skills to nurse.
Nutritional and medical interventions are also available to help encourage milk supply. A lactation consultant, nutritionist, naturopath or other health care provider trained in breastfeeding medicine can provide mothers with guidance on foods, herbs and drugs that can increase milk supply.
For a woman who plans to breastfeed, insufficient milk supply can be devastating. She might feel as though her body is letting her down.
“Breastfeeding trouble and postpartum mood disorders go hand in hand,” says Heidi Koss, a Redmond psychotherapist and director of Postpartum Support International of Washington, an organization dedicated to supporting women with postpartum mood disorders.
West Seattle mom Kristin Hutchinson, who had a limited milk supply due to PCOS, recalls, “It was an incredibly emotional time. There are feelings of inadequacy and feelings of jealousy of people around you who are not having problems. And there’s this nagging thought that I must not be doing something right.”
Mothers struggling with breastfeeding issues should be watched for signs of a mood disorder, says Koss. She encourages women to remember that they are not alone and not at fault. “If a woman is having difficulties with breastfeeding, it’s appropriate to get support both for the feeding issues and for the feelings she is having.”
Tera Schreiber was surprised by her insufficient milk supply after the birth of her third child, despite having exclusively nursed the other two. She learned a great deal about the breastfeeding laws of supply and demand as a result.
Making ‘supply and demand’ work
1. Breastfeed exclusively. Erin Briggs, a La Leche League leader from South Seattle says, “Nurse early, nurse often! Nurse your baby as soon after birth as possible and nurse at least 10 times every 24 hours until your baby has regained its birth weight.” Pumping exclusively will not provide the same “demand” that a breastfeeding baby does.
2. Look for signs. “The best way to determine if your baby is getting enough is to look at output,” says Briggs. “What goes in comes out. You should see six very wet diapers and at least one fair-sized stool each day in the early weeks.”
3. Refuse supplements and artificial nipples. Well-meaning friends and family may want to feed the baby or offer a pacifier. But the best thing they can do is make life easy so that mom’s only job is to breastfeed the baby and sleep. Maybe those well-meaning folks can feed your baby her first table foods when she is 6 months old.
4. Get support. Hutchinson credits her success with breastfeeding to the generous support of family. “Nursing was pretty much a 24-hour job for me,” she says. “I was able to do this because I could stay home with my girls and let go of a lot of other responsibilities, like cooking and most other chores. I could not have dedicated the time to feeding that I did without that support.”