Reasons for low milk supply
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) - see What is the range of "normal" when it comes to breastfeeding?
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.
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