How to Tell the Difference Between Perceived Low Milk Supply and True Low Milk Supply?

Do you feel that you lack of milk and your newborn is constantly asking for more? Carefully read the article on to find out whether you shall supplement your baby with formula. Unreasonably reaching for infant formula can cause more harm than good.

Mums often complain that they have low milk supply. This problem is the most common reason for discontinue breastfeeding or introduction of baby formula which leads to a real decrease in milk production. Doubts arise most often when the breast become soft and the baby demands milk and “hangs on the breast” constantly. These symptoms do not necessarily mean that your breast milk is running low.

Are your concerns justified?

Lactation consultants warn against over diagnosing low milk supply. Often it only appears in the form of numerous worries in mother's head:

I have small breasts and I can't feed my little hungry one enough

The size of the breast depends on the amount of body fat, which does not affect the amount of milk produced. Food production depends on the efficiency of the glandular tissue located mainly near the breast envelope.

My baby has short breaks between feeds and wakes up very often for feeding

Breastfed babies are more likely to wake up more often than bottle-fed ones. Mother's milk is digested much faster (about 1.5 hours) than modified milk.

My breasts have been bigger and harder and now they are smaller, soft and as if empty

In the first weeks, milk production begins at full speed and breasts produce a lot of it. Most mothers have a breast fullness just a few days after delivery. After a few weeks, the milk river changes into a quantity adapted to the needs of the baby and regulated by the rhythm of feedings. The breasts become soft and their size may decrease. But it doesn't mean that the milk is running out.

My son sucks and sucks, and then he cries and seems to be still hungry

If he gains weight properly, he is not sick and yet he stubbornly shows you that he is not getting enough milk, most likely he is undergoing a growth spurt and has a temporarily greater demand for milk than you can provide him. This time is called the lactation crisis and occurs most often in the 3rd week, 6 week, 2-3 month, 6 month and 9 month of infant's life. In such moments be patient and have some mother’s milk tea. After a few days of crisis, increased suckling frequency and duration, lactation will be stimulated and there will be as much milk as it is needed.

Your baby may also have a need to suck more because of painful teething. Suckling at the breast can provide some babies relief for their itchy gums.

The milk has stopped flowing from my breasts

Fatigue, anxiety, tension, severe stress and pain may be blocking the flow of milk. The food remains in alveoli and is not pumped towards the nipple. If you feel that you had some hard time lastly, slow down and ask your loved ones to help you with the little one.

Before you reach for infant formula

Consult the problem with the paediatrician and a lactation consultant. The basic criterion for assessing the situation is the assessment of the baby's general condition, examination and checking its weight. If a baby gains weight correctly and it is healthy, there is no need for introducing supplementation. The introduction of infant formula in case of perceived low milk supply cause true low milk supply. A baby who receives formula suckles breast less often and for shorter periods of time. It reduces breast milk production and is followed by increase of number of formula feedings.

When should you start worrying, true low milk supply

The basic sign indicating a low milk supply is the lack of weight gain. Other signs of low milk supply are:

  • mum’s breasts stay soft both before and after feeding for the first two weeks of breastfeeding,
  • during feeding from one breast, no drops of milk flow from the other one,
  • the baby sucks quickly, briefly, only a few minutes and makes no swallowing noises,
  • the infant is restless when suckling, cries and does not fall asleep after nursing or is listless, not active and does not wake up for feedings.

According to lactation specialists, Magdalena Nehring-Gugulska and Monika Zukowska-Rubik, there are several basic factors that cause low milk supply:

  • Incorrect feeding techniques

The baby is latching on incorrectly, his suckle movements are shallow, milk remains in alveoli. The breasts are not properly emptied and the remaining milk decrease your breast milk supply.

  • Ineffective suckling

As a result of oral defects, illness or prematurity, a baby may not be able to suckle milk from its mother's breast. Ineffective suction prevents proper stimulation of the pituitary gland, which releases prolactin, hormone responsible for breast milk production.

  • Separation of a baby from the mother

A baby must be away from its mother because of health or unforeseen reasons. Then, it is necessary to pump milk with a breast pump regularly, at least 7 times a day. If the milk won’t be pumped regularly, you can experience low milk supply or the process of lactation can be ceased.

  • Use of medications or substances that affect lactation

Some medications and substances can reduce the level of prolactin which is responsible for producing milk in your breasts. These include: estrogens and progstagents contained i.e. contraceptives, androgens, nicotine, marijuana, clostilbegite, levodopa and ergot alkaloids.

The amount of milk is also reduced by some herbs (e.g. sage, mint; note the content in teas or syrups) and medicines, e.g. pseudoephedrine, which is often a component of commonly used OTC drugs, so-called cold medicines.

Problems with let-down reflex which is responsible for the milk release are caused by the action of such substances as: oxytocin administered for more than 2 weeks, alcohol and drugs.

  • Malnutrition

Mums often limit their diet without consulting a doctor at the beginning of breastfeeding. They do it because they are afraid of infant’s allergies or they want to lose unnecessary kilograms and return to the figure before pregnancy. They do not provide their body with important nutrients, which leads to lactation disorders. Eating only boiled vegetables is not enough. A nursing mother should consume about 1800 calories per day.

  • Hypothyroidism

Hypothyroidism can affect hormonal activity responsible for milk production and let down. That is why it is so important to test the levels of TSH, FT3 and FT4 in pregnancy in order to possibly diagnose Hashimoto's disease and make up for thyroid hormone deficiencies. If you have a history of thyroid problems, it is the best to seek the advice of an endocrinologist when you are still pregnant. Certainly you shall do that when you have any problems with lactation. He shall refer you for relevant tests.

  • Overweight and obesity

Problems with overweight and obesity before pregnancy as well as excessive weight gain during the pregnancy can interfere with the prolactin secretion (under the influence of suckling) responsible for the production of milk in alveoli.

  • Diabetes

Low insulin levels in the blood may be responsible for some lactation problems. Patients with diabetes often have a one-day lactation delay compared to healthy mothers.

  • Polycystic ovary syndrome

In patients with polycystic ovary syndrome, weak lactation was observed in the first weeks of pregnancy (increased amounts of testosterone and LH, and small amounts of progesterone cause a reduction in the growth of glandular tissue in the breast), but already in the 3rd month of feeding the differences between them and healthy nursing women were eliminated.

  • Mammary hypoplasia

In the case of unilateral mammary hypoplasia, mother can feed with only one breast. When hypoplasia is bilateral, feeding is not possible. This problem only affects about 2% of woman of child-bearing potential. It is characterized by very small, flat breasts, not enlarging during pregnancy and after delivery, soft even after a few days after delivery, without any signs of breast fullness.

Radiotherapy or breast surgery damaging the breast glandular tissue responsible for lactation

Radiotherapy during childhood disrupts the development of glandular tissue. Radiotherapy carried out in adulthood can disrupt the gland activity and reduce or prevent lactation.


How to increase milk production and enjoy lactation?

In addition to the rare cases associated with glandular tissue disorders, the problem of low milk supply can be overcome. Try to solve the problem in a few steps:

Step one: believe in yourself and get rid of negative emotions

Feelings of guilt, anxiety, fatigue and thoughts that you will never breastfeed again are enemies of lactation. By increasing stress, they slow down or inhibit the milk let-down. That is why it is so important for you to find a moment for yourself, time to rest and stop worrying. Ask your loved ones for help in household chores.

Step two: seek expert attention

Go to a lactation clinic or clinic where you can count on meeting with a lactation consultant. He will diagnose your problem, determine the source and show you how to feed correctly. He will also suggest what can be done to increase milk production.

Step three: strengthen your body

Analyse your diet and the amount of fluids you drink every day with your consultant. Modify it to be healthy, rich in proper nutrients and properly caloric. Take care of adequate sleep (including feeding breaks). Baby's mother should not sleep 5 hours a day. Take advantage of moments when your infant has a nap to have a moment of rest and allow yourself to have short naps during the day. Talk to your partner, mother and mother-in-law how important their help is for you.

Step four: feed often

Feed every 1.5 hours during the day and at least every 3 hours at night. If your baby uses pacifiers, stop using them.

Step five: stimulate your baby to suckle actively

During feedings, when you see that your baby is suckling poorly, massage his hands, feet and a stretch just behind the jaw. During one feeding session, feed alternately with both breasts so that each breast is given several times, e.g. 2x2 or 3x2. During feeding, embrace the breast at the base and squeeze it when the baby suckles, release it when the baby pauses in suckling. The compression produced this way increases the amount of milk that the baby swallows.

If your infant is suckling lazily, express milk after breastfeeding. This will stimulate lactation. Give your baby milk in a way that does not affect the sucking reflex, e.g. through a dynamic feeding teat or from a drinking cup for newborns and infants.

Step six: follow the feeding instructions

Specialists will assess the child's state of health at the lactation clinic. If they diagnose malnutrition, they will recommend temporary supplementation. The most important thing for the baby is to grow properly. The method of feeding determined strictly by lactation consultants will allow your child to regain strength and allow you to focus on returning to lactation.

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