Most women naturally produce enough breast milk for their babies, but there are circumstances where mothers can experience problems with lactation volume. Lactation Consultant Diana West talks with Suite about her upcoming book The Breastfeeding Mother's Guide to Making More Milk [McGraw-Hill, November 2008], which explores the different explanations for low milk supply and helps mothers take appropriate steps to address them.
Not Breastfeeding Enough Can Lead to Low Milk Supply
According to West, most problems with low milk supply are due to the management of feedings. Perhaps the baby isn’t being fed often enough and long enough. If your nurse in the postpartum ward told you how often to breastfeed (i.e. 10 minutes per breast every three hours) this is likely your problem. Small babies need unrestricted access to the breast in order to build and maintain the milk supply.
It’s also important to realize that some of the popular controlled crying programs marketed to parents can affect a mother’s milk supply and her baby’s growth. Says West, “Common parenting programs like the Baby Whisperer or Babywise dramatically limit baby’s time at the breast.” These programs are meant to teach babies to soothe themselves, but in many cases the baby not only wants to nurse, she needs to nurse.
Poor Latch or Tongue Tie Can Affect Breast Milk Supply
The second-most common cause of low milk supply has to do with the baby. A poor latch can be painful and does not allow the baby to extract milk efficiently. The less milk that is removed, the less milk that is produced by the mammary system.
If baby’s sucking still hurts after three weeks, West warns that the problem lies beyond the latch. “Most babies latch well from three weeks on. Babies do self-correct. If he is not nursing efficiently by 3 weeks, you need someone who knows what they are doing to assess the baby’s suck.”
A knowledgeable lactation consultant can evaluate your baby for tongue restriction, also known as tongue tie. Says West, “We have new information in the last couple of years on tongue tie and new ways of evaluating tongue movement. Some babies don’t appear to have tongue tie, but they do. It’s called posterior tongue tie.”
Diagnosing posterior tongue tie is difficult, but not doing so can cause severe nipple damage and a lot of pain to the nursing mother. Adds West, “Not every lactation consultant knows about it and few doctors do.”
Hormone Imbalances May Cause Low Milk Supply
In cases where the problem is not the management of feedings, latch, tongue tie, or an obvious cause such as a mother who is breastfeeding after breast surgery, West says that the issue is likely to be hormonal, and may be linked to the thyroid. “Most postpartum moms have some degree of thyroid dysfunction. If levels are too high or too low, it can cause problems with milk ejection. The mother makes enough milk, but the milk doesn’t get ejected as easily. Milk production goes down because milk is not being removed.”
If you suspect you might fall into this category, West suggests to have a thyroid test done and to compare your results with the normal reference ranges for lactating women outlined in the book. Don’t be fooled if the lab results come back “normal” right away. Says West, “Most TSH (Thyroid Stimulating Hormone) reference ranges are based on non-lactating men. A research study done in 2004 described the limits for pregnancy, and we are extrapolating for lactation. The ranges are much tighter, and women with subclinical levels who were treated had better lactation outcomes.”
Another common hormonal issue is PCOS (Polycystic Ovary Syndrome). Women with this condition have infertility and insulin resistance issues, and often their breasts don’t have enough breast tissue. “There are new protocols with herbs and medications that can make a huge difference,” says West. “Hormonal problems are one of the easiest problems to fix, but you have to know what you are looking for.”
As the author of Defining Your Own Success: Breastfeeding After Breast Reduction Surgery [La Leche League, 2001], Diana West has worked with countless women to help increase their milk supplies. Her upcoming book, The Breastfeeding Mother's Guide to Making More Milk, addresses the causes of low milk supply and talks about the many new findings in lactation that can help mothers achieve a full milk supply, or as close to it as they are able.
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