Why do Mama’s worry about a “lack of breast milk”?
There are a few signs that can cause uncertainty regarding breast milk production, such as:
- frequent breastfeeding at short intervals
- evening “permanent breastfeeding”, also called cluster feeding
- baby is restless/crying
- intense need for physical contact, being carried and rocked
- soft breasts
- no or only small amounts of milk in pumping attempts
Many parents often interpret these factors as signs that breast milk is insufficient or that the breasts are “empty”, but they are not reliable indicators of milk supply and child thriving. A breast can never be emptied so to speak – it doesn’t work like a bottle. Milk is constantly produced and can’t run out.
Far more meaningful in assessing the situation are factors that consider the child’ weight, output, and general wellbeing.
Signs of adequate breast milk production and child wellbeing:
- frequent breastfeeding, at least 8-12 times in 24 hours
- audible swallowing of the baby when the milk ejection reflex begins
- from the 4th day postpartum: at least 5-6 wet nappies per 24 hours
- in the first 4 weeks of life: at least 2-3 bowel movements per 24 hours
- birth weight is regained within 10 days postpartum
- in the 1st and 2nd month a weekly weight gain of about 110-330 g
- bright baby with good muscle tone and smooth skin
ILCA, the international umbrella organization of breastfeeding and lactation consultants IBCLC, offers detailed guidelines with a list of the associated evidence.
Actual insufficient breast milk production
Of course, there are also situations in which there is actually too little breast milk production, or the child is not thriving enough on breast milk only.
Common factors that can lead to actually insufficient milk production:
- unfavorable breastfeeding management
- regulated breastfeeding periods
- incorrect attachment technique
- lack of breast milk ejection reflex
- ineffective sucking technique of the child
- routine administration of food supplements/tea/water/glucose or similar
- use of a dummy or improper use of nipple shields
- separation of mother and child
- late or infrequent pumping
- placenta retention (progesterone prevents breast milk production!)
- severe peripartum blood loss
- maternal pituitary or thyroid disease
- anatomical peculiarities/diseases on the part of the child
- anatomical features or previous breast surgery
Especially these first hours and days with your newborn are so important to build a strong breastfeeding relationship and very often new mums have unrealistic expectation of “how it should go” or “how baby is supposed to feed”, like how often, how much, how satisfied baby should be etc... One thing is very important to remember: baby and you are learning together how to do the feeding as you are both new to the whole feeding-baby-with-body-thing. And it truly is a big thing! Allow yourself time and try to be as patient as you can. Free yourself from expectations because every baby and every boob are different. It is normal that baby latches on and off multiple times in an hour or even minute, it is normal that baby comes off unsatisfied and cries – which does not need to mean that baby doesn’t get enough. It might just mean, that baby is frustrated and just will try again after calming down. It might just mean that baby needs your help trying a more comfortable breastfeeding position or angle. Every breastfeeding relation is absolutely unique. There is no “it should” or “it must”, there is also no “normal” or uncommon. The first couple of weeks are all about learning and getting to know each other. It is about establishing a breastfeeding relationship with your baby together. Although breastfeeding looks easy (and it is, once it is well established) most women struggle the first two to three weeks. Sore nipples, tender breasts, and the constant worry about your own breast milk supply can be frustrating and stressful. But it doesn’t have to be. Look for support – I mean ongoing 24/7 support. There are lots of breastfeeding groups or support workers available. Check in your community for breastfeeding buddies – yes, they do exist. I had one and she was brilliant - available 24/7 on WhatsApp for me and really an amazing help whether it was about improving my breastfeeding positions or general inquiries and breastfeeding tips. Whenever something didn’t work, or I was unsure about I was able to contact her to get advice or reassurance.
Tips to support breast milk production
- detailed anamnesis, improvement of breastfeeding management: unrestricted and frequent breastfeeding as needed
- checking attachment technique, checking use of soothers and aids
- promotion of frequent body and direct skin contact
- review of weight history
- check breast pump management and equipment if necessary (some pumps really work inefficiently!)
- strengthen mother’s self-confidence, warm-hearted companionship
- plan small steps, don’t overwhelm yourself, set achievable goal
- if supplementary infant feeding is necessary, use nursing-friendly supplementary feeding techniques, prefer supplementary feeding at the breast
Final words
Always remember: it is intended by nature to be able to feed your baby with your own body. Our boobs are designed to produce breast milk! ENOUGH breast milk. It CANNOT run out. Whenever baby demands more breast milk, the body changes and reacts. Breast milk production is ongoing and changes daily if needed. Most women feel or think that they cannot feed their baby because they fear it won’t get enough. At times that is because they give up too soon. They might not have the right support at their side, become nervous, impatient, and then start supplementary infant feeding. Once that has started, the breast milk supply reduces, baby finds it easier to drink from the bottle and might be fussier on the boob. That again results in mum giving up sooner when baby is fussy, then gives more bottles... which again reduces their own breast milk. It is a cycle. Babies are fussy (by nature), some even cry a lot – that does not mean that you don’t have enough milk or that baby isn’t getting enough. It just simply means (in most cases) that baby is fussy and having a hard time (with the world, the light, the belly, the (any other circumstances) …. My advice: be patient, place your baby directly on your chest – skin on skin. Offer the breast, stay on the sofa or in bed and really take your breastfeeding time for two-three weeks. There is no need to “make it work in public” within the first weeks. Take your time. Even if that means you walk around topless in your house and don’t want to see anybody for the first weeks. THAT IS FINE! You just birthed your baby, and you are allowed to just stay home for the first couple of weeks. Most mums expect too much of themselves and then panic, because they think they have seen other mums breastfeeding their babies easily. If you have seen a breastfeeding mum in a café or somewhere else and it looked easy, please think back how old that baby was? Was it 2 months? Or 3? Or even just 4 weeks? I am nearly sure that you have not seen an easy-peasy breastfeeding (first-time) mum within their first 2 weeks for one simple reason: EVERYBODY needs time to establish their breastfeeding relationship. Especially the very first time. Be kind to yourself. You are amazing and you can do this, and you are certainly not alone.
Some pages that give breastfeeding support (there are much more!):
