Why am I not making enough milk?
The perception of inadequate milk production or inadequate milk intake is the most common reason for discontinuing breastfeeding. Contributing factors could include the baby having troubles removing milk from the breast or the mother not being able to make sufficient milk, or a combination of these factors. These two factors can be improved by optimizing breastfeeding frequency and technique, with close monitoring and lactation support from a lactation specialist. The lactation specialist can help in problem solving issues surrounding low milk intake by confirming the following: too few wet or dirty diapers, insufficient feeding habits based on a breastfeeding history, and the baby losing weight.
Factors that may cause or contribute to young babies not getting enough milk:
Breast surgery: Including breast reduction, breast augmentation and breast biopsy.
Nipple conditions: Sore nipples may decrease milk supply because of infrequent breastfeeding or the breasts not being emptied.
Medications associated with low milk supply: Antihistamines, oral contraceptive pills with high estrogen content, Pseudoephedrine Nicotine Ethanol (excessive use may decrease milk supply Diuretics).
Hormonal: Retained placenta (piece of placenta that did not come out of the uterus). Not enough milk making cells in the breast. Other factors include: obesity, preeclampsia, high blood pressure, diabetes, thyroid disease, polycystic ovarian syndrome, stress pituitary insufficiency.
Infant: Tongue-tie or lip-tie. Babies born before 37 weeks gestation. Sucking and swallowing problems. Neuromotor delay. Cleft lip and/or palate.
Mother and baby together: Poor latch to breast. Delayed time in starting to breastfeeding. Mother and baby were separated.
Possible solutions/management options to consider if one (or more) of the above factors are contributing to low milk supply:
Breast surgery: Improve breastfeeding techniques like latching and positioning. Expressing breast milk with a pump may help increase making milk. If the baby is not gaining weight well, consider giving supplementation of donor breast milk or formula.
Nipple conditions: Find the cause, and then work on breastfeeding position and latch. Take measures to heal nipples, and continue breastfeeding to make enough milk. Consider using a nipple shield.
Medications associated with low milk supply: Consider alternative medication if possible. Review alternatives with your doctor/midwife. Practice good breastfeeding techniques.
Hormonal: The degree of these factors affecting milk supply and ability to breastfeed varies with severity and cause. Work with a lactation specialist to measures baby’s weight, while practicing good breastfeeding skills. Talk to your care provider to find the cause and a treatment.
Infant: Work with a lactation consultant or other expert in swallowing problems, checking for lip/tongue tie.
Mother and baby together: Work with a lactation specialist on learning skills to help baby latch to breast. Mother and baby should be skin-to-skin as much as possible. Having baby closer by in the room, bassinet or crib in bedroom is best for learning cues and encouragement of breastfeeding.
Feeding problems and inadequate milk intake are more common in babies born between 34 and 37 weeks gestation or babies with other medical problems. It would be especially important to work with a lactation specialist for breastfeeding support and monitoring. The lactation specialist and lactating parent often work together to plan scheduled feedings and after-feeding pumping, and do a weighted feeding (weighing baby before and after eats) to determine actual milk intake. These steps can help in being successful in breastfeeding and having proper milk intake.