Dr. McCue:
It’s fair to say that I make a living regulating milk supply. The number one complaint we hear from clients is, “I don’t have enough milk!” Sometimes I’m in agreement and other times, expectations are totally unrealistic. There are so many things that come into play; storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump.
Here are some of the issues I look for, and as always, a consultation with an International Board Certified Lactation Consultant (IBCLC) will help determine what’s happening and how to assist:
- Do you have adequate breast tissue, in other words, do you have very small or conical shaped (meaning tubular-shaped) breasts? Did your breasts increase with size during pregnancy? You should have gone up approximately one cup size.
- Are you bleeding for a prolonged period or passing clots in addition to not making enough breast milk? These are signs of retained placenta, which can prevent the milk from fully coming in.
- Are you using a personal use pump to express milk more than 3-5 times a week? The pumps from insurance companies are rarely adequate to pump when separated from babies for extended periods. This means if you’re exclusively pumping, or back at work, leaving the house at 8 and returning at 6, you’re going to most likely need a hospital grade pump. Insurance pumps that you own are sometimes called “hospital grade” but in the world of lactation consultants, we mean the kind that you rent from your lactation consultant or hospital. My favorite is the Medela Symphony because it’s only seven pounds and has a soft stimulation phase that helps moms produce prolactin.
- Are your flanges the correct size? The flanges are the funnels that cover your breasts and nipples. I can’t tell you how many times we’ve seen JUMBO flanges that are totally unnecessary. You want some stimulation for the nipples. You can size your flanges properly by looking at the nipple when you pump. There should be clearance enough around the entire perimeter of the nipple (mid base to tip) and you should not have a large part of the areola or breast itself being sucked in. You also don’t want them too small or you could cause damage (read: soreness) from pumping, and prevent milk from draining well from the breast. This can be tricky, so again, find a local lactation consultant to help you.
- I always recommend double pumping (both breasts at once) for 20-30 minutes when back at work or when pumping to substitute for direct breastfeeding. Fifteen minutes rarely cuts it unless you have an oversupply but again, if that’s your problem you’re not my reader! Yes, I know the milk stops coming but if you can hang in there a few minutes longer, you’ll get another letdown, meaning the milk will start to squirt out again. It’s great to have at least two or three letdowns. Some moms can initiate another letdown but putting the pump back on the stimulation (or letdown) phase, or by taking a short pause to massage the breasts before resuming pumping.
- Have you had a low supply since baby’s birth? Maybe you’re dealing with a tongue tie or lip tie or both. Is baby a good feeder, meaning is he/she gaining at least an ounce a day? If you suspect your baby is having difficulty latching onto your breast and emptying them well enough to bring your supply in, an in-person evaluation with an IBCLC will help you figure out how best to help.
- Is your baby sleeping through the night? If they are in bed by 7 or 8pm, you should pump before going to bed at 10 or 11pm. If you go to bed when baby does, you should optimally not go longer than 6 hours without stimulation to the breasts.
- Do you have PCOS, thyroid problems, low iron or insulin resistance? These can all cause low milk supply.
- Are you on ANY type of hormonal contraception? OBs and midwives sometimes aren’t aware that even progesterone only (mini-pill) or IUDs like the Mirena can really impact milk supply negatively.
- Are you drinking more than what you’re thirsty for? More water than you need actually works against you and you’ll end up peeing more and making less milk.