Tricky to Treat
When a mom is experiencing difficulty making enough milk for her baby, the usual suggestion from well meaning professionals is often, “Nurse your baby more —your body will rally and you will make more milk in just a few days.” This suggestion is based on the law of supply and demand. When more milk is removed from the breast, the breast will respond by making more milk. While this advice can be legitimate in some situations, many times it can result in an exhausted baby who, despite mom’s best efforts, can’t get enough milk to gain well.
Meet Mom A. She made an appointment with me because her milk supply was low. She was supplementing with formula and exclusively breastfeeding was important to her. She wanted to try Domperidone to help with her milk supply because the herbs that she had tried weren’t working. Her baby was 2 months old. I learned from this mom that she had ample supply for the first 6 weeks. In fact, she was even able to pump extra!
I watched baby breastfeed, assessed her for tongue tie and anything else that could interfere with breastfeeding. This baby was a champion breastfeeder and had no other issues. So how did Mom A’s supply decrease so quickly and dramatically? After some detective work, it became clear. She had started taking oral contraceptives – the “mini pill” at about 6 weeks. Shortly after that is when her supply began to decrease. She decided to stop taking the pill and, with herbal support, her milk supply has been increasing steadily ever since! (Both the mini-pill and the Mirena IUD are hormone-based methods of birth control that can decrease milk supply in some mothers.)
Meet Mom B. She originally met with me because her nipples were terribly sore. She had more than enough milk for her 2 week old baby but the pain was unbearable. I identified a tongue tie in that first visit, told mom she could pump for feeds instead of breastfeed until her nipples healed, and to come back after baby had a frenotomy.
When I saw her after the frenotomy, Mom B was still exclusively pumping. She was understandably afraid to nurse her baby without guidance. She was also very upset and tearful. Yes, her nipples were feeling much better, but her once ample supply was now extremely depleted. She was using 12 oz of formula per day. How did this happen? At first I couldn’t figure it out. It made no sense. Then I asked her about her pumping routine. She explained that she had a lot of family in town.. she was feeling stressed. She had only been pumping 3-4x per day. Her milk supply gradually decreased over the 1 ½ weeks between appointments with infrequent pumping.
At the visit I stressed the importance of milk removal every time her baby eats, gave her an herbal supplement to help it along, and baby breastfed with minimal discomfort. Her milk supply is increasing steadily.
Meet Mom C. Mom C called me because she was worried about her baby’s weight gain. Her baby had only gained 7 oz in 2 months. Baby was 4 months old. During the visit it became clear that Mom C had plenty of milk in the first 2 months. She had pumped extra milk and stored it in the freezer. Baby’s weight history also showed normal growth until his last weight check. Mom C believed her low milk supply may have been caused by her augmentation surgery 5 years prior. But she had nursed her first baby after the surgery with no problem. It seemed like a mystery—until I looked in the baby’s mouth.
Baby was tongue tied. He could not move his tongue normally during the oral assessment. He also had a difficult time at the breast—pulling his tongue back frequently and pulling away from the breast to handle a fast flow of milk. I referred him for a frenotomy. He is now nursing better, and mom is working at building her supply while she is supplementing her baby at the breast. He is gaining well and mom reports he his much happier.
So what happened with Mom C? Often when a baby is tongue-tied, she seems to do quite well the first 4-6 weeks or so when mom is making more than enough milk. Baby’s suck may be weak or incorrect, but with milk easily pouring into the baby’s mouth, baby gains adequately. If there is no nipple pain, mom may not seek help because she doesn’t recognize the subtle deviations in the sucking pattern that are characteristic of poor tongue mobility. As the mother’s supply becomes regulated by the baby instead of hormones, and baby isn’t doing a great job of milk transfer, supply drops. Then, “all of a sudden” baby doesn’t gain weight. I see this happen way too often.
Meet Mom D. Mom D never made enough milk for her first baby. She didn’t know she had a problem until her baby was diagnosed failure to thrive after a week of breastfeeding and continuing to lose weight. When she was pregnant with baby #2, she contacted me for a prenatal lactation consultation. Given her breastfeeding history, breast shape and her medical history, I became convinced that this mom likely had insufficient glandular tissue (IGT) to make enough milk for exclusive breastfeeding. She ordered Domperidone and other supplements to have on hand after the birth of this baby.
I saw Mom D again shortly after the birth of baby #2. At the visit, he was able to latch and transfer milk well—although mother had minimal milk at this point. Mom started on Domperidone and Goat’s Rue (one of the best herbs to help with IGT) right after birth. She rented a scale so she can keep track of his weight. She noticed supply increases by day 4 and at this writing it is still increasing. Because baby is such a great breastfeeder, she can supplement at the breast and avoid a lot of pumping. Will this mother make enough milk for her baby? Maybe not. But she realizes there may be limitations and is comforted knowing she is doing all she can and her baby is thriving.
Four mothers—all of them with low milk supply. Four very different solutions.
If you’re having problems with milk supply, please don’t wait. Please don’t rely on social media for the answers! Contact an experienced, trusted IBCLC as soon as possible. She will help you find the cause and determine the best course of action for you and your baby!