Milk Supply
Are you interested in breastfeeding? Did you know that learning to breastfeed is a joy for some, but an uphill climb for others? Did you know that it doesn’t come ‘naturally’ for the majority of women? I advise my patients that it can take up to six weeks for a woman and baby to feel confidant breastfeeding. In my personal experience, it took ten weeks. I’m not suggesting that supplementation is automatically necessary in these cases, what I am saying is that the learning curve can be steep. Creating reasonable expectations is one of the best ways to set women up for success. As a naturopathic physician working with pregnancy and paediatrics, I am all about setting families up for success!
One of the biggest concerns breastfeeding women have is their milk supply. This article will focus on not-enough-milk (the most common supply issue), but there can also be challenges with over-supply. Read on for more information on diagnosing a supply issue, and how to start addressing it from home.
The numbers:
In general, women produce 90 mL colostrum / 24 hrs for the first two – five days post partum. Milk typically comes in between day three – five, and it is estimated that 500 mL/day are produced. This increases to 750 mL/day for months three – five and then reaches an estimated 800 mL/day at six months and onwards. These are ballpark numbers because every body is unique.
Do you actually have a low supply?
A low supply is suspected when babies don’t grow at an expected rate (according to charts, care providers, or the parents themselves), when babies are fussy, feed frequently, fall asleep at the breast, or are unable to stitch together long enough stretches of sleep. Some women worry about their supply if they have small breasts, when pumping does not produce much milk, or their breasts do not feel full. However, there are lots of myths around assessing supply, and I’d like to debunk a few.
First, remember that growth rates are guidelines, and that most babies don’t grow on a perfect curve. Growth charts are only one piece of the puzzle on determining how a baby is doing. Did you know that a baby can be anywhere from 3rd-97th percentile and still be in the realm of normal? Breastmilk supply cannot by assessed by a baby’s weight alone.
As well, fussiness, feeding frequency, and sleep behaviour can be indications of several issues beyond supply. Breast size is not proportional to breast milk supply, and if your breasts don’t leak it doesn’t mean you have insufficient supply. If you don’t feel engorged, or if you don’t feel a let-down, again it doesn’t automatically indicate a problem. Did you know that some women produce a perfectly fine supply, but their pumped volume remains low? Take home message: be cautious what information you use to judge your supply.
So how do we know?
Combining weight, alongside milestones, and baby’s behaviour is wise. When assessing weight, it is important to take into account the size of the biological parents, and to watch how a baby follows the weight percentile curve they are on. As well, watching for typical developmental milestones like smiling, babbling, rolling over, sitting, etc. are important factors. Also look out for numbers of wet and dirty diapers for more clues. Unfortunately, there is not one way, and it is not a perfect science.
Why do women have low supply?
The reasons are multifaceted. Maternal health plays a big role (i.e. postpartum haemorrhage and maternal illness both decrease supply). A woman’s hydration level, caloric intake, and stress levels are also factors. Hormone balance influence supply (i.e. elevated oestrogen from birth control pills or deficient thyroid levels). A history of breast surgery / trauma may play a role. And remember: breastmilk production is based on demand, if the breast is not emptied, the supply will be lowered. Did you know that a great many cases of low supply are actually caused by insufficient or too-infrequent emptying of the breasts? If you are supplementing with bottles, distracting baby with a pacifier, trying to lengthen intervals between feedings, sleep training your baby, or doing anything that results in nursing baby less than baby might need/want, you are at risk of decreasing your own milk supply. A lot of mothers are delighted to learn that they’re capable of producing much more milk than they realized, they were just being led astray by faulty advice or information.
Solutions:
Address technique (especially latch). An experienced care provider needs to watch a baby nurse to get a good reading on latch and milk transfer.
Breastfeed on your baby’s demand. This is key to all supply issues.
Consider breast compression, offering both sides per feed, and potentially pumping after/between feeds.
Stay hydrated and well fed. I recommend drinking water every time you nurse. Women need 500 kcal extra /day than they required pre pregnancy. A nutrient dense diet with lots of protein and healthy fats will help. Specific foods to increase supply include oats, barley, peas, legumes, walnuts, and almonds, sunflower, sesame, flax seed, pumpkin, and hemp seed. Also, limiting caffeine, pineapple and sage is a good idea.
Get rest and address stress. This is where partners, friends, families, and postpartum doulas come in. Women working on their supply should do little else beyond nurse, rest, and eat.
Consider herbal medicine. There are several herbs out there that act as galactogogues to increase milk supply. They come in tea and tincture form. The list includes fenugreek, blessed thistle, goat’s rue, milk thistle, fennel, hops, and many more. These can be highly effective. I often recommend combining tinctures with teas to cover more bases. Every practitioner has their favourites, so speak with a licensed practitioner to get a specific prescription and dosing regimen.
Consider prescription medication. Domperidone is the most commonly prescribed medication to increase milk supply. It can be highly effective and requires a prescription from an MD or ND.
If you choose to supplement get informed on what you are giving, your delivery system, and how this will impact supply.
According to Dr. Jack Newman “the majority of women are perfectly capable of producing all the milk their babies need”. So if you are at home struggling, try some of the above tips. And please reach out to a friend, family member, lactation consultant, birth educator, postpartum doula, la leche league leader, or naturopathic physician well versed in breastfeeding support. There is no reason to suffer alone, and there are wonderful resources and support out there. And remember: with every steep learning curve comes a stretch of smooth sailing! Happy nursing!!
References
Dr. Jack Newman’s Guide to Breastfeeding
Diane Bengson’s How Weaning Happens
Kathleen Huggins’ The Nursing Mother’s Guide to Weaning
About the Author
Dr. Stephanie Peltz is a naturopathic doctor practicing in the Yaletown area of Vancouver, BC. Her area of expertise is working with women through conception, pregnancy, delivery, the postpartum period, breastfeeding, and treating children of all ages. She uses low invasive natural therapies including lifestyle modification, nutritional advice, the prescription of herbs and nutrients, and more. As a mother herself, she is passionate about supporting women through the joys and challenges throughout their journey. She is currently accepting new patients. Visit www.drpeltz.com for more information.
