Chronic low milk supply
Foreword by a lactation consultant
One of the main concerns that I am approached with as a lactation consultant is concern about the baby's weight. Sometimes a family needs confirmation that the baby's latching technique is correct and that the baby is gaining enough weight. Sometimes a family may be worried about the baby's crying, which often leads to the premature conclusion that the baby is hungry, even though the weight gain and urine volume (which are the only indicators of a full baby) are normal. Concerns related to a child's low weight gain can usually be resolved at the first visit. But I’ve also supported families where, despite all their efforts, the baby's weight does not increase enough when breastfed alone. In my practice, I can count these mothers on the fingers of one hand, which is a completely non-existent indicator in statistical terms. But for these few families, this concern is a 100% real thing, that affects them every night and day. So it’s important topic, isn’t it?
Today I am sharing an article by biologist Auli Veske about chronic low breastmilk supply so that all families feel noticed and heard. As Auli repeatedly says in her article, chronic low breast milk supply is not easy to detect, it requires long-term and trusting cooperation between the family and a lactation consultant to rule out all other causes that may negatively affect breastfeeding. This article is also not a basis for diagnosing chronic low breast milk supply. It is a call to investigate the causes of low weight gain in more depth and to help women with chronic low breast milk supply set realistic goals for continuing breastfeeding.
If you are concerned about your baby's feeding or low weight gain, or would like to consult about chronic low breast milk supply, I am here for you.
Have a nice read!
Daisi Kuuse, lactation consultant, postpartum doula
Could I have a physiological low milk supply?
Physiological or chronic low breast milk supply is a situation where, despite an effective breastfeeding routine, a woman's body does not produce enough milk to ensure normal weight gain for her baby. We can only talk about chronic low breast milk supply if all the usual methods for increasing breast milk have been thoroughly tried beforehand. The amount of breastmilk must be assessed using reliable indicators, such as weighing before and after breastfeeding. Tongue and lip ties or incorrect latch that would prevent the baby from sucking must also be checked. Therefore, if you suspect that you have low breast milk supply, you should first contact a lactation consultant to rule out all these problems. In most cases, low breast milk supply is apparent or can be resolved by following the appropriate recommendations.
However, there are a certain number of women who are biologically unable to produce enough breast milk. In medical terms, this is called primary lactation insufficiency. According to various studies, these women account for 1-15% of the population. Most women are not aware that they are facing a physiological lack of breast milk before they start breastfeeding, because it may not be accompanied by any other noticeable symptoms or health problems.
However, there are also some health problems that can cause a physiological lack of breast milk, such as:
• hypothyroidism or hyperthyroidism,
• polycystic ovary syndrome,
• insulin resistance and/or diabetes,
• low prolactin levels,
• unexplained infertility problems,
• other hormonal problems (e.g. pituitary disorders).
These factors can be considered risk factors. However, the connection is not clear - many women have enough milk even if these health problems are present. Physiological lack of breast milk can also occur without these risk factors.
Therefore, you cannot diagnose a physiological lack of breast milk yourself, but this requires thorough cooperation with a lactation consultant(s). However, if you have already made targeted efforts for weeks or months, consulted with consultants repeatedly, and the amount of breast milk really does not increase, then it cannot be ruled out that the cause of the problem is physiological.
How can I continue breastfeeding when my milk supply is so low? Does it even make sense?
The most important thing to remember is that you can breastfeed successfully and for a long time even with a little breast milk! A low breast milk supply does not have to be a reason to stop breastfeeding. Even a small amount of breast milk is beneficial for your baby and worth the effort. And even with little breast milk, you can enjoy breastfeeding and feel a special closeness with your baby.
Breastfeeding through chronic low milk supply can be emotionally challenging and requires some support. How to ensure adequate weight gain depends on your specific situation and goals. An experienced counselor can help you make choices.
To identify a chronic low milk supply, it is necessary to determine how much milk your body can actually produce. Therefore, it is very important to follow an effective breastfeeding routine under the supervision of a lactation consultant in the first weeks. This may include intensive pumping, regular weighing of the baby, etc. However, if it has been determined that despite great efforts, the amount of breast milk does not increase beyond a certain limit, it is important to establish a breastfeeding routine that is within your reach and enjoyable, so that you can breastfeed for a long time and with joy.
Why do I have a chronic low breast milk supply? Is it treatable?
Physiological low breast milk supply is often caused by a hormonal problem. This in turn can lead to other health problems throughout life, in addition to low breast milk supply. So it makes sense to delve deeper into the topic and find out what is behind the low milk supply.
You should start with a consultation with a lactation consultant and blood tests, which can be ordered by your family doctor or gynecologist. These tests can also be performed in private laboratories (e.g. Synlab in Estonia). Blood tests can detect thyroid problems, insulin resistance (pre-diabetes), polycystic ovary syndrome and determine prolactin levels. All of these indicators can be related to low breast milk. For example, in the case of thyroid problems, it is also possible that low milk supply will resolve with the right medications. It is important to find a supportive doctor who can help you understand the results and plan further steps.
If blood tests do not reveal any problems that could explain the lack of milk, then it may be glandular tissue insufficiency. This is rare, but still possible. Unfortunately, there is no direct way to confirm glandular tissue insufficiency. It cannot be diagnosed based on the appearance of the breasts alone, nor can it be diagnosed with an ultrasound, for example. Insufficient glandular tissue can only be suspected after blood tests have been performed, when all other possible causes have been ruled out.
Read more:
Low Milk Supply Foundation: https://www.lowmilksupplyfoundation.org/
Insufficient glandular tissue: https://kellymom.com/bf/got-milk/supply-worries/insufficient-glandular-tissue/
Evidence-based on the physiology and problems of breastfeeding: https://lowsupplymom.com/
Support group for women with chronic low milk supply (you must fill out a comprehensive questionnaire to join): https://www.facebook.com/groups/IGTmamas
Text by Auli Veske. If you wish, you can ask me for Auli's contact information to get clarifications or share experiences.
