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 technique is correct and that the baby is gaining enough weight. Another 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. Families often seek the support of a lactation consultant when the child's weight gain is low, and where the lactation consultant can find the cause of the low weight gain and give advice on weight gain at the first visit. And then there are those few 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 real 100% of the time.

Today I am sharing an article by biology PhD student 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?

 

Kõige tähtsam on meeles pidada, et ka vähese rinnapiimaga saab edukalt ja kaua imetada! Rinnapiima vähesus ei pea olema põhjuseks, et imetamine lõpetada. Ka väike kogus rinnapiima on Sinu lapsele kasulik ning väärib pingutust. Ning ka vähese rinnapiima korral saab imetamist nautida ning tunda erilist lähedust oma beebiga.
Imetamine läbi kroonilise rinnapiima vähesuse võib siiski olla emotsionaalselt keerulisem ning eeldab ka mõningaid abivahendeid. Kuidas tagada piisav kaaluiibe, sõltub konkreetsest olukorrast ning Sinu eesmärkidest. Kogenud nõustaja saab Sind valikute tegemisel aidata.
Füsioloogilise rinnapiima vähesuse tuvastamiseks on vaja kindlaks teha, kui suur on Sinu maksimaalne piima tootlikkus. Seetõttu on väga oluline esimestel nädalatel järgida tõhusat imetamisrutiini nõustaja jälgimisel. See võib sisaldada intensiivset pumpamist, lapse regulaarset kaalumist jpm. Kui aga on kindlaks tehtud, et hoolimata suurtest pingutustest ei suurene rinnapiima kogus teatud piirist edasi, on oluline seada sisse imetamisrutiin, mis on sulle jõukohane ja nauditav, et saaksid imetada kaua ja rõõmuga.

Miks mul ikkagi krooniline rinnapiimavähesus on? Kas see on ravitav?

Füsioloogilise rinnapiima vähesuse taga on sageli mingi hormonaalne probleem. See omakorda võib elu jooksul põhjustada ka muid terviseprobleeme peale rinnapiima vähesuse. Seega on igati põhjendatud, kui soovid teemasse süveneda ning välja selgitada, mis on piima vähesuse taga.
Alustada tuleks imetamisnõustaja konsultatsioonist ja vereanalüüsidest, mida saab Sulle määrata pere- või naistearst. Samuti on neid analüüse võimalik teha eralaborites (nt Synlab). Vereanalüüsidega saab tuvastada kilpnäärmeprobleeme, insuliiniresistentsust (eeldiabeeti), polütsüstiliste munasarjade sündroomi ja määrata prolaktiini taset. Kõik need näitajad võivad olla seotud rinnapiima vähesusega. Näiteks kilpnäärmeprobleemide puhul on ka võimalik, et õigete ravimitega piima vähesus laheneb. Oluline on leida toetav arst, kes aitab tulemusi mõista ja edasisi samme planeerida.
Kui vereanalüüsid ei tuvasta ühtegi probleemi, mis võiks piima vähesust selgitada, siis võib olla tegemist rinna- e. piimanäärmete puudulikkusega. See on haruldane, kuid siiski võimalik. Kahjuks pole olemas ühtegi otsest viisi piimanäärmete puudulikkuse kinnitamiseks. Seda ei saa diagnoosida pelgalt rindade välimuse põhjal ega ka näiteks ultraheliga. Piimanäärmete puudulikkust saab kahtlustada alles pärast vereanalüüse, kui kõik muud võimalikud põhjused on välistatud.

Edasist lugemist (ingl. k):

Low Milk Supply Foundation: https://www.lowmilksupplyfoundation.org/
Piimanäärmete puudulikkusest (insufficient glandular tissue): https://kellymom.com/bf/got-milk/supply-worries/insufficient-glandular-tissue/
Tõenduspõhiselt imetamise füsioloogiast ja probleemidest: https://lowsupplymom.com/
Tugigrupp naistele, kellel on füsioloogiline rp vähesus (liitumiseks tuleb täita põhjalik ankeet): https://www.facebook.com/groups/IGTmamas

Teksti koostas Auli Veske. Soovi korral võid küsida minult Auli kontakti, et saada täpsustusi või jagada kogemusi.