by Anne Smith, IBCLC

Nearly all nursing mothers worry at one time or another about whether their babies are getting enough milk. Since we can't measure breastmilk intake the way we can formula intake, it is easy to be insecure about the adequacy of our milk supplies. The "perception" of insufficient breastmilk production is the most common reason mothers give for weaning or early introduction of solids or supplements. Although there is a very small percentage of women who can't produce enough milk no matter what they do, this is very rare.

The first thing to determine is whether your supply is really low or not. Some mothers have unrealistic expectations, and feel that if their baby isn't on a three-hour schedule, or sleeping through the night by six weeks, they must not have enough milk. There is a tendency for a nursing mother to blame everything on her breastmilk -- for example, if your baby spits up or is gassy, it must be something you ate; if he has a day when he feeds more often than usual, it must be because you don't have enough milk. Be careful not to get into the habit of attributing everything your baby does to nursing. All babies, formula or breastfed, have laid back, easy, and fussy days.

Often mothers worry about their milk supply if:

• The baby nurses often, or seems hungry soon after being fed. Remember it is normal for babies to feed often. They have a strong need to suck, and love to be held close. Breastmilk digests faster than formula, so nursing babies tend to eat more often. Nursing 10-12 times or more in 24 hours is not unusual. In fact, we lactation consultants worry a lot more about the baby who is sleeping long stretches than we do about the baby who wants to nurse "all the time". Growth spurts commonly occur at around 10 days to 2 weeks, at 3 weeks, at 6 weeks, at 3 months, and again at 6 months. The baby will nurse more frequently during a time of rapid growth and not seem satisfied. After nursing frequently on demand for a few days, most babies will level off and go back to their old schedule. Also, many babies will "cluster feed" in the evenings before going to sleep. This is a normal pattern for a breastfed babies. Formula fed babies also have fussy periods in the evening, but their mothers don't have a built-in way to comfort them, so they cry more.

• The baby spends less time at the breast (maybe 5-10 minutes rather than 15-20), he takes one breast rather than both at a feeding, or your breasts feel softer and don't leak as much as they did in the early weeks of nursing. These changes are normal and just mean that your body is adjusting your supply to meet your baby's needs.

• You compare your baby's nursing patterns, weight gain, or sleep habits to other people's babies, or even your previous baby. Remember that each baby is an individual, and the same rules don't apply to everyone, just as the same rules don't apply to formula-fed and breastfed babies.

To determine if you really do need to increase your supply, see the article on How To Tell If Your Baby Is Getting Enough Milk. If your baby is losing weight or not gaining rapidly enough, you need to determine why your milk supply is low, and take steps to increase it.

The following factors can contribute to an inadequate milk supply:

• Not getting enough sucking stimulation. A sleepy, ill or jaundiced baby may not nurse vigorously enough to empty your breasts adequately. Even a baby who nurses often may not give you the stimulation you need if he is sucking weakly or ineffectively.

• Being separated from your baby or scheduling feedings too rigidly can interfere with the supply and demand system of milk production. Nursing often is the best way to increase your supply.

• Limiting the amount of time your baby spends at the breast can cause your baby to get more of the lower calorie foremilk and less of the higher fat content hindmilk. Usually babies need to spend from 20-45 minutes nursing during the newborn period in order to get enough milk. Offer both breasts at a feeding during the early weeks in order to receive adequate stimulation. While some babies can get plenty of milk from one breast, and after nursing only a few minutes, usually this happens after the milk supply is well established, and not in the early stages of breastfeeding.

• If you are ill or under a lot of stress, your milk supply may be low. Hormonal disorders such as thyroid or pituitary imbalances or retained placental fragments can cause problems. Many mothers find that their supply goes down when they have a cold, or when they return to work.

• Using formula supplements or pacifiers regularly can decrease your supply. Babies who are full of formula will nurse less often, and some babies are willing to meet their sucking needs with a pacifier rather than spending time at the breast. If you need to supplement with formula, try to pump after feedings to give your breasts extra stimulation. If you use a pacifier, make sure that it isn't used as a supplement for nutritive sucking.

• If your nipples are very sore, pain may inhibit your letdown reflex, and you may also tend to delay feedings because they are so unpleasant. See the article on Sore Nipples for causes and treatment. Often careful attention to positioning will correct the problem.

• Previous breast surgery can cause a low milk supply. Anytime you have breast surgery, there is a risk of breastfeeding problems, especially if milk ducts have been damaged. Generally, breast implants or breast biopsies cause fewer problems than breast reduction surgery.