Need Help With Supply

QUESTION

Dear Lactation Consultant,
It's been 10 days since the birth of our baby girl. My breast milk took about five days to come in. Our baby wouldn't latch on to me because of my flat nipples. I was given nipple shells, but she didn't like those either. Since then I've been pumping with a double breast pump and bottle feeding in order to supplement with formula since I wasn't producing enough milk.

I get about an ounce worth with each pumping session on my left breast, but my right breast barely puts more than a few drops. Is this common? Is there anything I can do to catch up production? I've been pumping a few minutes longer on the lazy breast in hopes I would stimulate it, but I haven't noticed a difference. Is there a chance it may never catch up? Help!

Sincerely,
Shalmar

ANSWER

Hi Shalmar,
I'm sorry that you are experiencing so many breastfeeding difficulties. I know that this is a very stressful and frustrating time for your family. I wish that I could tell you exactly what you need to do to turn things around for you, but that is impossible without having the opportunity to work one on one with you and your baby.

I don't know what kind of support you have available in your area, but it is essential that you locate someone knowledgeable (Lactation Consultant or La Leche Leader) in your area who can work with you individually to resolve this problem, because I don't have enough information to diagnose and recommend treatment based on the limitations of internet correspondence.

I can give you some general information that may be helpful.

  • Most cases of low supply are due to the baby not nursing often enough or effectively enough to give your breasts the stimulation they need to produce an adequate supply. If this is the case, then the problem can usually be resolved by nursing more often or using a good breast pump for awhile to increase the stimulation.
  • A low milk supply can be caused by problems with the mother (pituitary or thyroid imbalance, breast reduction surgery, flat or inverted nipples, congenital lack of glandular tissue, estrogen containing birth control pills, etc.) or with the baby (tongue tie, prematurity, improper latch, neurological dysfunction, etc). Depending on what the problem is, there are a number of different strategies for dealing with it.
  • Women's bodies are designed to produce adequate milk for their growing infants, but the system of breastmilk production works best when they are available 24/7 to nurse whenever the baby wants to feed. New technology has developed sophisticated breast pumps that allow mothers who are separated from their infants to maintain milk production even in cases when they aren't able to nurse for extended periods of time, but there is no pump on the market at an price that can equal the stimulation of a healthy baby feeding well at the breast. Even the best electric pump is no substitute for a real baby nursing. Most mothers will not get the same stimulation from the pump that they get from nursing their baby. That's why you need to focus on getting help ASAP, so that you can get your baby to latch on and nurse effectively to ensure that your breasts so receive optimal stimulation and milk production is maximized.

In the meantime, your baby needs to eat. If you are unable to express enough milk (2 1/2 ox to 3 oz for every pound of weight in 24 hours), then you need to supplement. One of the problems than can crop up when you supplement with formula is that while it solves one problem (making sure the baby gets enough to eat), it can also create problems because your baby doesn't have much incentive to go on the breast and nurse vigorously for long periods of time if his tummy is full of formula.There is no scientific evidence that herbal supplements will increase milk supply, although they are fairly safe and inexpensive and seem to help some women, so it doesn't hurt to try them. However, they will not cause a significant increase in your supply, and neither will drinking lots of water or eating a special diet. I wish it was that simple! If your milk supply is so low that your baby is losing weight, then you and your baby need to be carefully evaluated by a breastfeeding specialist who can determine what the underlying problem is and how to address it.

There are articles that might be helpful ("Establishing Your Milk Supply" and "Increasing Your Milk Supply"), but your best bet is to find someone who can work with you in person.

If you want to find help locally, contact your local La Leche League or call 1-800-LALECHE or go to lalecheleague.org. You can also find an IBCLC in your area by contacting ILCA (International Lactation Consultant Association) at 312-541-1710 or by e-mail at ilca@erols.com. You can find information about lactation resources in your area by calling 1-800-TELLYOU or visiting medela.com

There is a very small percentage of mothers who are unable to produce a full milk supply no matter what they do. If this is the case, then it is almost always possible to combine breast and bottle feeding and not stop nursing completely. Any amount of breastmilk at all is beneficial, even if you have to supplement with formula.

I wish you all the best,

-- Anne, IBCLC

Kathleen Tackett

Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.

Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.

Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.