Low Supply

As you might have gathered if you've read some of my blog posts, I have IGT (insufficient glandular tissue), also known as mammary hypoplasia, which means I don't have enough breast tissue and so can't make enough milk for my babies. This puts me in the minority of women. However, the number of times I've heard people say they had to give up breastfeeding because they didn't make enough milk, you'd think that it was much more common.

Low supply isn't a myth, but true low supply is pretty rare. And low supply is no reason to give up breastfeeding either. 

First of all, let's discuss what low supply isn't. Frequent feeding is not a sign of low supply. Nor is frequent waking. Both of these are normal behaviours for newborns - frequent feeds are baby's way of building up your supply. And frequent wakings help to protect baby against SIDS. Babies' tummies are tiny and breastmilk is quickly digested, hence the need for frequent meals. And during growth spurts babies feed much more often to put in their orders for more milk. The 4 month sleep regression is often a time when women believe that their milk supply has dwindled, but it's just a huge growth spurt and totally normal. Feed feed feed. 

Check out this Kellymom link to find out a bit more about what isn't a sign of low supply.

Now, there are behaviours that can cause low supply:

Supplementing - giving baby formula will, first of all, fill baby up, making him nurse less, which in turn will cause your breasts to make less milk, resulting in a downward spiral of more supplementing and less breastfeeding, because your breasts aren't making enough milk. If you choose to supplement, then pump after every top up to ensure your breasts don't miss a feed. Supplementing with a bottle can also cause nipple confusion or nipple preference, where the baby prefers the fast flow of the bottle over having to work at the breast.
Scheduled Feeds - feeding baby on a schedule, for a specific length of time, can mess up your supply, by interfering with the demand side of supply & demand. When a baby is fed whenever they show hunger cues, then they are telling the breasts how much milk they need. Schedules remove this element and the breasts don't produce as much as baby needs. This often results in weight loss/slow gain, leading to supplementing due to perceived low supply.

When low supply is behavioural, there are plenty of ways to increase supply. Feeding on demand, allowing baby to 'comfort suck', and avoiding all supplementation are the first steps.

It's also important to note that the amount you can pump is not a good measurement of your supply. Some women just don't respond well to a pump. My mum exclusively breastfed four babies, and couldn't get a drop with a pump.

Biological issues are harder to deal with:
Heavy blood loss during/after labour.
Insufficient glandular tissue.
PCOS.
Thyroid issues.

Retained placenta.
Some medications.

With some work, low supply in some of these cases can be combatted. Pumping after feeds to put in more of a demand; taking galactagogues; increasing water intake; nursing vacations; some medications (e.g. domperidone, metformin); vitamin supplements; lactation cookies. The more you breastfeed, the more milk you should make. The action of breastfeeding also causes more breast tissue to be made. Second time round, mums often have a greater milk supply. This has certainly been the case for me - I have made more milk for M than for B.

And then, in the minority of cases, full supply will never be achieved. In this case baby needs to be fed in other ways - formula or expressed milk supplementation. It doesn't mean the end of a breastfeeding relationship though. It is possible to continue to breastfeed your baby and give them top ups.

I breastfed B and topped her up with formula in bottles; I breastfeed M and supplement her with donor breastmilk in a Supplemental Nursing System. Different methods work for different people. Having tried both ways, I have to say that I prefer the SNS. I don't have to express after feeds as my breasts are stimulated during the feeds. An SNS, therefore, is ideal for anyone who has a - perceived or real - low supply, because a supply that can be boosted will be.

If you really believe that you have low supply, then consider joining the IGT and Low Milk Supply Support Group on Facebook. I have found out so much more information on boosting supply there, as well as receiving a lot of support. There are women there with many different breastfeeding stories - some breastfeed and supplement with bottles; some uses SNSes; some have given up breastfeeding altogether; some only provide comfort sucking; some have gone on to have full supplies with subsequent babies; and some never make a drop - you are sure to find support, encouragement and advice there.

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