This post is something I have been thinking about for a long time and feel as though it’s time for a discussion about low milk supply as it is desperately needed and long overdue. There are a few things that I repeatedly see written in comments on Facebook…including my own page (unfortunately). These include:
“You know, only 1-2% of women cannot make enough milk for their babies.” (FALSE…research is lacking on this and current estimates are anywhere from 5% all the way up to 15%. It also doesn’t take into account that while she physically might be able to MAKE enough, her baby might not be able to REMOVE enough so it’s not a helpful statistic…).
“You were just not committed enough to make breastfeeding work.” (FALSE…who are we to define “committed”?).
“Just pump every 2 hours and that will increase your supply.” (It MAY…or may NOT).
“Women just need support to be able to breastfeed.” (FALSE…they don’t just need “support” they need FACTUALLY CORRECT, honest, awesome support and EVEN THEN it does not mean she is guaranteed to make enough milk to breastfeed exclusively or that she will WANT to, or be physically and emotionally ABLE to cope with the frequent pumping, mixed feeding *formula feeding and breastfeeding*, nipple pain, nipple damage, etc.)…
There are a few different problems with these comments…simply put, they are incorrect and lacks understanding or empathy for what women go through. There are HUGE misunderstandings about low supply, what that really means and why it’s happening. I have consultations with women every day who are struggling with low supply. Some of these women will eventually make enough milk for their babies to exclusively breastfeed and others will not. Yes, for the majority of women around the world (statistically speaking), getting awesome, correct information and breastfeeding on demand from the start will put her in the position to make enough milk for her baby. However there are many different possible reasons as to why this will not work for some women. Here are just SOME of the reasons 
Possible contributing factors from the mother:
- Breast surgery
- Chronic illness of any type
- Connective tissue disease
- Eating disorder
- Inverted nipples
- Polycystic ovary syndrome
- Postpartum hemorrhage
- Autoimmune disease
- Thyroid conditions
- PTSD, depression, history of abuse and/or other psychological/emotional concerns.
(*AMONG MANY OTHERS!)
And the infant:
- Tongue/lip tie
- Biliary atresia
- Cleft lip or palate
- CNS abnormality
- Congenital heart disease
- Cystic fibrosis
- Gastrointestinal infections
- Gastrointestinal malformations
- Gastroesophageal reflux
- Inborn errors of metabolism
- Increased caloric needs from chronic disease, infeaction, malabsorption
- Neurological disorders
(*AMONG MANY OTHERS!)
**Important to note these MAY contribute to supply issues. You are not guaranteed to have low supply if any of these are going on. They are possible risk factors. This list does not include birthing practices which can affect how our milk comes in.** If you are questioning your supply, click here.
Problems with the “support” that some women receive…
I see a lot of women online arguing, “But I did receive support! I had loads of support! I saw 17 different people and I still could not breastfeed!”
Over the years of doing consultations with women I have identified some of the most common reasons women have been let down by the “support” and “breastfeeding information” they have been given. So many women with low supply are told, “You need to pump every 2 hours and then give your baby that express milk after every breastfeed.” They just say it like it’s the same as suggesting the woman go eat a piece of cake and watch Netflix. PUMPING. IS. HARD. WORK. Most women hate it and most women find it incredibly challenging. Of course women are feeling let down after receiving said “support”! They walk away feeling overwhelmed, no plan except “pump” and no understanding of what is going to happen even two days down the road…
This is how I suggest we give breastfeeding women support and information…
- Give the woman an honest picture of what is needed for the short term vs. long term plan. When we give women with low supply advice, it’s often along the lines of, “Pump every 2 hours, take Domperidone for a few months and breastfeed on demand.” The woman then goes off trying to keep up with the plan without going crazy and no clear picture of when or even IF she will eventually make enough milk. It’s so important that as IBCLC’s (International Board Certified Lactation Consultants), doctors, midwives, child health nurses etc. we give short term plans and long term plans with different options the woman can do that will work best for HER. It might not put her in the best position to make the maximum amount of milk but it will work for HER. We must be honest about how frequently our breasts need to be drained while also being honest in how challenging it can be to pump and breastfeed.
- Giving the “ultimate” scenarios and then being clear that it might not be the reality of what the woman can manage on a day to day basis. I always present it like this to a woman, “Since breastfeeding works on supply and demand we know that our breasts need to be drained frequently. This means at least every 2-3 hours during the day and 3-4 overnight. HOWEVER what I suggest to you might not be possible for you on a day to day basis. While my suggestion is the ultimate ‘ideal’ situation, do what you are capable of doing. This might change day to day depending on your circumstances. It’s just important to understand that this frequent milk removal is what will put you in the best position to make as much milk as possible.” BE HONEST with the woman and her family. Some women have no problem pumping after every breastfeed or every 2 hours…others struggle to pump more than 1-2 times per day. Others will not be open to pumping at all. *Very important not to go too far the other way as well! Don’t automatically assume it will be too hard for her as some women find long term pumping very doable!”
- Acknowledging the different scenarios of what the future might hold. I always go through the different possible outcomes including: eventually being able to breastfeed exclusively, breastfeed while supplementing through a supply line, breastfeed while supplementing with a bottle, exclusively express and bottle feed or switch 100% to formula. Pumping may or may not be a big part of these different outcomes.
- Suggesting the woman take it day to day, giving herself small goals and re-assessing along the way on how she is coping and if she is OK with what she is doing. It’s important that women consciously take the time to check in with themselves. Take it day to day and re-evaluate their goals and what they would like to do.
- Help her investigate WHY she is struggling with low supply. I have written about the steps to take following a recommendation to supplement and one of the most important steps that I mention is figuring out why the woman has low supply. Is it that she has things going on which is preventing her from physically being able to make enough milk? Or is there something going on with her baby’s ability to remove enough milk which then affects the amount being produced? Or it could be a combination of challenges that both mother and baby are facing. This investigation is CRUCIAL when helping a mother struggling with low supply who would like to breastfeed.
If you make a comment about breastfeeding and low supply…enter the discussion with kindness and without assumption. We have no idea what women are experiencing or why they are struggling with low supply. Ask questions and listen…that’s always a good place to start.