Nurshable

“Too Little Milk” Supply Triage

These are the questions I ask when I’m trying to help a mom figure out IF she has low milk supply and what is causing it. Low supply is rather rare and usually easy to fix. 

1- How old is your baby?

2- Was your baby full term or premature?

3- What symptoms make you think that you have low supply?

4- How many wet diapers has your baby made in the past 24 hours? How many poopy diapers? Were the diapers damp, wet, or soaked?

5- How is your baby behaving?

6- Does your baby have any health or physical issues?

7- What does your baby eat? (breastmilk from the breast, breastmilk from the bottle, vitamin supplements, formula supplements, solids)

8- Is your baby on any sort of a schedule?

9- Do you use a nipple shield, pacifier, supplemental nursing system, or bottles?

10- Do your nipples/breasts have any visible damage? (Cracks, bleeding, creasing after nursing, whiteness, clogged ducts, redness, tenderness, swelling)

11- What is your baby’s weight gain history? (Birth weight, lowest weight, weights at weigh-ins)

12- Are you on any medications? (Birth control, antidepressants, antibiotics)

13- Have you ever felt that your milk supply was sufficient/normal?

14- Are you exclusively breastfeeding, exclusively pumping, breastfeeding and pumping?

15- Are you separated from your baby during the day or night for any period of time?

16- How often do you nurse during the day?

17- Are you timing feedings and switching baby’s sides based on a clock or based on baby?

18- Are you letting baby comfort suck or do you stop feedings when baby’s sucking slows down?

2 responses to ““Too Little Milk” Supply Triage”

  1. Casie Cowan Avatar
    Casie Cowan

    My baby is 9 months old now but I’m going to answer these questions as I would have when my issues started to see if you have any suggestions that I could have done bit did not know about. I think I tried everything but I’m not sure.

    Parker was 2 weeks old when we were told we had to go to the hospital. He was born at 48 weeks. Parker lost over a pound and the visiting nurse called a lactation consultant and she said that we needed to go to the hospital immeadeatly. At the time he rarely peed, I have logs somewhere,but it was only a few times a day and they were wet but not soaked and pooped maybe every three days. Parker would sleep all of the time, I figured at two weeks old that was normal, I would put him on one breast per feeding (until I was told otherwise)and he always fell asleep when he was latched on. He was not on a set schedule, we followed his lead for everything. He had no health issues at all. He was EBF. No pacifier or anything else. I had no nipple damage at all. He was born 7lbs 6oz, and he dropped down to around 6lbs 2 oz. I was not on any meds, just the prenatal. For those two weeks I thought I was doing everything right with breast feeding, he had no latching problems, and I thought everything was good. I was never separated from him,I nursed many times a day, whenever he wanted it. I did let him comfort suck a lot.

    Working with lactation consultants I was put on a medication called domperidone, three herbal medications and they worked ok, I was never able to produce more than half oz with both breasts combined with a pump. I would nurse before every bottle, but we had to supplement with formula from that point on. One of the doctors I saw basically said that I do not have a lot of mammory tissue, and speculated that I may have PCOS and that caused me not to develop breasts during puberty. But she was a pediatrician and I never had any tests done. I would love to be able to at least breast feed my future children. As of right now sometimes I let Parker “nurse” to comfort him and if he is having trouble go to sleep, but I have dried up.

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    1. sarah Avatar
      sarah

      Hi Casie,

      PCOS and insufficient glandular tissue are definitely something that will complicate things.

      Did you mean to say he was born at 48 weeks or did you mean 38 weeks? If he was 8 weeks “postdate” that might have contributed to your issues some. Especially if he was a c-section baby.

      What I’d look into if I were you would be this:

      Find an IBCLC locally as soon as you’re pregnant. Work with her to formulate a plan for after your baby’s born. See if you can find one who has experience with women who have PCOS and insufficient glandular tissue.

      Goat’s Rue: It purportedly increases glandular tissue and can be helpful for moms with hypoplastic breasts, insufficient glandular tissue or PCOS.

      Look into what effect a progesterone supplement might have on your supply. Make sure to avoid birth control options that contain estrogen.

      Consider Reglan as soon after birth the next time around as it is safe to try and help bring in a stronger supply.

      Use a hospital grade pump to pump after every feed.

      Switch sides frequently while nursing in the early weeks.

      Nurse on a schedule of forced frequency rather than on demand. At least every hour during the day and every 3-4 hours (at least) at night. More often if baby requests it more often. (Doing this for the first six weeks increases your supply)

      Keep close track of wet diapers and start supplementing with the milk you pump after feeds. Use a Supplemental Nursing System to give the supplement so that baby is still at the breast when getting the supplement. More stimulation to the breast = more of a chance of maintaining milk supply.

      Find people who have dealt with PCOS or insufficient glandular tissue. Find out what worked for them.

      What I’d be trying to do in your situation is I’d try to spend the first six weeks immediately after birth doing everything I could to bring in my milk and establish as much of a supply as possible to see what my “baseline” would be, and then re-evaluate after six weeks and define my goals.

      You might not be able to breastfeed exclusively. You might find that your experience the next time around is much easier. You might find there are things you can do that help. You might find that the amount of effort you need to put into maintaining a supply is too taxing and you might only be able to do some of it. That’s fine. You’ll find your balance and you’ll find what works for you and what doesn’t.

      Resources for you:
      http://www.breastfeedingwithlove.com/PCOS.html
      http://www.amazon.com/Defining-your-Own-Success-Breastfeeding/dp/0912500867 (about breastfeeding after breast surgery- but has a lot of good information not applicable to breast surgery)

      It sounds like you put a lot of effort in with your first. That must have been scary and heartbreaking for you to have that experience when you thought everything was going well. Being taken by surprise like that is hard. Going into it prepared and with a plan for how to try will be easier for you. hug

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