S1 EP6 – Why is my supply low?

Breastfeeding … with ABA podcast transcript.

Link to the podcast episode.

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BELINDA: When my mum was a new mother, she was told to feed to a schedule, so she had a 6 am feed, and a 10 am feed, and a 2 pm feed, so 4-hourly feeds. And we know that in the many years since my mum’s been a mum, I won’t let on how many years that is, the advice has changed to not to follow a scheduled feeding pattern or routine but that we should be responding to our baby’s feeding cues. And baby’s feeding cues may not be in a regular pattern, like at a set time, so they might be showing signs of wanting to feed within an hour that they’ve just fed. But those feeding cues really help the baby to give those cues to your body to build the supply.

JENNIFER: Welcome to Breastfeeding … with ABA. A podcast brought to you by volunteers from the Australian Breastfeeding Association. Breastfeeding … with ABA is a podcast about breastfeeding made by parents, for parents. In this episode we’ll be talking about signs of low supply, reasons for low supply, how to increase supply and where to get help if it’s needed.

BELINDA: We are recording this podcast in different parts of Australia. We acknowledge the Traditional Custodians of the land on which we are recording and on which you are listening to this podcast. We pay our respects to elders past, present and emerging and to any Aboriginal people who are listening today. We also acknowledge that the Indigenous women of Australia have been living, working, birthing, breastfeeding and raising children successfully on this country for tens of thousands of years.

JENNIFER: In each episode you will hear from different mums from around Australia.

BELINDA: My name is Belinda Chambers and I’m a volunteer breastfeeding counsellor with the Australian Breastfeeding Association, and a mum. I’m speaking from Wadawarrung Country.

JENNIFER: And I’m Jennifer Hurrell. I’m a volunteer breastfeeding counsellor and community educator with the Australian Breastfeeding Association and also an internationally board-certified lactation consultant. I’m also a mum. I’m speaking from the land of the Dja Dja Wurrung people.

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BELINDA: When I was a new mum, I had concerns about my supply when my babies became really unsettled in the evening time. I’d worry whether I was making enough milk for the day and whether there was happening with my supply was running out.

JENNIFER: I think the time I remember most worrying about my supply was when my baby, my second child, was born. She was very tiny; she was only 2.3 kg at term and spent a week at the nursery. And within the first 24 hours, she was being offered my milk, but also on a drip. The drip came out and the hospital staff just wanted me to suddenly start making more milk, which I wasn’t able to suddenly do. And I got really stressed because they were like, ‘if you don’t make enough milk, we’ll have to give her formula.’ And I knew, I breastfed before, that I was probably going to be able to make enough for my baby, so I was hoping that wouldn’t be necessary. And I got my partner to help me. We asked to speak to the paediatrician who was able to be very reassuring, reassured the staff and us that it would be okay and arranged for her to be given a drip just to keep her fluids up while my milk came in and it was in by the next day.

BELINDA: So, Jennifer, we’re talking today about low supply. Many mums have worries about their breastmilk supply, so what does low supply mean?

JENNIFER: So low supply is generally a situation where for some reason a mum’s breastmilk supply is not sufficient to meet the growing needs of her baby so perhaps a baby may be growing a bit more slowly, or there may be issues with the baby not growing, or actually losing weight. In most instances low supply is something that can be addressed so there may be things that can be changed for mum, maybe some issues going on with baby that can be addressed to actually improve the situation so that mum and baby are feeding well, so the supply will grow and meet that baby’s needs. There are a small percentage of mums whose supply may never fully meet their baby’s needs. However, for the vast majority of mums with the right support and some intervention from health professionals or by mum, supply will grow to meet her baby’s needs.

BELINDA: The amount of milk that we remove from our breasts is the amount of milk our body makes, that’s how demand and supply works. So, if we feed our baby directly at the breast or we express our milk via pump or via hand, that’s removing milk and that signals our body to make more milk. When I talk to mums on the National Breastfeeding Helpline, many are concerned about their baby’s weight or the baby may be hungry. One of the major reasons many women stop breastfeeding is that they feel they don’t have enough milk to nourish their baby. So, what are some signs of a good supply of breastmilk or that baby’s getting enough milk?

JENNIFER: Yeah, it’s a great question. I think one of the big things to be aware of is that often times when a mum’s asking that question, they’re concerned and with the right information they can be reassured. For most families, good supply – the best signs are that the baby’s doing plenty of wet nappies, at least 6 wet cloth nappies, or at least 5 wet disposable nappies. A baby in the first few weeks of life is frequently pooing, at least 3 poos a day for young babies, so passing lots of poo is a good sign and a baby who is alert and bright and has some happy times. Just because a baby’s crying doesn’t mean they’re not getting enough milk. When a baby cries sometimes it just means they need a cuddle, or they may want a breastfeed, but it may be about more than just food. The other sign of a good supply is that a baby is gaining weight, so if a baby is growing and putting on a reasonable amount of weight as they continue to grow and growing in length and their head circumference is growing, they’re all really reassuring signs. And before seeing a health professional, sometimes families may notice that nappies are starting to get a bit tighter and they’re having to adjust them when they’re putting the nappies on their baby because their baby’s thighs are getting bigger. Or their baby’s growing and their baby grow suits, or their baby clothing is starting to get a bit firmer or they have to move up a size in clothing. All of those are really great signs that baby’s actually getting a good [amount of] milk.

BELINDA: I found that what was really reassuring with my little babies was as they grew through their different sizes of their clothing, I felt like I was constantly having to empty out the drawers and put in the new lot of clothing as they were growing.

JENNIFER: When my daughter was really tiny, we used cloth nappies and she didn’t fit any of them, she was too small. So, we had somebody make us up some nappies that were about the size of a cloth napkin you might use when you’re in a restaurant, quite small, and at 6 weeks she graduated to normal nappies and I was so excited because she’d actually grown enough that we were able to use normal newborn nappies, it was very exciting.

BELINDA: With poo in the early weeks, we sort of expect to see frequent poos, but that changes around the 6 week mark when babies can go from having frequent poos to perhaps pooing once a day or once every couple of days. It is normal, the range of normal for them to poo once every week.

JENNIFER: When a baby who’s been pooing regularly may be moving into that pattern of pooing a bit less often, and that is not an uncommon pattern for babies, that happens slowly. So, baby might go from pooing 3 times a day, to once or twice a day, then once a day then maybe once every couple of days then stretching out. So, a baby who suddenly starts pooing once a week is pretty rare, most babies do it gradually over time. But a warning, if your baby does do that and, unfortunately for me, fortunately as well, but unfortunately both my children did, when they do poo, it’s definitely a ‘poonami’. I used to pull over to the side of the road and let them poo on the picnic rug with blankets everywhere so they didn’t poo all inside their car seat because that’s messy. It maintains that softness and that almost like a yoghurt-y scent. It’s yellow and quite easy to pass, there’s no signs of firm stool, that’s not a good sign. We’re not looking for that in a little one, their poos when they’re breastfed are really still quite soft.

BELINDA: Some reasons that mums might be concerned about their supply if their baby does not return to birth weight sort of 2 to 3 weeks of birth, baby’s not putting on sufficient amount of weight, and the baby’s not growing in other ways. So, we look at the whole picture of weight and growth together, not just the scale weight.

JENNIFER: That’s right, Belinda. So, I think those are definitely markers that other people, health professionals, will be concerned with mums as well. Sometimes it’s worth having a conversation about a plan with those health professionals that is proactive. So, if a little one isn’t growing, my big suggestion is to get on the front foot quite quickly to get some additional support to keep breastfeeding going and improve breastmilk supply. Helping a baby grow is really important and often some people suggest some supplement for the baby and that may need to happen, but mum also needs help to boost her supply so supplements are used for as short a period of time as possible.

BELINDA: So, what are some reasons for low supply?

JENNIFER: There are a number of reasons why a mum may have low supply, you’re right. There are some that are primarily about what’s going on for mum and some that are mainly about what’s going on for baby and sometimes it’s a combination of the two. One of the common things I hear people say is to ‘never wake a sleeping baby’ and that doesn’t apply when a baby’s not 100%.

BELINDA: A sleepy baby may not wake when they’re hungry. They may end up sleeping a bit longer than they should. Then that can lead to them not feeding often enough to stimulate and dial up mum’s milk supply. That’s probably the reason why some hospitals will suggest to families to feed fairly frequently and to wake babies in the early days.

JENNIFER: The other thing which is really common is that attachment. So, for babies hurting mum during feeding, babies causing some pain or discomfort for mum during feeding, pinching the nipple, that is going to impact milk supply. Whenever baby’s pinching the nipple, the nipple’s coming out looking a bit creased or pinched, that baby’s actually pinching off some of the milk ducts and that’s actually going to delay or slow down the transfer of milk. So, pain for mum often also means not great feeding for baby. Lots of mums will say, ‘Oh just put up with the pain, at least he’s on!’ My tip to mums is if it’s hurting you, it’s actually not very efficient feeding for your baby as well. So, getting help to fix attachment can be really important to ensure mum’s making enough milk.

BELINDA: Are there other things that might be happening with the mum that might impact? What about hormones?

JENNIFER: In the early days, one of the most common is that if a mum has got retained placenta from the birth or she’s had a haemorrhage, that can affect milk supply and so it is really important for a mum whose supply is not quite right is to see a health professional to make sure that yes, all of the placenta has been delivered. The placenta actually makes hormones to help sustain the pregnancy and, in part, the hormones being produced by the placenta actually supress milk supply.

BELINDA: So, if not all of the placenta has been born or delivered, the milk supply can be low.

JENNIFER: It’s possible that mum may have lost enough blood that her body’s struggling to make sufficient milk so addressing her body’s need for iron and for blood cells sometimes is necessary to make sure that mum’s going to make sufficient milk. The other things which do occur sometimes is that there are small percentage of mums who may have thyroid issues and a mum with thyroid problems can sometimes have trouble making milk, certainly not true of all mums, and if a mum has got a thyroid issue that is being well managed and is being overseen by her health professionals it shouldn’t be a problem but sometimes these issues pop up in lactation or may not have been picked up and it’s worth having that checked by a health professional.

The other thing that many mums will have heard, mums with polycystic ovarian syndrome (PCOS) may have heard that that can affect their milk supply. There is a small percentage of mums who have polycystic ovarian syndrome who do struggle sometimes with making enough milk, but the vast majority of mums with PCOS will be able to make sufficient milk for their baby. The reality is that as long as you’re following your baby’s lead and feeding really frequently, breasts can often make sufficient milk just with the right amount of support and the right amount of stimulation.

Some mums may have heard from a friend or family member that has been diagnosed with IGT or insufficient glandular tissue this is a situation that can occur where a mum’s body hasn’t made sufficient milk making tissue in the breasts to meet all of the baby’s needs. Generally, this is something that’s diagnosed after all of the other strategies have been tried to boost a mum’s milk supply. If you’ve got concerns during pregnancy, or maybe you have a medical diagnosis of insufficient glandular tissue, make sure you get help early get some support and put a plan in place. 

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You’re listening to Breastfeeding … with ABA. I’m Heather Miller and I’m a volunteer breastfeeding community educator with the Australian Breastfeeding Association. I’m passionate about providing breastfeeding education and information to the community. And that’s why the ABA website’s LiveChat service is perfect for me. During a typical shift we may refer users to pages on our website, assist them with questions they may have about breastfeeding, or provide details of their local ABA group or breast pump hire service. We take chats from people all over Australia but it’s generally mothers. Many expect an automated service only to find they’re chatting with a real person. So, the questions asked vary, but often include is their baby getting enough breastmilk, managing engorgement, blocked ducts and mastitis, expressing and storing breastmilk, fussy or unsettled babies and mothers returning to work. I just love it when I’ve been able to assist a mum with the information she needs, leaving her feel more confident and reassured no matter how big or small her question. Our website LiveChat is open for 2 hours each weeknight and some weekdays.

JESSICA: To check availabilities or use the LiveChat service, visit breastfeeding.asn.au. The Australian Breastfeeding Association receives funding from the Australian government.

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BELINDA: When my mum was a new mother, she was told to feed to a schedule, so she had a 6 am feed, and a 10 am feed, and a 2 pm feed so 4-hourly feeds. And we know that in the many years since my mum’s been a mum, I won’t let on how many years that is, the advice has changed to not follow a scheduled feeding pattern or routine but that we should be responding to our baby’s feeding cues. And baby’s feeding cues may not be in a regular pattern, like at a set time, so they might be showing signs of wanting to feed within an hour that they’ve just fed. But those feeding cues really help the baby to give those cues to your body to build the supply. And it’s a bit like, sometimes when I have a small breakfast and a larger morning snack and a really big lunch depending on how I’m feeling on the day, that impacts a rhythm.

JENNIFER: I think you’re absolutely right; the other thing is that every mother’s body is different; some mums may find their babies naturally feed every 3 to 4 hours and other mums may find their baby naturally feeds every 1.5 to 2 hours, everybody’s body is a bit different and no sort of prewritten schedules. Some mums need to feed 12 to 15 times a day to ensure that their bodies are being well stimulated to make enough for their babies, and a mum whose body responds to being super full by turning their supply down quite quickly, and there are other mums who are able to feed less often and still make enough milk. It’s not about bra size either, ladies. It’s just very independent of even the visual look of the breast as to what our body’s capable of. So, following a schedule can risk not emptying the breast often enough for an individual mum and not ensuring that their breasts are being stimulated frequently enough to be able to make enough milk. We know that, on average, babies need to feed about 8 to 12 times a day to really get sufficient milk in, and a baby who’s being fed for example, every 4 hours, that’s only 6 times a day. For the vast majority of mums that will not be sufficient stimulation to ensure a good milk supply.

BELINDA: And if mums respond to their baby’s feeding cues that will help support their supply.

JENNIFER: That’s right and I think one of the most important things to think about is that when we’re responding to our babies and meeting their needs, they sometimes know better what they actually need for their growth than we can guess. As long as they’re alert and they’re actively feeding they will be able to drive up supply and meet their needs.

BELINDA: So, when we talk about feeding cues we’re talking about things like baby starting to open and close their mouth. They might put their fist or their hands across their mouth and start to seek something in their mouth. They might turn their head from side to side and, if somebody’s giving them a cuddle or mum’s giving them a cuddle, they might start to root around and look for the breast and bob their head around. They’re the types of things where baby’s sort of looking for that oral sensation of having something in their mouth. If you’re finding this all a bit hard to picture, there’s a link in our show notes where you can look at some photos and videos on our website.

JENNIFER: If a baby does have a tongue-tie, that can affect attachment and as we said before, bad attachment, pinching of the breast can actually affect the drainage of the breast and that can affect milk supply in the longer term. So, a baby who does have an anatomical issue like a tongue-tie which may need treatment, that’s where it’s important to see somebody like an internationally board-certified lactation consultant to thoroughly assess breastfeeding and work out whether or not there’s an issue that may need to be addressed regarding issues like a tongue-tie can make such a huge difference to ensuring that mums are able to make enough milk.

BELINDA: When I counsel mums about their breastfeeding, they often have concerns when their baby is crying in the evening and seems really hungry and worry that they’ve lost their supply and wonder whether they need to give them a top up of some formula. Early evening or late-night cluster feeding or fussiness or not really wanting to be put down is a normal baby behaviour. It doesn’t always mean that baby is hungry, babies who are cluster feeding or fussy might just need mum’s attention or another family member’s. There are also some theories that frequent feeding in the evening is helping to boost signals to your body to make more milk overnight when some of the milk making hormones are higher. And if you do have concerns during a cluster feeding time or a fussy evening time that something might be wrong, it’s a good strategy to sort of take a little bit of stocktake of all the signs that baby’s getting enough milk. So, what’s their nappies been like over the last 24 hours. Have they had some periods of contentedness over that 24-hour period, how have they been going with filling out those grow suits and growing in length and head circumference and are they putting on some weight over time. So, going back to that list of things that we can check if they’re getting enough milk and look at the past day or the last couple of days. Another one to check is if they’re well so, you know, is baby well? Because when I’m sick, I feel a bit fussy and a bit whingey and really want some comfort from the members of my household. So, if baby’s sick that can also be a little bit more fussy at night and it doesn’t necessarily mean that they’re hungry or you’ve lost your supply.

JENNIFER: Lots of mums have concerns that their supply might have dropped when their breasts turn soft or become softer and stop becoming quite so engorged, which happens after the first few weeks. It’s a really common reason for mums to reach out saying, ‘I think there’s something wrong with my supply’ and often we go back to the basics, don’t we? We’re checking that the baby’s having regular wet nappies and pooing regularly and they’re growing, milk production stabilises within the first month of lactation so mums may not have that sense. Prior to this time I would you know check my breasts and touch each of them and go, ‘Oh that’s the one I need to feed from’ and the truth is it probably didn’t matter. My little one sometimes only fed one breast at a time but if I managed to pick the wrong one, I just ended up lop-sided and I certainly knew I’d fed lop-sided by the next feed. But generally, breasts do become softer, they stop becoming quite so engorged, they may even not make milk as much for mums who do have leaky breasts around this month mark and all it is is a sign that your breasts are becoming really efficient at feeding.

BELINDA: That’s why when new mums are breastfeeding, ‘we’ve never breastfed before, this is a whole new experience for our bodies and our breasts as well’, so they [breasts] often respond with the engorgement and the leaking as they’re getting used to it. So, when your breasts do stop leaking and stop getting that engorgement and they are a bit softer, your body’s finally worked out what’s going on so it can be a good sign as well. What about night-time waking, Jennifer? Some mums start to worry when their babies start to wake more in the evening around the you know could be 4 months could be around 6 months that that could be of concern with their supply.

JENNIFER: Yeah, I think one of the big things is babies’ sleep is so changeable, so some babies may never sleep very well overnight until they’re 10 or 12 months of age, and some babies will develop a pattern of sleeping in quite good blocks overnight. By, you know, around 3 months what typically happens for a lot of families is their babies will start waking again. There seems to be probably a developmental change, so it isn’t about milk supply just about where our babies are at, and what stage they’re at in their life that they’re starting to stir a little bit more often. Babies may need milk at this time of night. They’re growing quite rapidly their brain is still developing and often at this time they’re starting to crawl, rolling over, maybe starting to explore using up more energy than they were at 3 months when they were probably still sitting on their back kicking their toes. So, perhaps their needs have increased but it’s not a sign of low supply and a mum whose baby isn’t growing well, it’s a sign that baby’s needs have changed. So, if a mum does have a concern that perhaps her supply isn’t sufficient for her baby and is wanting to do something to actually boost her supply, one of the best things to do is to feed more frequently. More frequent feeding means more milk. It’s really important that the frequent feeding includes a baby who’s well attached to the breast, with a nice good mouthful of breast, no compression at the nipple so that the milk is flowing well, that baby is alert and actively feeding for a period of time and that if they’re falling asleep perhaps offering a second breast, so going from the left to the right. You can even go left and right again and offer up four breasts in a feed to really boost the stimulation, the drainage of the breast and therefore, over time, milk volume. Feeding baby more frequently can be really useful, for some mums. I reckon the best way is to give yourself permission to camp out do some streaming of a TV show and just feed and feed and feed. If a mum has older children as well, this might be the time to leave the mess for a little while, to put out some extra toys that they’re old enough, to call on the support of a partner, family member or friend to come and entertain the older children.

BELINDA: If mums do have concerns that they need some more help and some support, where would they go?

JENNIFER: I think one of the best things a mum can do is to speak to a trusted health professional that might be their child health nurse, their GP perhaps their midwife, or the hospital where they gave birth just to get some support around assessing them and their baby.

BELINDA: And they can call the National Breastfeeding Helpline, too. It’s there 24 hours a day. I regularly used this as a brand-new mum and found them so helpful and knowledgeable and kind and they were there at 2 o’clock in the morning when I really needed them.

JENNIFER: I have to say, the support I got from calling a breastfeeding counsellor via the helpline when I was in the early days, was so useful it made such a difference to me feeling confident as a mum.

BELINDA: And there’s also LiveChat service on the Australian Breastfeeding Association website where mums can get breastfeeding information and support.

JENNIFER: The other thing to be aware of is that if a mum does have a recognised low supply it could be really beneficial to see a lactation consultant. That’s somebody who’s an internationally board-certified lactation consultant who’s completed their exams as highly skilled in assessing breastfeeding and helping to work out what aspects of the situation may be related to mum, to baby, to the pattern that’s going on in the feeding journey and helping that family find a pathway to successfully breastfeeding and meeting their breastfeeding goals.

BELINDA: ABA also has a really good information article on supply which you can search for at breastfeeding.asn.au as well as our booklet on supply on the ABA online shop which is shop.breastfeeding.asn.au, it’s available for electronic download or you can order a print copy of the booklet.

JENNIFER: Following the first few weeks after birth for most mums, breastmilk supply matches the amount of milk removed. Breastmilk production is a process that’s actually really robust, with the right support and the right information your body will be able to meet your baby’s needs in most instances just as it’s designed to do, but if you’re worried seek help.

BELINDA: Mums can get help from trusted health professionals if they have concerns. Thanks for the chat today, Jennifer.

JENNIFER: My pleasure. For more on this topic, you can go to the Australian Breastfeeding Association’s website at breastfeeding.asn.au and check out the show notes for a link to this episode’s blog post which contains further links and information. To speak to a breastfeeding counsellor, call the National Breastfeeding Helpline on 1800 686 268. Or you can use LiveChat available via our website, breastfeeding.asn.au

BELINDA: Find your local ABA group by visiting our website where you can also find lots of breastfeeding information and a link to join the Association as a member. You also might like to join our Facebook group to continue the conversation. Just search for Breastfeeding … with ABA, and make sure you answer the joining questions so we can add you quickly.

JENNIFER: A word about sponsorship and advertising; in each episode you will hear about other ABA services and products that we think could help families. We are a not-for-profit member organisation; we are a charity, and we need to look for sources of income to support our activities so you may also hear about non-ABA products or services that we have chosen carefully as they are consistent with our goals and aims. You can feel reassured that advertising on our platforms will always be compliant with the World Health Organization code on the marketing in this area. We want this podcast to be a resource that any new parent can find and come back to, because these issues are timeless. Do you like what you’ve heard? Please rate, review and subscribe to Breastfeeding … with ABA. We would love it if you would share this podcast and our website with all of your friends and family so that other families can use this information and find support too. 

Thank you for listening.


TRANSCRIPTION // Madina Hajher