Little breast milk: causes of insufficient milk production in a woman

Lack of milk - far-fetched and real

Working as lactation consultants, my colleagues and I are constantly faced with the fact that the vast majority of requests from nursing mothers are related to complaints of lack of milk.

Fortunately, most of these mothers worry in vain - upon closer examination of their situation, breast milk turns out to be quite enough for them.

What symptoms most often make mothers doubt whether their infant is getting enough nutrition?

• The baby attaches to the breast “too often” and does not maintain an interval of 2-3 hours between feedings;
• The baby sucks for too long;
• The baby cries often;
• The mother does not feel the breasts being full, the milk does not drip or leak between feedings;
• Mom can't express milk;
• When expressing, the milk does not appear rich enough (for example, clear or bluish);
• The mother already had a bad experience with breastfeeding with her older child;
• The baby was born very large or, on the contrary, low in weight, or premature;
• A baby sleeps longer if he is fed formula.

And although such facts do make mothers worry and worry about whether their baby is full, in reality they are not objective signs of insufficient milk supply. In fact, all these symptoms can occur for a variety of reasons. For example, frequent and prolonged latching of a newborn baby to the breast is a normal part of his behavior, and is due to his physiological and psychological characteristics of development. Some newborns are attached to the breast more than 20 times a day, thus receiving not only the nutrition they need, but also communication with their mother, a feeling of security and comfort that arises in the close proximity of breastfeeding. Plus, some babies may actually cry more than others for no apparent reason (and can sometimes be quite difficult to calm down). Such crying can be both a character trait and a temporary stage of development, which most babies safely outgrow by six months. With the advent of experience, each mother learns to distinguish the shades of her baby's crying and respond faster, eliminating the cause of the baby's anxiety. Sensations in the mother's mammary glands and the amount of expressed milk are also not indicators of the sufficiency of lactation: many mothers who did not feel breast fullness, tingling, hot flashes and other sensations usually associated with the milk separation reflex, and also could not express a drop of milk, successfully fed breastfeed their children for more than one or two years (or as long as they themselves wished). Moreover, by the time lactation begins in the vast majority of mothers, milk practically no longer accumulates in the breast between feedings, but is produced during the process of sucking or other stimulation of the areola and nipple; Thus, most of the time the mother may feel the breasts soft and unfilled. Need I mention that the appearance of the milk has absolutely no effect on whether the child gets enough? Every mother's milk is ideal for her baby, and its composition constantly changes depending on whether the baby was born at term or premature, the age of the baby, the time of day, and even during one breastfeeding! Indeed, the appearance of breast milk is different from the cow's or goat's milk that we are used to seeing. Human milk, especially the “foremilk” that baby receives at the beginning of a feeding and which the mother is most often able to express, appears clearer and may have a grayish or bluish tint (however, the hue can vary depending on what natural and artificial colors are present in the diet of a nursing mother), and this is completely normal. And even if for some reason a mother was unable to breastfeed her older children, it is not at all necessary that she will have another bad experience - the main thing is to get support in time and learn as much modern information about breastfeeding as possible in advance! However, of course, in our consulting practice there are situations when the child actually does not receive enough breast milk. It is immediately necessary to make a reservation that a child may not receive enough milk either due to a lack of milk from the mother, or due to the fact that for some reason he cannot effectively extract milk from the breast, provided that the mother’s body is currently producing a sufficient amount of milk . In this article we will look at a situation where there is really not enough milk. Lack of milk (hypolactia) can be caused by both physiological reasons and errors in the organization of breastfeeding, and the overwhelming number of cases of lack of milk fall into the second category.

How do you know when to be wary? What signs actually indicate that a child is not eating enough?

• The child is slowly gaining weight: for example, by two weeks of life the child has not regained his birth weight; and/or his weight gain is less than 500 grams per month (125 grams per week);
• The child does not urinate enough: a child older than two weeks has less than 12 urinations per day, and the urine looks dark (dark yellow, orange) and has a distinct, pungent odor.

The counting of urinations per day should be done by removing the child’s disposable diaper. And if counting urination is impossible for some reason, instead, you can approximately estimate daily urine output by weighing the wet diapers used by the baby per day. The daily weight of used diapers (minus the weight of dry diapers) can be compared with the norms of daily diuresis for children of this age. Of course, it makes no sense to assess the number of urinations if the child receives additional drinks (water, tea). If a mother notices that her baby has one or both of these alarming signs, she should immediately contact a pediatrician to assess the condition of the baby and find out about the need for additional feeding (most likely temporary) with formula, and a lactation consultant to analyze the organization of breastfeeding and start working on increasing lactation as quickly as possible.

The following physiological factors can lead to insufficient milk production:

In addition, milk production can be affected by the emotional state of the mother. For example, stress, pain, fatigue and physical discomfort (especially those associated with breastfeeding) can temporarily impair milk production and release. Fortunately, some of the physiological factors that can lead to insufficient milk production can be corrected or are temporary. But, unfortunately, there are situations when the cause of hypolactia cannot be eliminated. In these cases, the optimal solution is to select the required amount of supplementary feeding for the baby with the help of a pediatrician and a lactation specialist and organize mixed feeding. In this case, naturally, one should strive to preserve the largest possible share of breast milk in the baby’s diet, for which relatively frequent and prolonged feedings of the baby are organized in compliance with the basic rules of successful breastfeeding, such as, for example, correct latching and correct alternation of breasts. Mixed feeding is best done without the use of breast substitutes (such as bottles and pacifiers) so that the baby does not experience “nipple confusion”, he does not refuse to suckle at the breast, and the attachment to the breast remains correct. Your lactation consultant will help you learn how to feed your baby more easily and comfortably without resorting to a bottle. It is worth noting once again that lack of milk caused by physiological reasons is quite rare. Much more often, hypolactia occurs as a result of improper organization of feeding the child.

So, what are the typical mistakes in breastfeeding that most often lead to a lack of milk?

• Delay in starting breastfeeding immediately after the baby is born;
• Incorrect attachment to the breast - leads to insufficient stimulation of the nipple and areola, insufficient emptying of the mammary glands;
• Low frequency and short duration of feedings also affects breast stimulation and emptying;
• No night feedings;
• Using pacifiers or bottles - as this often interferes with breastfeeding and leads to less frequent feedings;
• Unreasonable introduction of supplementary feeding or additional feeding of the baby;
• The desire to organize the feeding of the baby according to the regime.

When all these errors are eliminated and adequate breastfeeding is established, the amount of milk quickly returns to normal and begins to meet the baby’s needs. However, since the lack of milk is a fairly serious problem, it will be better if the mother carries out “work on mistakes” under the supervision of a specialist to be sure that she is doing everything correctly, and the child receives the right amount of nutrition for his growth and development at every day. moment of time.

Note to mom:

Your baby is definitely getting enough milk if:

• By the age of six months, he gains weight by more than 500-600 grams per month (125-150 grams per week);
• A child older than two weeks urinates more than 12 times a day, the urine is light and transparent;
• The child has soft, creamy, yellow or mustard-colored stools;
• The child is active, he regularly wakes up on his own and requires the breast;
• The baby's mucous membranes are moist, and the skin is elastic and elastic;
• He actively sucks at least 8-12 times a day;
• You hear him swallow;
• After feeding, your nipples are not damaged and have not changed shape or color;
• You and your baby are satisfied with feedings.

Alena Lukyanchuk Psychologist, lactation consultant, member of ILCA (The International Lactation Consultant Association)
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About correct and incorrect breastfeeding

Below are signs of correct and incorrect attachment. A mother who understands that she is acting correctly will not worry about the fact that she has little milk.

Correct application

The baby's chin touches the mother's chest.

•His mouth is wide open.

•His lower lip is turned out.

•Most of the areola is located above the baby's mouth, not below it.

•His cheeks are rounded

•Breasts take on a rounded shape during feeding

•Baby sucks slowly and deeply

•The baby's body is pressed tightly against the mother, facing the chest, the baby's head and body should be in one straight line.

•Mom does not feel pain when sucking (tongue on the gum)

Incorrect attachment

The baby's chin does not touch the chest.

•Mouth is not open wide

•His lips are pulled forward or his lower lip is curled inward.

•Most of the areola is located under the child’s mouth

•His cheeks are tense or sunken when suckling.

•The breast becomes tense or stretched during feeding.

•The baby sucks quickly and superficially, you can hear smacking

•The body is turned away from the mother

•Mom feels persistent pain when sucking (the tongue is not on the gum - incorrect posture, short frenulum)

Is the duration of pumping important?

Different moms have different preferences.

Some prefer a combination of 20 and 10 minute intervals (classic scheme).

Others prefer 10 minute intervals for both pumping and rest (see Jodie's recommendations), while some prefer 15 minute intervals, which add up to an hour and a half session:

• Pump for 15 minutes
• Rest 15 minutes
• Pump for 15 minutes
• Rest 15 minutes
• Pump for 15 minutes
• Rest 15 minutes

It happens that you can devote only 5 minutes to pumping,

and that's okay too, as long as you can
maintain your pumping frequency
(see Diane West's definition of "stimulant pumping" above).

So, let's move on to the next important question.

Folk remedies

The best option in such a situation would be to consult a doctor in a timely manner, but if this is not possible, and the breasts continue to burst from gushing milk, it is worth trying some folk remedies, including:

• breast massage;
• compresses made from camphor oil and chopped parsley;
• ice packs applied to the chest;
• bandaging the chest with an elastic bandage;
• infusions and tea from herbs such as sage, hop cones, mint, bearberry, alder, lingonberry, horsetail, elecampane.

All these remedies are available to every woman, so her health is only in her hands. And yet, you should not try to eliminate this problem on your own: no one except a doctor can help with hyperlactation. Having coped with the panic, received advice from a specialist and waited a couple of days, you need to be happy that the baby is not in danger of running out of invaluable breast milk.

For what reasons can mother's milk really decrease?

• Most often, the volume of breast milk decreases for the following reasons:

The use of bottles and pacifiers (the child loses the habit of sucking the breast, is less likely to be applied to the breast, which leads to a decrease in the intensity of lactation);

• Unreasonable introduction of additional nutrition (supplementary feeding);
• Lack of night feedings, increasing the intervals between them;
• Intentional separation of the child from the mother (sleeping in different beds, long separations during the day, feeding for a short time).

Is it possible to do “incentive pumping” with a single breast pump?

I've seen a lot of questions about whether a single electric breast pump can be used for "incentive pumping."

In general, it is generally recommended to use a double electric breast pump

to
express milk from both breasts at the same time
, and thus reduce the time you have to devote to pumping.

However, "incentive pumping" is possible with a single electric breast pump.

Here's what you can do (I'm only using 10-minute time intervals for clarity, but you can change the duration of the intervals to suit your needs).

• Pump your right breast for 10 minutes (do nothing with your left)
• Switch sides, express your left breast for 10 minutes (the right one rests)
• Switch sides, express the right breast for 10 minutes (the left one rests)
• Switch sides, express your left breast for 10 minutes (the right one rests)
• Switch sides, express the right breast for 10 minutes (the left one rests)
• Switch sides, express your left breast for 10 minutes (the right one rests)

In total you will need 1 hour. That is, you'll still pump for an hour, but instead of resting 10 minutes between "double pumps," you switch sides and continue pumping, then repeat again until you've pumped each breast three times.

Starting breastfeeding

In the first days after childbirth, it is important to follow the following principles.

• Feed the baby on demand (up to 10–12 times a day). The baby's increasing needs for breast milk stimulate the formation of more and more milk in the mother; the child himself “dictates” to the mammary gland how much milk it should produce not only in the first, but also in all subsequent days and months.
• Avoid using pacifiers and bottles. If a baby is started bottle-fed in the first 3-4 days after birth, the chances of breastfeeding success are reduced.
• Prevent cracks and engorgement of the mammary glands (lactostasis).

When to do “incentive pumping”?

Many mothers prefer to allocate one or two time periods

, where they can do “incentive pumping.”

This means you can pump when:

• Your baby sleeps soundly
  (at night or early in the morning)
• If you are often separated from your baby, you can replace one of your regular pumping sessions with a “stimulus pumping” session
  , for example during an hour-long lunch break. Some women prefer to arrive early and do an “incentive pumping” immediately upon arriving at work.
• Some mothers prefer to combine a “pumping stimulation” schedule with their daily routine
  . This is especially convenient if you pump every 2 hours around the clock. If your baby happens to be ready to feed during your "pumping stimulation" session, you can either feed baby on one breast and pump on the other at the same time (then switch sides), or feed baby first, then pump.

Because prolactin levels (the hormone responsible for milk production) are usually highest between midnight and early morning, some moms choose to pump during this time.

And now the last and most important question.