July 20, 2011

A Mother's Milk: Overcoming the "Not Enough Milk" Hurdle

Umm Layth is an American mother of one, currently living in Riyadh, Kingdom of Saudi Arabia. She is a WHO/UNICEF Breastfeeding Counselor. Note: This post has been reviewed by a group of practicing and certified Breastfeeding Counselors before being published to help ensure the accuracy and usefulness of the information. 

Hurdle #1: "Not Enough Milk"
It's true that a woman may not be able to produce enough breastmilk to effectively breastfeed her child. But the likelihood of this happening is rare. For the vast majority of moms the right education, a strong commitment to breastfeeding, and a little faith can keep our bodies producing plenty of milk not just for one child, but for two, three, and even four or more.

Since the vast majority of us are able to produce enough milk, the reality of our supply concerns isn't so much about "am I making enough?" as it is about "is my baby getting enough?"

Here's a few common reasons moms give for believing that their babies may not be getting enough breastmilk:
1. He/she cries a lot
2. He/she wants to eat all the time
3. My breasts don't feel full
4. I tried pumping, but nothing (or very little) came out
5. Some days, he/she just doesn't want to feed

Although experiences like these can be frustrating and exhausting for any mother, they are not accurate indications of whether or not a child is getting enough breastmilk. Here's why:

1. Babies cry for lots of reasons. Hunger, boredom, illness, upset from a recent change, and being tired are just a few.
2. It's not uncommon for newborns to want to eat all the time. Some newborns feed as often as every hour for the first week or more. Older infants want to feed often usually due to an oncoming growth spurt.
3. As your body regulates its milk supply to suit the nutritional needs of your child, your breasts won't feel as full as they did when your milk first came in.
4. A baby's ability to extract milk from our breasts is FAR more effective than a pump. Pumps are cold, hard, and emotionless. They do nothing to stimulate to our milk flow, so more effort needs to be exerted to get milk out than when baby is on the breast. Even expressing by hand can do a better job!
5. Babies refuse breastfeeding for lots of reasons, usually because they're ill, distracted, or a recent change upset him or her.

Signs That Your Baby May Not be Getting Enough Milk
When it comes down to it, there are only two, surefire signs that a baby may not be getting enough milk.

Sign #1: Poor Weight Gain
As moms know, every child is unique and every child grows differently. So when I say "poor" weight gain, it doesn't mean compare your child's weight to the plump Gerber baby look-a-like next door. It means compare your child's current weight to his own weight in the past. If he's gained less than 500g per month or weighs less after two weeks than he did when he was born, then he may not be getting enough milk.

Sign #2: Small Amounts of Concentrated Urine
When a baby is getting enough breastmilk, he will produce 6-8 wet diapers a day where the urine is pale and odorless. On the other hand, when he's not getting enough milk, the wet diapers will be few, the urine will be yellow, and it will smell badly.

Getting Mom and Baby Back on Track
When a baby shows surefire signs of not getting enough milk, it almost always comes back to one of the following root problems:

1. Ineffective Drainage of Milk
When a baby is not latched properly to his mother's breast while feeding, he will not be able to get enough breastmilk to meet his needs. This can lead to baby wanting to suckle frequently, mother getting sore or damaged nipples, baby showing frustration (through crying or refusal) at the breast, and mother getting blocked ducts. Ensuring that you and baby have a correct latch is vital to baby's growth and nutrition as well as to your health and comfort. Check out Dr. Jack Newman's latching videos to make sure the latch is correct and baby is feeding effectively. (Warning: videos contain partial nudity)

Until you and your baby have mastered the latch, it's important to offer baby expressed milk so that his nutritional needs can still be met and you can maintain your supply.

2. Restrictive Feeding Habits
Limiting our children's feeds by either overall frequency or individual length can cause serious problems, among which are baby not getting enough milk. The easiest way to remedy this is to feed him on demand.

On-demand feeding simply means allowing your baby to breastfeed when he/she wants, for as long as he/she wants. This will help ensure that baby is getting his fill at each feed. There is no need to force babies into switching breasts. Instead, allow your baby to determine how long he wants to stay on one breast. You'll know he's finished when he detaches himself in contentment.

3. Suckling Problems
Baby suckling problems can be complex and have a wide range of causes, including illness or mouth injuries (sores or scratches), breathing difficulties (blocked nose or airways), and physical complications (tongue tie). It's important that the cause be identified and treated early on, so breastfeeding can stay on track.

I recommend first seeing an IBCLC (International Board Certified Lactation Consultant). He or she will be able to address and help remedy the first two root problems if needed, as well as identify any concerns with baby's suckling abilities. If, after that, you are still concerned about baby's physical ability to suckle, feel free to take him to see a medical doctor. When you do, make sure that your commitment to breastfeeding is known up front so that any procedures or medications that could interfere with the breastfeeding process can be avoided. Find a lactation consultant near you.

In the meantime, express your milk and cup-feed it to baby. Cup feeding your expressed milk is an easy way to avoid giving unnecessary supplements to baby, which can further complicate breastfeeding. Read more about cup-feeding here. Hand expression is easy, effective, and can be done anywhere you have privacy. Medela offers easy-to-understand instructions on how to express milk by hand.

Ways to Maintain and/or Increase Your Milk Supply
If you still have concerns about a low milk supply, try the following:

1. Breastfeed at Night
The hormone that keeps your body making milk for future feeds is secreted more at night, so feeding at night helps ensure that your body produces enough milk for the next day. Co-sleeping with your baby is the easiest way to do this. To co-sleep is to have baby sleeping next to you, in the same bed as you sleep. With baby right next to you, the feeding process won't disturb his or your routine as much as it would if you had to wake up, walk to the next room, and wake him from his crib.

2. Feed on Demand
Breastmilk production is a supply and demand system. The more you feed, the more milk your body will make. Regularly feeding on demand helps maintain a healthy supply.

3. Fenugreek
The herb fenugreek is the only herbal remedy proven to increase milk supply. It's available as supplements or tea. Visit Kelly Mom to read more about the benefits of Fenugreek and how to use it.