Supply Busters: Top 5 cases of low milk supply in physician mothers by Laurie B Jones, MD, IBCLC, FABM

The number one reason that women stop breastfeeding is perceived or real low-milk supply. Even mothers who have a great milk supply during their maternity leave may find that they have a fluctuating or low milk supply when they return to WOTH (work outside the home). Some of these issues apply to SAH (stay-at-home) mothers as well.

Here are the top five causes for low breast milk supply.

1. Schedule

Schedule refers to both mother and baby’s schedule. Are you able to get in enough pumping sessions while away from home? Do you get in “make-up” pump sessions right after arriving to work, right before picking baby up, or just before bed? Do you limit baby’s time at the breast when you are home with him or her on your time off? Are you missing your baby’s hunger cues to keep her on a timed schedule?

Remember, babies have growth spurts at 6 weeks, 3 months, 6 months, and other times where they need to nurse more often than usual. It does NOT mean that you don’t have enough milk. It just means listen to your baby and feed him when he wants it! Even if you think there’s nothing there — the breast is never empty. Those back-to-back feeds are almost pure fat since all milk starts out as fat and sugar is added to it over time.

2. Solids

Solid food should be added at the earliest to the diet of a breastfed infant at 6 months. Many mothers start earlier and feel that it is a developmental achievement akin to getting into preschool early or the wait-list for Harvard! However, the American Academy of Pediatrics, the World Health Organization, and the Academy of Breastfeeding Medicine all recommend that babies start on solids around 6 months of age. Solids DISPLACE breast milk from the diet in calories 1:1, rather than adding to the milk calories.

Solids displace breast milk and lower your milk supply – which is fine after 6 months, but not sooner. Don’t be surprised to see your daily pump volumes go down when you introduce solids, but it is okay since the calories are now coming from solid food. If you work 5 days a week, consider limiting solids on the weekends when baby is home with you and you have more time at the breast. If your daycare is bugging you about sending more milk, it can be helpful to use solids as a distraction and calories at 4 months of age using iron-fortified rice cereals; however, it is not recommended that you give solids at home until baby is at least 6 months.

3. Sleep Training

What is the ultimate bragging right in parenting (besides toilet training!)? You guessed it, “getting your baby to sleep through the night”, of course! This is a cultural imperative but not a biological one. In fact, our bodies make the most milk when our prolactin levels are highest at night. Babies prefer to sleep near their parents and to suckle off/on throughout the night. I won’t get into a debate about attachment parenting vs. sleep training, but I will tell you the simple fact that most women’s breasts cannot hold 12 hours of milk in them without activating the FIL factor. The FIL factor (Feedback Inhibitor of Lactation) is a substance that builds up as milk is not removed from the breast. When it reaches a critical level, it tells the breast to make less milk the next hours and days. Over time, supply will drop slowly (there’s a chance here to rebuild supply), but then there will be some point of no return when the cells that make milk die and involute.

The point at which your breast can hold a volume of milk without decreasing your supply is called your “storage capacity”, and it is different for every woman and is not related to size of the breasts, but somewhat to shape and genetics. Every woman has a remodeling of the breast and decrease in storage capacity at around 6 months postpartum, right around the time you hit the 6 month slump. You really don’t know what your storage capacity is until your supply drops – and then you realize how long you go without pumping or feeding.

In most cases, breastfed babies that are older than a year of age can sleep 6 to 8 hours through the night without affecting milk supply. But younger breastfed infants may need to feed at night to maintain milk supply – increase volume during growth spurts – and they use it as “make up time” from missing mother while she is away at work. This is where it helps to know your body! Decide what’s most important to you – uninterrupted sleep or your milk supply. Life’s about choices, and there’s no right or wrong.

4. Sex

Another reason for low supply is s-e-x. The sex I am referring to is a mixture of the following:

a. You are having sex (good for you!), and you are pregnant which will usually tank you milk supply. Some women ovulate and conceive before getting their first period postpartum and don’t realize that they are pregnant.

b. You are having sex (yeehaw!) and you don’t want to get pregnant, so you are on a hormonal contraceptive which can lower your milk supply depending on when you start them and if you are changing other factors at the same time. Consider a barrier method instead or copper IUD.

c. You have gotten your period back and your supply is cut in half for the 2 days before and 2 days after the arrival of “Aunt Flow”.

d. You want to have sex, but you feel horrible about your body and you are exercising like mad and wearing a tight jog bra for hours and hours and eating less than 1800 calories a day.

5. Stockpiled Frozen Stash

Most women feel a powerful nesting need to stockpile frozen milk in crazy quantities before returning to work. Many abandon breastfeeding entirely for fear that they haven’t stockpiled enough before starting back to work. In the book, “Working Without Weaning”, the author describes the myth of the frozen stash and how it decreases milk supply.

When you find your supply is going down and you reach for frozen stash to top off baby, then you aren’t getting the root of why your supply is down — you can’t get your body to make more — you are probably giving baby too much and may create a breast refuser because they will need to be topped off, even when they are at the breast!! “Feed the baby … not the freezer.”

It’s hard to feed a newborn and that newborn’s future self in 6 months by breastfeeding and pumping from frozen stash. What you pump on Monday at work should be given on Tuesday — what you pump on Tuesday is given on Wednesday — and on and on. Fresh milk has more vitamins and anti-infection properties than frozen milk ever will. And many babies refuse frozen milk, so you’ve wasted a whole lot of time!

You never make more milk than you will make at 4-6 weeks postpartum. Human babies eat human milk in the same volume at one month through 6 months of age, then the volume of milk needed goes DOWN, not up because of introduction of solid foods. Seriously, this finding has been published in 1999, 2003, and 2008 showing that the volume of milk produced at 1 month through 6 months is the same, but the calories change dramatically from day to day and hour to hour.

Breast milk fed babies require fewer calories to grow over time; however infants fed cow’s milk require escalating volumes of milk to meet their higher calories to grow over time. When you metabolize your own species’ milk, it’s a very efficient process, so your kcal/kg/day goes DOWN, as your infant grows. This means the same volume of milk feeds a 10 pound, 1-month-old, as a 20 pound, 1 year old!

Okay, so I said there were five causes, but there are really six causes for low breast milk supply. You guessed it. The obvious number one reason is STRESS!

Avoiding stress is really not an option for mothers who juggle many aspects of their lives. However, you can make choices that leave your body and mind in better shape to produce the milk that your baby needs.

Here are some workplace and social life verbs to help you de-stress your life: procrastinate – delegate – defer – accept less than perfection – be average – achieve the minimum – be flabby – wear maternity clothes for another month – be late – let people down – get a pedicure – call an old friend – skip Facebook. You can increase your milk supply by simply distressing and relaxing.

St. Joseph’s Pediatrics provides exceptional care to newborns, infants, children, and adolescents in our outpatient pediatric clinic. All of our physicians are board certified in pediatrics. Our goal is to offer excellence in children’s health care to our patients and their families. We’ve been serving the community for more than 58 years based on a foundation of clinical excellence, customer satisfaction, and compassionate care. For more information on our Mother-to-Mother Support Group, please call ResourceLink at 1.877.602.4111, or to make an appointment with Dr. Laurie Jones or any of our board-certified pediatricians, call 602.406.3520.

The Original Dr. MILK Booklet