Can your milk supply dry up? Signs of a low milk supply - Evidence Based Babies
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Can your milk supply dry up? Signs of a low milk supply

One of the most stressful things about being a new mom and a breastfeeding mother is not knowing how much milk your baby is getting. Are they getting enough breast milk? Then there is another issue at hand, is it possible for your milk to dry up, just like that? You’ve probably heard it many times from other mothers on how their breastmilk just dried up one day and they could no longer breastfeed.

Can breastmilk dry up?

First things first, can your breastmilk dry up just like that? The answer is complicated than just a simple yes or no, as this can in fact happen, but not in the way many people think it does. There will always be a reason why it happened and more often than not, it’s due to taking the wrong medication. In most cases, it’s not that the milk supply has dried up, it’s just that some normal changes occurred such as softer breasts or cluster feeding that made the mother think that there is suddenly no longer any milk for the baby.

You can’t successfully breastfeed for 6 months and wake up one morning and suddenly your milk has dried up for no reason at all. That’s not how milk production works. As long as there is enough demand, there will be enough supply. Your milk supply can’t just dry up, but there are certain things that can drastically reduce your milk supply at a very fast rate.

A perceived low milk supply vs a true low milk supply

As a new parent, the hardest thing to trust, is that your baby is getting enough milk while breastfeeding, especially in the first days and first week after birth. You don’t get to see how much milk they’re getting, or if they’re even getting any milk at all. It’s stressful, nobody wants to starve their child.

The number one reason for parents to quit breastfeeding is due to a perceived low milk supply. They think their milk has dried up when it hasn’t dried up at all. A perceived low milk supply means that they didn’t actually have a real low milk supply to begin with, something made them feel and believe that their baby isn’t getting enough milk. This is why it’s important to know the signs of adequate milk intake and the signs of when there may be a real low milk supply issue.

Things that can reduce your milk supply

Supplementation

When you’re supplementing with anything other than breastfeeding directly at the breast, such as water, infant formula or even solid foods, your baby will take less milk from the breast. It will then signal your breasts to make less milk. It’s important to remember that milk supply works on a supply and demand system, what the baby demands, the body will supply. So, if there’s less demand, there will automatically be less supply.

Scheduled feedings

Breastfed babies should be fed on demand and responsively. This means they should be fed whenever they let you know they’re hungry or whenever you feel they may need a feeding. Scheduled feedings can cause a low milk supply and it can lead to poor weight gain.

Pacifiers

Pacifiers can cause confusion between the breast and pacifier which can cause a low latch and damaged nipples. This not only increases the risk of inadequate milk transfer, but also increases the risk of infections such as Mastitis. If pacifiers are not used responsibly, it may cause babies to breastfeed less due to the hormone cholecystokinin tricking their bodies into thinking they are full when in reality they’re not.

This once again means babies will then feed less than they would’ve if they haven’t been sucking a pacifier. This means less demand for the breasts and therefore less supply. Pacifiers can also cause parents to miss feeding cues and babies going long stretches between feedings which can cause a lower milk supply.

Nipple shields

When low quality and wrongly fitted nipple shields are used, it can cause less stimulation to the nipple and less milk intake for baby.

Sleepy baby

Some newborns are very sleepy in the first few days or even in the first few weeks. This can be due to the type of labor, or medications used during or after labor. Some babies may just be very sleepy with no explanation at all. If a baby doesn’t wake up by themselves in the early days, it can cause inadequate milk intake which will cause the milk supply to drop. When the baby is feeding less than they should, the body makes less milk than what is actually needed to sustain a baby.

Medical reasons in babies

Babies may have issues causing them to be less effective at the breast than ideal. This will cause inadequate milk intake and eventually a low milk supply. Health issues in babies can include heart conditions, jaundice, oral ties, hypo and hypertonic muscle tone, prematurity, illness and many other anatomical and health conditions.

Medical reasons in mothers

Mothers can also have issues that can cause a low milk supply. This includes things like previous breast surgeries, breast trauma, underdeveloped breast tissue, hormonal conditions such as polycystic ovarian syndrome (PCOS), hypothyroidism, Sheehan’s syndrome, a retained placenta, postpartum hemorrhage, smoking and excessive alcohol use, severe stress and many other anatomical issues.

Certain herbs

Certain herbs can reduce your milk supply. Usually these will have to be taken in very large doses to have an effect, so if you had some of these by accident, it probably won’t have any effect on your milk supply.

Some of the herbs that can reduce your milk supply if taken in large quantities include parsley, peppermint, spearmint, sage, oregano, chasteberry, chickweed, buckthorn, Dong Quai, ginseng, jasmine, lemon balm and kava.

Certain medications

There are some medications that can drastically reduce the milk supply. This is why it’s always important to check the safety of medications for breastfeeding mothers before taking it.

Some of the medications that can reduce your milk supply include medications or birth control containing estrogen, bromocriptine, cabergoline, vitamin b6, any medications containing antihistamine, medications containing pseudoephedrine, methylergonovine and clomiphene.

Pregnancy

Falling pregnant will highly likely affect your milk supply as the hormones change during pregnancy, drastically reducing or even completely drying up the breastmilk supply.

You can continue to breastfeed your child during breastfeeding, but if your child is under 12 months of age, they may need supplemental milk such as donor breastmilk or formula as milk is the main source of nutrition in the first year of a baby’s life.

Ineffective breastfeeding

Ineffective breastfeeding can cause the milk supply to slowly falter to a point where it may no longer meet your child’s intake requirements.

Things like oral ties, stretching out feedings or feeding by schedules, not breastfeeding frequently enough, supplementing, pacifiers sleep training and ineffective milk transfer due to many different medical conditions in both mother and baby can all cause the milk supply to falter.

Things that are not signs of low milk supply

Growth spurts

Growth spurts are short periods of rapid growth in babies, toddlers and children. During growth spurts babies will usually start feeding much more frequently, they may cluster feed and they may have increased night wakings. Most babies may also become very fussy during a growth spurt, and it may seem like they get frustrated at the breast. So, it makes sense why many parents may believe the milk supply is no longer enough. A lot of parents even quit breastfeeding as they believe their milk has dried up. But it’s important to know that this is completely normal, and it will usually subside with 3 days to a week.

Cluster feeding

Cluster feeding is when a baby, toddler or child suddenly breastfeeds much more frequently than they usually do. Cluster feeding can happen at any time during the day and babies may want to feed for a few hours at a time. They may also become very fussy and seem frustrated at the breast. Cluster feeding is normal, and it happens for many different reasons including building and establishing the milk supply, growth spurts, mental development phases, sleep regressions and times of discomfort and illness.

Frequent feeding

Sometimes parents just aren’t prepared for normal feeding behaviors. Parents often expect a baby to breastfeed every 3-5 hours and sleep through the night from the very beginning, but this isn’t normal for babies to do. Babies are meant to feed frequently during the day and the night as breastmilk digests very quickly and the frequent feeding also reduces the risk of SIDS.

Frequent waking

As already mentioned above, frequent feeding is very normal behavior for babies and toddlers. Breastmilk digests quickly, frequent waking reduces the risk of SIDS and it’s completely normal for a baby or toddler to require assistance in falling back to sleep by breastfeeding.

Fussy behavior

Fussy behavior is also very normal in babies and toddlers, this can be due to many reasons such as discomfort, pain, illness, mental development, sleep regressions and growth spurts. Fussy behavior while breastfeeding can also be normal due to a few reasons such as growth spurt, during the evening when the milk flow is a bit slower, infant dyschezia and a fast let-down reflex.

If a baby is always fussy during and/or after a feed and it doesn’t seem to pass after a few days to a week, it would be best to consult with an International Board Certified Lactation Consultant (IBCLC) to assess and rule out any issues that may be present.

Cluster feeding and fussiness in the afternoon

Cluster feeding and fussiness in the afternoons or in the evenings can be due to things like the flow of the milk being a bit slower in the evenings than during the day, being overwhelmed and overstimulated after a long day, it could be overtiredness, or babies can simply be filling up for a longer stretch of sleep at night.

Not pumping a lot of milk

If you’re not pumping much or any milk at all, it could be due to many things like a bad quality breast pump, the wrong size flanges, not replacing the silicone pump parts regularly and not pumping frequently or long enough. It also depends on when you pump, if you pump right after baby has fed, you will definitely not be able to pump a lot of milk.

Some women will pump very little milk when they try to pump and yet they still have a good enough supply to directly breastfeed their babies. Babies are much more efficient in removing milk from the breast than a pump. It’s important to remember that the amount of milk you pump, is absolutely no indication of your milk supply at all.

Your baby will drink an entire bottle of milk after breastfeeding

Babies will almost always accept a bottle if you offer it, even right after they breastfed. This happens because babies have a natural instinctive reflex called the sucking reflex, which means not only do they have a high sucking need, but they will automatically suck almost anything that stimulates their mouth and tongue.

Babies can also not regulate bottle feedings on their own, unlike when they’re breastfeeding where they control the flow by the way they suck, they don’t have much choice with a bottle. If you don’t pace feed and you just tip a bottle into their mouth, they will keep sucking and swallowing until you stop the feeding.

Your breasts don’t leak milk or it no longer leaks milk

Some women may leak from pregnancy until well into the first year, others may never leak at all. Leaking is absolutely not a sign of low milk supply. Most of the time when you do leak and it suddenly stops, it’s probably due to your milk supply being established and your breasts no longer producing too much milk.

Your breasts feel soft

When your breasts feel soft after a feed, or even all day long during a growth spurt, it’s a good thing. It means your baby is probably drinking efficiently and draining the breast well and your supply is well established. Some mothers may feel their breasts are fuller than usual when it’s time for a feeding or if they’ve gone too long between feedings, but this may eventually stop, and the breast will feel soft most or all of the time.

Breasts will eventually become soft when the milk supply establishes, for some it may take weeks and for others it may take months. But soft breasts are usually not a cause for concern. If you’re breastfeeding frequently and your baby has enough diapers and is growing well, everything is just fine with your milk supply.

Signs that your baby is getting enough milk:

  • Your baby is breastfeeding frequently. At least 8-12 times or more in a 24-hour period in the first few weeks.
  • Clear signs of sucking and swallowing.

There will be times where your baby will very obviously be swallowing milk. It may sound like gulping to you. This is during a letdown where the milk flows more quickly than usual.

  • Your baby is having enough wet and dirty diapers in a 24-hour period.

1+ wet and 1+ stool on day 1

2+ wet and 2+ stools on day 2

3+ wet and 2+ stools on day 3

4+ wet and 2+ stools on day 4

5+ wet and 2+ stools on day 5

5+ wet diapers and 2+ stools every day from day 6 onwards.

After about day 4, we expect brick dust (the orange looking urine) to disappear completely, if it persists for much longer it would be best to have you and baby assessed by an International Board Certified Lactation Consultant (IBCLC), as this can be a sign of delayed lactogenesis II and/or dehydration.

After about day 4, we expect stool to be mustard yellow with no green, brown or meconium. If your baby’s stool does not transition to mustard yellow after about 4 days, it would be best to have baby assessed to ensure adequate milk intake.

After about 6 weeks, sometimes a bit sooner, breastfed babies may have less frequent stools. As little as 1 in 10 days are common. Wet diapers should always remain the same, never less that 4 in a 24-hour period.

  • Your baby is gaining weight as expected.

Losing weight in the first few days are normal and babies can lose around 8% of their birth weight. It’s expected that babies will be back at their birth weight around 2 weeks after birth.

Weight gain will vary greatly from each individual baby, but the expected weight gain per week in the first 4 months is between 140-250g or more per week.

If your baby is gaining less than 140g per week or gaining excessive weight of more than 400g or so each week, it may be a good idea to contact an International Board Certified Lactation Consultant (IBCLC) to do an assessment of both you and your baby to ensure everything is as it should be.

  • During awake times, your baby seems to be active and alert.
  • Your baby seems content after most feedings.

They will relax, open their clenched fists and release the breast on their own. Although cluster feeding, very regular feedings and fussiness in babies are usually normal, it can signal a problem if your baby is never satisfied during or after a feed. A very sleepy baby can also be a sign that there may be something wrong.

  • Your baby is growing well in weight, height and head circumference and they’re hitting their milestones as expected.

Important notes on the milk supply

Breast milk can’t just dry up just like that unless you’ve taken medications that are not breastfeeding or breast milk supply safe. If your baby suddenly fusses or feeds more than usual, you suddenly stopped leaking milk, your breasts are suddenly softer or your baby wants to feed continuously, it’s probably normal and it will pass after a few days.

The best way to know whether your baby is getting enough milk is to look at your baby’s diapers and their weight gain. If they have enough diapers in a 24-hour period and their gaining weight as expected, they are getting enough milk regardless of their behavior at the breast.

Always make sure that you’re breastfeeding responsively and that you have good latch at all times. Make sure you have lots of skin contact with your baby as this will help feeding behaviors and ultimately the milk supply.

Always talk to your baby’s doctor if you need any medical advice. If your baby is showing any signs of dehydration or inadequate milk intake, contact your healthcare provider immediately. Dehydration in babies can be very dangerous and your baby may need medical attention as soon as possible to prevent further complications.

If you ever need information on breastfeeding, or if you have any complications with breastfeeding, contact an International Board Certified Lactation Consultant (IBCLC) to help assess you and your baby and help you with a feeding plan best suited to your needs. A breastfeeding support group is an excellent way to get some more support from other breastfeeding mothers.

Additional information and resources:

E-Lactantia medication safety

Maternal Perceptions of Insufficient Milk Supply in Breastfeeding

The rates and factors of perceived insufficient milk supply: A systematic review

Physiology and Endocrine Changes Underlying Human Lactogenesis II

Anatomy and physiology of lactation

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