What Causes Low Milk Supply in Breastfeeding (Part 4)

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This article is the fourth article in “What Causes Low Milk Supply in Breastfeeding” series. To read the previous articles in these series, please click here .

Previously we have discussed about how things that you do and your baby’s action and body may affect your milk supply. Now, let’s talk about your body. Yes, there are things on our body which may cause low milk supply issue if not addressed properly. What are they? Here you go.

#1 Flat and inverted nipples

To breastfeed effectively, a baby needs to be able to grasp mother’s nipple and pull it towards his mouth. 

With typical nipple that protrudes out, it is not a problem. But things may become difficult in the case of flat or inverted nipple. Your baby may experience difficulty in grasping your nipple, making it difficult to breastfeed effectively, which in turn can affect your milk production.

First, let’s check whether your nipple is flat or inverted by doing a simple pinch test.

• Hold your breast about 1 inch behind your nipple using thumb on top of the areola and index finger in the bottom, and pinch it gently.
• If the nipple protrudes, then you have a normal nipple.
• If the nipple stays flat (does not protrude), it is a flat nipple.
• When your nipple retracts and disappear with this pinch test, then you have a truly inverted nipple.

*Please note that it is common for first-time expecting mothers to have not-fully protruding nipples and this is a temporary condition which will get better as the baby is born and starts nursing.

If your problem is a not fully protruding nipple, encouraging baby to have a deep latch while nursing will certainly help him to remove milk more effectively.

If you have truly flat or inverted nipples, the following tips may help during feeding:

• Stimulate the nipple with cold compress before each feeding to make it protrudes right before bringing baby to breast.
• Pumping for a few minutes before feeding may also help to make the nipple stays protruded so that baby can start nursing easier
• Use of nipple shield can also help baby to breastfeed, but please note that it is best to consult with lactation consultant before you decide to use nipple shield for nursing. You also need to slowly wean your baby from nipple shield as he grows older.

#2 Insufficient glandular tissue 

Women have breasts with various sizes and shapes. While breast size is not an indicator on how much milk a mother can produce, the amount of glandular tissue (which reflects the amount of milk-making cells) may affect how much milk you can produce and store in your breast.

Identifying whether you have sufficient glandular tissue is not so straight forward, but there are some signs that you can be cautious at:

• there is no or minimum breast change after puberty (breast stays under developed and not becoming fuller)
• there is no or minimum breast change during pregnancy
• there is obvious asymmetric between left and right breast, where one breast is smaller than the other
• widely separated breasts, 1.5 inch or even more
• tubular breast shape ( see here for more illustration)

When you experience one of these signs, you may have insufficient glandular tissue, or in short, IGT. This condition is also known as mammary hypoplasia.

The problem with IGT is not whether you can breastfeed or not, rather how much milk you are able to produce.

Some IGT moms, regardless their breast shape difference, is able to produce full milk intake that baby needs. Some reported that they can breastfeed partially, so that they combine breast milk and supplemental feeding ( formula milk or donor breast milk).

Sometimes the condition improves throughout subsequent pregnancies. I especially love the blog written by Nyssa Retter which tell a lot about her breastfeeding journey with IGT.

To maximise the milk production, there are a few things that you can do:

• always ensure to feed baby on demand
• use at breast supplementer if you need to supplement so that breast gets stimulation at the same time
• herbs supplement such as goat’s rue can be taken prior to birth to stimulate breast tissue growth

Do remember that if you cannot afford to have full milk supply that your baby needs, every little drop of breast milk from you is such a precious gift to your baby. Breastfeeding is not all or none. By trying your best to breastfeed your baby, you are giving him the best head start in his life.

#3 PCOS (Polycystic ovary syndrome)

PCOS affects about 15% of women and highly related to infertility problem.

If you suspect your milk supply issue is related to PCOS, please consult on medical practitioner or skilled lactation consultant right after you know you are expecting. They may prescribed you some medication (metformin is one of the popular ones) to take regularly throughout or in certain phase of your pregnancy. These medications would help regulate your hormones, which can be related to PCOS symptoms and hormones that affect milk production.

There are also supplemental herbs that you can try to boost your milk production, such as goat’s rue and saw palmetto. Chaste-berry is famous in easing PCOS symptoms, but before you take it, please consult with your doctor about the correct dosage since over dosage may lead to reverse effect (lowering milk production).

As always, with all medications and supplements that you consume, you should always ensure to perform good breastfeeding practice such as nursing baby on demand, ensure proper and correct latch position, and so on. You can read further on things you should avoid to protect your milk supply here.

#4 Diabetes

Diabetes is a disease where insulin hormone is not regulated properly within your body.

How does it affect milk supply? Insulin plays a big role in mammary development and milk production. Any significant fluctuations in insulin may affect how much milk you are able to produce.

If you have diabetes, please consult with your health practitioner for possible treatment. You may be put in strict diet on sugar-intake and insulin to help in maximizing your milk production.

#5 Breast surgery

Breast surgery, depending how invasive it is and in which location it was done, may damaged milk ducts and nerves related to milk production. But, please remember that not all breast surgery is harmful for milk supply.

Breast implant, for instance, if done carefully, may not have any negative effect at all. See this mom’s video where she talked about her breast augmentation surgery and her breastfeeding experience.

Breast reduction surgery, on the other hand, can be more invasive and has severe effect on milk supply in terms of lower milk production and impaired let down reflex (and hence, milk cannot be removed from breast).

If you want to learn more about breastfeeding after breast and nipple surgery, this website provides plenty of resources and supports for moms and family.

#6 Thyroid dysfunction

Thyroid is hormone secreted by thyroid gland (located some where in your neck) and plays important role in regulating lactation (milk-making) hormone.

Imbalanced thyroid hormone, both too low (hypothyroidism) and too high (hyperthyroidism) may affect mom’s and baby’s health starting from pregnancy and continues after baby is born and may affect milk production. If you suspect you have thyroid problem, please consult with your trusted health practitioner and get your hormone level tested. You may be prescribed certain medications to be taken regularly to help you maintain hormonal balance in your body.

 

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So here are six factors from your body that may affect your milk production and can cause low milk supply issue. If your milk supply issue was caused by one of these 6 factors, solving it may not be so straight forward. You may need specific treatment or regular intake of medication or milk-booster supplements, in addition to good breastfeeding practice, such as nursing on demand and ensuring a proper latch.

Even after doing all of this, no one really knows whether you will be able to achieve full milk supply for your baby. Some mothers succeed, and some mothers don’t.

It can be frustrating when you have tried all things you know and yet not being able to achieve what you want.

But, I strongly believe that:

 

I hope these 4-part series of ‘What Causes Low Milk Supply in Breastfeeding’ helps you to rule out the culprit behind your milk production problem, and thus, address the problem more efficiently.

Have you experience low milk supply problem before? What was the cause and how did you go through it? Feel free to share your story here.

And lastly, if you have any friends or family who struggle with low milk supply issue, please share this article to them. Hopefully, it will shed some light on what to do and how to solve the milk supply issue.

If you want to learn more on how to increase your milk production and making more milk, I strongly suggest you to read this making more milk guide.