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One of the most common concerns of new breastfeeding parents is whether they have enough milk. One of the most asked questions is “Is my baby getting enough milk?” Luckily, even though there aren’t full/empty gauges on your breasts, there are many ways to tell if your baby is getting enough milk. Review the page above for more information.
But sometimes the answer to that question is “no,” and the next question is “Why is my baby not getting enough milk?” Here are some things to consider.*
*Adapted with permission from LLL Canada Blog, “Breastfeeding and Low Milk Supply”
There are two things that may indicate that you that you have a problem with low milk supply:
POSSIBLE CAUSES OF LOW SUPPLY
The following can cause or contribute to low milk supply:
TONGUE AND LIP TIES
Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.
Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn’t happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.
Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move his tongue freely and extend it over the lower gum with his mouth open wide to be able to breastfeed well.
Tongue and lip ties can restrict mouth movement so that a baby does not receive adequate milk from the breast. This can also lead to milk production dropping over time since milk is not being removed efficiently from the breast.
Read more about Tongue and Lip Ties.
HYPOTHYROIDISM (UNDERACTIVE THYROID)
Thyroid issues often cause difficulty with milk supply and with milk removal. You may find your thyroid levels change with pregnancy and childbirth, which is why frequent testing is recommended. Depending on the medication, your baby’s levels may also need to be checked regularly postpartum.
HYPOPLASIA/INSUFFICIENT GLANDULAR TISSUE (IGT)
“Maybe you just need to try a little harder.” “Have you tried fenugreek?” “You’re probably not drinking enough water.”
Those who struggle with milk production and low milk supply hear advice like this from well-meaning friends and family members (and sometimes, from breastfeeding supporters who should know better). While the vast majority of milk production problems can be remedied by addressing issues of breastfeeding management, there are some for whom making enough milk to sustain their babies is difficult or impossible. Called “primary lactation failure”, this condition occurs when a mother’s body does not make an adequate amount of milk for her baby, even when everything else is in order (including but not limited to: latching and positioning, breastfeeding frequency and exclusivity, mother and baby being kept together, baby’s oral anatomy is fine with no tongue-tie or cleft palate).
Primary lactation failure can be due to a variety of factors, including previous thoracic or breast surgery that severs critical nerves or ductwork; hormonal complications, such as those that accompany polycystic ovarian syndrome or thyroid abnormalities; and a condition in which mammary tissue simply did not develop during adolescence. Called tubular (or tuberous) breast deformity in the plastic surgery literature, hypoplasia of the mammary gland (also called insufficient glandular tissue or IGT) was previously thought to be a simple issue of cosmetics. Corrections addressed the appearance of a woman’s breasts, with little regard for their function. However, as breastfeeding gains significance as an issue of public health, more mothers seek to nourish their babies in this manner, but little is known about what to do when breastfeeding doesn’t work.
Read more about Hypoplasia and Insufficient Glandular Tissue (IGT).
Breastfeeding: More than Milk, LLL USA
Is My Baby Getting Enough Milk?, LLL USA
Helping to Get Breastfeeding Off to a Good Start: Milk Supply, LLL USA blog
Perceived Insufficient Milk, KellyMom
Increasing Low Milk Supply, KellyMom
Breastfeeding after Breast Augmentation and Reduction Surgeries (PDF), LLL USA’s New Beginnings
Breastfeeding after Breast or Nipple Surgery, Cleveland Clinic
Breastfeeding After Reduction Information and Support, BFAR.com
Breastfeeding After Reduction (BFAR), Facebook Group (not affiliated with LLL USA)
Feed The Baby: Building A Milk Supply, LLLI
At-Breast Supplementer Nursing, LLLI
What Breastfeeding Taught Me about being a Mother (Low Milk Supply), LLL USA blog
Evolution of a Breastfeeding Mother, LLLI
Breastfeeding With A Lactation Aid, LLL USA blog
IS YOUR CONCERN OR QUESTION NOT COVERED HERE?
Please contact a local LLL Leader with your specific questions.
Medical questions and legal questions should be directed to appropriate health care and legal professionals.
Page updated March 2022
Portions partially adapted from LLLI materials.
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