As a pediatrician and lactation consultant, I am a problem solver.
Low milk supply is by far one of the most frustrating problems that breastfeeding mothers face. Sometimes, I can solve this problem and sometimes I can’t.
Causes for low breast milk supply are often multi-factorial. Which means that they could be due to a baby issue, an issue with mom or both. Additionally, solutions are easier to achieve if the problem is found early.
Exclusive breastfeeding is not achieved overnight. Preparation for this lofty goal is the key to success. As a result, the early days after birth are not the time to start learning about the process. The steps to successful breastfeeding are time sensitive. You don’t want to get behind the ball.
Some of the causes for insufficient milk supply are predictable and need to be identified early. Understand your risk factors for low milk supply ahead of time so that you can put one foot forward in your journey.
Through social media and on my YouTube channel, I spend time urging mothers to educate themselves about breastfeeding. I also encourage them to prepare both mentally and physically before they give birth. While not every cause of low milk supply can be prevented, there are things that you can do. The first step is to learn about the causes of low milk supply that are due to maternal health issues. This can help you to identify anything that you can modify before your baby arrives on the scene.
In this article, we will look at the maternal health problems that can potentially lead to low breast milk supply.
What is Low Breast Milk Supply?
As a medical community, we define low breast milk supply as production that does not sustain the needs of the baby. When mothers have a full milk supply, their body should produce 24-30 ounces of breast milk per day (for a single baby). This sustains the growth of a metabolically normal baby for the first 6 months of their life.
Health Reasons for Low Breast Milk Supply
Low breast milk production occurs for many reasons. A lower than average supply of breast milk potentially results from factors that have to do with the baby, the mother or both. Babies who have trouble with effective milk removal from the breast can cause a decreased supply over time. Generally, babies with a cleft palate, born before 36 weeks postpartum or who have other reasons for poor milk removal can lead their mothers to have an inadequate supply.
While there are many reasons why the baby can contribute to low milk production, we are going to focus on maternal causes in this article.
Non Pregnancy Related Conditions
As a breastfeeding medicine physician, I urge mothers to prepare for breastfeeding ahead of time. For me, this means that a woman should sit down with her health care provider to assess her health. Ideally prior to pregnancy, but definitely prior to delivery. We want to identify and treat potential reasons for low breast milk supply.
Many of these conditions can be treated which will decrease the risk of insufficient milk supply.
Increased Body Mass Index
While BMI is not a perfect measure of a person’s health status, women with a higher than average body mass index can potentially experience low breast milk supply. Unfortunately, increased body weight contributes to hormonal imbalances that decrease the body’s ability to make breast milk.
This is not true for every woman, but it is a potentially modifiable risk factor for inadequate milk supply.
Polycystic Ovarian Syndrome
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects various aspects of a woman’s health. The effects are seen in fertility, regulation of menstrual cycles, as well as breast milk production.
In the earliest days of breastfeeding, milk production is entirely driven by hormonal regulation. Women with PCOS potentially will experience insufficient milk supply due to these imbalances. Additionally, insulin resistance plays a role in both PCOS and insufficient milk supply.
Breast Cancer
Surviving breast cancer is a reason to celebrate.
Unfortunately, it can also make breastfeeding more challenging. While exclusive breastfeeding is not completely impossible, you do have to account for many things when considering this after surviving breast cancer.
Successful breastfeeding after breast cancer is possible depending on many factors. The type of cancer, modality of treatment and need for surgery all change whether or not a woman can produce plenty of milk for her new baby.
After consulting with your healthcare professional, you may need to adjust your expectations for what successful breastfeeding looks like to you. Your vision of maintaining a breastfeeding relationship with your newborn may need to include infant formula or donor milk.
Surgery on the Breast(s)
Previous breast surgery can have different effects on breast milk production. Some surgeries, like breast augmentation or a benign breast lesion biopsy, typically do not greatly impact a woman’s ability to breastfeed.
On the other hand, women who have undergone breast surgery due a history of breast anomalies or surgeries that require cutting of milk ducts and nerves may experience decreased milk production. Your healthcare provider can review your surgical history and guide you in the best breastfeeding practices for your anatomy.
Insulin Resistance
Insulin metabolism is involved in the production of breast milk. While the exact mechanism is not completely clear, we know that insulin plays a role in breast milk synthesis.
Diabetes is caused by insulin resistance, but there are other conditions that are also associated with abnormal glucose metabolism.
Low Prolactin
Hypoprolactinemia is a maternal health condition that causes actual milk insufficiency. The pituitary gland (in the brain) produces prolactin and releases it into the blood stream. This hormone travels to the breast where it is essential for maintaining a breast milk supply.
There are various causes of prolactin deficiency:
pituitary gland disorders
hypothalamus dysfunction
certain medications
excessive stress
severe malnutrition
Mothers who do not know that they have this condition may try to breastfeed. Their infant will experience weight loss, inadequate diaper output, show constant signs of hunger and feed more than 12 times per day. These are indications of insufficient milk production in breastfeeding mothers.
Insufficient Glandular Tissue
Insufficient glandular tissue (IGT) is a condition where the breasts have not developed enough milk-producing structures. Women who experience insufficient glandular tissue may not know that they have this condition until they try to breastfeed. Often, this anomaly runs in families and is a result of differences in development.
Women with insufficient glandular tissue may have very distinct physical findings such as wide spaced nipples, tubular shaped breasts or significant size differences between breasts. While other women with this condition don’t have any of these findings.
Often babies who are born to mothers with this condition will fail to thrive if they are exclusively breastfeeding. Due to the decreased amount of glandular tissue, mothers will have an inadequate milk supply for their baby. While, a woman may be able to increase the amounts of milk that she is producing over time, often she will never have a full milk supply. Mom’s breastfeeding goals will need to be adjusted to include infant formula or donor milk.
Low Thyroid
Hypothyroidism potentially leads to a decrease in breast milk supply. The thyroid gland produces hormones that play an important role in the development of mammary tissue. Insufficient thyroid hormone will lead to breastfeeding challenges.
Consultation with your endocrinologist as well as a breastfeeding expert prior to delivery will increase your success with breastfeeding in the months after birth.
Postpartum conditions
Now we are going to shift gears to medical complications that occur during and after delivery of the infant.
Unfortunately, you may not have much control over what happens postpartum. These conditions may not be entirely preventable, but it is important for you to know that they may cause low breast milk supply.
Postpartum Hemorrhage
Postpartum Hemorrhage (PPH) is a medical condition in which the uterus does not contract properly after childbirth. This results in excessive blood loss. PPH can have an impact on milk production. Not only does blood loss potentially disrupt the oxygen supply to the pituitary gland, but it also puts extra stress on your body. Increased stress and decreased prolactin secretion from the pituitary gland leads to decreased milk production.
An additional, but rare, complication of a severe postpartum hemorrhage is a condition called Sheehan syndrome. Women who experience this phenomenon make little to no breast milk. This is due to a complete lack of blood flow and oxygen to the pituitary gland which leads to decreased or no prolactin production.
Retained Placenta
Retained placenta is another cause of low breast milk production. This can occur after a vaginal delivery where part of the placenta is still attached to the uterine wall. Even this small amount of placenta disrupts the hormonal process that occurs postpartum. In a normal delivery, once the placenta is delivered, there is a precipitous drop in the levels of progesterone in the mother’s body. This signals the body to increase prolactin and therefore breast milk production. A retained piece of placenta inhibits this process.
Signs of a retained placenta include
continued heavy vaginal bleeding
low milk supply
delayed onset of copious milk production (milk coming in)
fever
pain
malodorous vaginal discharge
If you are experiencing these symptoms, be sure to alert your obstetrician. They can perform an ultrasound to look for pieces of placenta that might be retained in your uterus.
High Blood Pressure
Elevated blood pressure can impact breast milk production. This is especially true in the setting of pre-eclamsia where the blood pressure is so high that it becomes dangerous for both mom and baby. In this condition, an OB may prescribe a magnesium infusion during delivery in order to prevent seizures. High blood pressure itself as well as these interventions can lead to decreased breast milk supply.
Please note that this article is purely for informational purposes and should not be interpreted as medical advice.
