Low Milk Supply
Perhaps the most common concern of breastfeeding mothers is whether or not they are supplying enough milk. In many cases women have stopped breastfeeding because of this fear. However, nearly all women are able to produce an adequate milk supply to nourish their children if they are using good latch-on and positioning techniques, and nursing often enough. A true milk supply issues usually require professional help and I cannot provide that on this site at this time. Here are some general guidelines and tips. If these don't reassure you or help you increase your supply withing a couple of days, you must seek help from a doctor or lactation consultant!

Your baby is getting enough if:

• She is nursing regularly, at least 8 times a day
  
  
• She makes clear sucking (in a suck-pause-suck pattern) and frequent swallowing sounds
  
  
• She is wetting at least 6 diapers every 24 hours by the fifth day after birth and her urine is pale. (Typically during the first few days, while the baby is only receiving colostrum, the newborn will wet only one or two diapers per day. Once mother's milk comes in, usually on the third or fourth day, the baby should begin to have 6-8 wet cloth diapers (5-6 wet disposable diapers) per day.
  
  
• She passes between 1 and 5 stools in 24 hours and those stools are soft or liquid, not dry or hard. (After the newborn period has passed, some breastfed babies have infrequent bowel movements. These less frequent bowel movements should still be loose and soft. Breastfed babies do not become constipated. Consult your doctor if you are concerned.
  
  
• She has regained her birthweight by 3 weeks of age
  
  
• She is not displaying hunger cues (trying to put her hands into her mouth, rooting, sucking on her hands) immediately after nursing.
  
  
• She is active, alert and has good skin color.
  
  

Call your lactation consultant or doctor if:

• Your baby does not meet the above criteria. This may indicate a serious concern and needs to be evaluated immediately. Also call if:
  
  
• Your baby is unable to latch on, suckle, or stay latched on.
  
  
• She falls asleep or stops nursing immediately after latch-on.
  
  
• She is showing signs of dehydration - a dry mouth, fewer tears than normal when crying, sunken fontanel (soft spot), decreased urine output, or dark yellow urine.
  
  
• Your baby sleeps a lot more than usual and is difficult to wake or is floppy.

Things to know about a low milk supply:

• Remember the principle of supply and demand: the more you nurse, the more milk you will produce.
  
  
• Night feedings are important to maintain a good milk supply in the first few months.
  
  
• Growth spurts generally occur during the second week of life, around 4 or 6 weeks, around 3 months and around the 6th month, and will often increase a baby's appetite. It may seem like you are constantly nursing during one of these growth spurts. This does not necessarily mean that your milk quantity (or quality) is inadequate.
  
  
• Get plenty of rest and take advantage of any help offered by relatives or friends. New mothers who breastfeed should sleep when their baby sleeps.
  
  
• Remember that crying does not always indicate hunger.
  
  
• A fussy baby may be getting too much lactose from foremilk (see forceful let-down below). The higher fat hindmilk which is important to satisfy her hunger also promotes weight gain. Make sure she is nursing on one side until she seems satisfied, before switching her to the other side. The key to this is "watch your baby, not the clock" If she is consistently taking less than 5 minutes or more than 50 minutes for a feed and doesn't seem content, you should probably consult a lactation consultant.
  
  
• If you have had breast surgery or any past trauma to the chest area make sure your doctor is aware of this so that any true milk supply or delivery issue can be identified and dealt with.
  
  
• If in fact you are not producing enough milk, there are ways to help you build up an adequate supply. Please consult a lactation consultant who can help you accomplish this without starting your baby on bottles of formula which will in turn further reduce your milk supply. Generally the first step you will need to take to build your supply is a schedule of pumping with a high quality electric pump.

See also:
Is My Baby is Getting Enough Milk?

Using Herbs to Increase Milk Supply

Forceful (or over-active) Let-Down

When a mother has a very strong let-down reflex, her milk is ejected from the breast quickly and in great quantity upon let-down. She may have pain when the milk ejects and milk may frequently spray from her breasts. She may (or may not) experience multiple let-downs per feeding.

An overactive let-down can lead to discomfort on the part of the baby. She has to gulp to keep up with the milk, which may cause her to swallow large quantities of air. This can cause excess gassiness and fussiness. She could be filled up on foremilk before she gets to the hindmilk. Hindmilk is richer and higher in fat, the foremilk is more "watery" and contains a higher percentage of lactose. This can cause green, curdy stools which are often mucous filled. The baby may choke and sputter at the beginning of a feed, and in very bad cases even refuse to nurse.

Though you can try some of the ideas to deal with engorgement to help with an over abundant supply of milk when you are just starting to breastfeed, you may need to get help from a lactation consultant to deal with this problem. Unresolved, it could lead to a nursing strike or early weaning and chances are it is not very comfortable for you or your baby!

Dr. Newman's article Colic in the Breastfed Baby discusses this issue and gives some good tips.

The La Leche League website has information which will be helpful to you and can assist you in determining if you need to consult a lactation consultant. (The L.L.L link leaves the Parentingweb site. Use your browser's back button if you would like to return)