SUPPLY BUSTERS: Top 5 reasons for low milk supply in physician mothers
by Laurie B. Jones, MD, IBCLC, FABM
SUPPLY BUSTERS: Top 5 reasons for low milk supply in physician mothers
by Laurie B. Jones, MD, IBCLC, FABM
The number one reason that women stop breastfeeding is perceived or real low-milk supply. Even mothers who have a great milk supply during their maternity leave may find that they have a fluctuating or low milk supply when they return to WOTH (work outside the home). Some of these issues apply to SAH (stay-at-home) mothers as well. Check out our links page for other books and websites that can help find the cause and solution for your supply issue!!
Schedule refers to both mother's schedule and baby's schedule. Are you able to get in enough pumping sessions while away from home? Do you get in "make up" pump sessions right after arriving to work, right before picking baby up, or just before bed? Do you limit baby's time at the breast when you are home with him on your time off? Are you missing baby's hunger cues to keep her on a timed schedule? Remember that they have growth spurts at 6 weeks, 3 months, 6 months, and other times where they need to nurse more often than usual. It does NOT mean that you don't have enough milk....it just means listen to your baby and feed him when he wants it! Even if you think there's nothing there -- the breast is never empty. Those back to back feeds are almost pure fat since all milk starts out as fat and sugar is added to it over time. All babies develop a "routine" on their own with naps and number of nursing sessions, but when a parent imposes a "schedule" from some popular book method ...... then you impact your milk supply and the health/growth of your baby. You can't respond to growth spurt needs - and you spend a crazy amount of energy trying to stick to the schedule with a baby that doesn't understand waiting for milk that's right there in front of them.
Solid food should be added at the earliest to the diet of a breastfed infant at 6 months. Many mothers start earlier and feel that it is a developmental achievement akin to getting into preschool early or the wait-list for Harvard! However the American Academy of Pediatrics, the World Health Organization, and the Academy of Breastfeeding Medicine all recommend that solids be started around 6 months of age. Solids DISPLACE breastmilk from the diet in calories 1:1 rather than adding to the milk calories. Solids displace breastmilk and lower your milk supply - which is fine after 6 months but not sooner. Don't be surprised to see your daily pump volumes go down when you introduce solids, but it is okay since the calories are now coming from solid food. If you work 5 days a week, consider limiting solids on the weekends when baby is home with you and have more at breast time. If daycare is bugging you about sending more milk .... it can be helpful to use solids as a distraction at 4 months of age using iron-fortified oatmeal cereals; however do not give solids at home with you until 6 months at the earliest. The more direct method would be to educate caregivers about human milk volume norms and reinforce paced bottle feeding - or switching to cup between 6 months and a year.
Many breastfed babies prefer self-feeding (Baby-Led) over forced spoon feeding and remember that the purpose of solid/complementary foods is for (1) iron and zinc, (2) developmental skill acquisition AKA "fun" (3) learn tastes and textures. You can also have solid food given primarily during your work days and on your precious time home with baby do mostly on demand feeding with less solids. Use cast iron skillet for cooking food to get more iron in your family's diet and the Lucky Iron Fish added to boiling water for pasta/rice/noodles especially in vegetarian families.
3. SLEEP TRAINING
What is the ultimate bragging right in parenting (besides toilet training!)? Getting baby to sleep through the night, of course! This is a cultural imperative but not a biological one. In fact our bodies make the most milk at night and our prolactin levels are highest at night. Babies prefer to sleep near their parents and to suckle off/on through the night. I won't get into a debate about attachment parenting vs. sleep training, but I will tell you the simple fact that most women's breasts cannot hold 12 hours of milk in them without activating the FIL factor. The FIL factor (Feedback Inhibitor of Lactation) is a substance that builds up as milk is not removed from the breast. When it reaches a critical level it tells the breast to make less milk the next hours and days. Over time supply will drop slowly (there's a chance here to rebuild supply), but then there will be some point of no return when the cells that make milk die and involute.
The point at which your breast can hold a volume of milk without decreasing your supply is called your "storage capacity", and it is different for every women and not related to size of the breasts but somewhat to shape and genetics. Every woman has a remodeling of the breast and decrease in storage capacity at around 6 months post partum --- right around the time you hit the 6 month slump described in the book "Working Without Weaning". You don't know what your storage capacity is until your supply drops - and then you realize how long you go without pumping or feeding. In general breastfed infants between 3 months and a year of age wake 2-3 times between 8pm and 6am to feed. Expectations for "sleeping through the night" are unrealistic based on how our human bodies make milk... MOREOVER societal expectations for post-partum mothers are insanely out of sync in modern times with our cave-woman body physiology. Sleep deprivation is universal for formula fed or breastfed infants. The sleep industry is worth $8billion a year for a reason. Sleep expectations are a family decision that cannot be generalized. Decide what's most important to you - know how sleep training affects your milk supply. Life is about choices - there's no right or wrong.
The sex I am referring to is a mixture of:
a. You are having sex (good for you!) and you are pregnant which will usually tank you milk supply. Some women
ovulate and conceive before getting the first period post-partum and don't realize that they are pregnant.
b. You are having sex (yee haw!) and you don't want to be pregnant and are on a hormonal contraceptive that can lower
your milk supply. Some women are very progestin sensitive. Estrogen containing contraception is extremely risky in an exact-producing mother who works many hours outside the home and is pump-dependent and doesn't get a lot of make up time with baby at the breast to rebuild any supply lost. Consider a barrier method instead (with major lube since vagina is in a low estrogen state) or IUD with very short systemic hormone exposure after inserted.
c. You have gotten your period back and your supply is cut in half for the 2 days before and 2 days after the arrival of
d. You want to have sex but you feel horrible about your body and you are exercising like mad and wearing a tight jog
bra for hours and hours and eating less than 1800 calories a day. This is a reminder to never change more than one thing at a time -- Example: don't go back to work and get IUD placed and start a new exercise regimen in the same week. Spread out changes that can impact supply .... by at least a week.
5. STOCKPILED FROZEN STASH
Most women feel a powerful nesting need to stockpile frozen milk in crazy quantities before returning to work. Many abandon breastfeeding entirely for fear that they haven't stockpiled enough before starting back to work. In the book "Working Without Weaning" the author describes the myth of the frozen stash and how it decreases milk supply. When you find your supply is going down and you reach for frozen stash to top off baby - then you aren't getting the root of why your supply is down -- you can't get your body to make more -- you are probably giving baby too much -- you may create a breast refuser because they will need to be topped off even when they are at the breast!! You need about 2 workday hours' worth of frozen milk for emergencies and spills (calculated at 1-1.25 ounces per hour), but more than that is unnecessary and may ultimately lower your supply if you use it to compensate for less pumped at work. We recommend a modest freezer stash and embrace #EXACTproducing ! You will skip pump sessions at work if you have a large freezer stash. You will be up pumping in the middle of the night when your baby is sleeping when you have to maintain oversupply that you created to make the giant freezer stash. You risk getting recurrent plugged ducts and mastitis from oversupply created on maternity leave that can't be emptied at same rate when back at paid work. You steal the joy of your precious maternity leave time making the freezer stash. And hopefully you aren't actually stealing milk from your baby growing in front of you! We see "freezer theft" as a cause for a slow growing infant.
"Feed the baby ... not the freezer." It's hard to feed a newborn and that newborn's future self in 6 months by at breast feeds and pumping for frozen stash. What you pump on Monday at work should be given on Tuesday -- what you pump on Tuesday is given on Wednesday -- and on and on. Fresh milk has more vitamins and anti-infection properties than frozen milk anyway. And many babies refuse frozen milk and you've wasted a whole lot of time! (and you might have high levels of lipase too!) Stay off the #frozenMilkTreadmill .... which is a time sink and time waster. It's when you have made this huge stash and feel obligated to use it and so you rotate some of it into the mix with your fresh. But then every single day some of your fresh milk has to be frozen (thus the treadmill.....). It adds about 20 minutes to each side of your day to coordinate labelling, thawing, freezing, transferring milk with ZERO benefit to the baby. That's 3.5 hours of time per work week WASTED that you could be staring at your gorgeous infant or binge watching a show or going on a date night with your partner.
Milk supply from month 1 - 6 is the SAME! (-ish) Human babies eat human milk in the same volume at one month through 6 months of age. Then the volume of milk needed goes DOWN not up because of introduction of solid foods. WHAT???? Publications from 1999, 2003, and 2008 showing that the volume of milk produced at 1 month through 6 months is the same (small +/- 30-60 cc in 24 hrs). The metabolic *burn* of an infant slows down and lessens (as the growth chart flattens) in that same time frame. Breast milk fed babies require fewer calories to grow over time; however cow milk fed infants do require escalating volumes of milk to meet their higher calories to grow over time. When you metabolize your own species' milk, it's a very efficient process - so your kcal/kg/day goes DOWN as infant grows. So the same volume of milk feeds a 10 pound one month old as a 20 pound one year old! Calories are relatively consistent in the milk if averaged over a 24 hour period. We are all trained in medical school on tables of dietary requirements that increase with weight in first year of life, but that data is all from cow-milk fed infants. A stay at home Mom knows that her breasts have not doubled in size (with double the volume) for her one year old versus her one month old :) So stop using any weight based volume calculators for your human milk fed infant...... normal volume 24-30 ounces per 24 hours (1-1.25 ounces per hour) is the same from month 1-6. From 6 months to a year, the total daily volume gradually drops to an avg of 18 ounces per 24 hours at 12 months of age. This is normal and not low supply. We recommend 2 cups (16 oz) of milk at 12 month well check..... which is exactly how much human milk most mothers make!
6. Okay there's really 6 if you count the obvious one "STRESS"!!
Avoiding stress is really not an option for most mothers juggling many aspects of their lives. However you can make choices that leave your body and mind in better shape to produce the milk that your baby needs. Here are some workplace and social life verbs to help you de-stress your life:
Procrastinate - delegate - defer - accept less than perfection - be average - achieve the minimum - be flabby - wear maternity clothes for another month - be late - let people down - get a pedicure - call an old friend - skip Facebook - get off this website!!!! Ha ha!!!