I know the title of this article, Medical Causes of Low Milk Supply is about as specific as telling someone who asks for your address, “I live in the USA,” so let me say that while there are hundreds, if not thousands of medical issues that affect babies that are the causes of low milk supply. The good news is that, from a milk supply stand point, they fall into three rough categories: nipple punishers, the sleepers and those who can not breastfeed. Let’s look at each of these:
Medical Causes of Low Milk Supply: The Nipple Punishers
These babies have medical issues that affect the shape, size, or strength of the mouth or tongue. Issues like, a tiny mouth, stiff jaw, tongue tied, or cleft lip create a nipple punisher. Like the name implies, these medical issues, make a good latch very difficult and without expert intervention from a lactation consultant they quickly result in damaged nipples.
Once the nipples are damaged, the frequency and length of breastfeeding and pumping is usually reduced which will leave more milk in the breasts. That’s the body’s signal to cut milk production and it’s often a tough road back to a good milk supply.
Here’s what to do:
- Fix the latch – see a lactation consultant on proper latching that takes the baby’s medical condition into account. The consultant can also give instructions on nipple care and health. Insist on a good latch every nursing, and maintain the good latch throughout the entire nursing. My second baby with her tiny mouth didn’t like the feel of my large nipple way back in her mouth, so after many attempts we would finally get a good latch, and then throughout the nursing she would do a little head maneuver quick as could be to try to get the nipple further forward in her mouth (like I wouldn’t notice)!. I’d have to take her off, and start all over. Believe me, it is worth the effort to insist on a good latch.
- Heal damaged nipples – After you breastfeed, hand express a little breast milk and spread it around your nipple, then let it air dry. Breast milk has incredible healing properties. Use nipple healing ointment or patches. The ointments containing Lanolin are easy and convenient because you don’t have to wash them off, but they don’t have as much healing power – they are better for protecting the nipple. The medicated patches are very good at healing damaged tissue, but you need to rinse your nipple and areola before nursing, which makes them a bit inconvenient. Air your nipples as often as you can to speed healing, just bare it all and put on a good show for your husband, maybe draw the blinds so it’s not also a show for the neighbors! Go bare as often as you can, it will really speed the healing time.
Try to avoid using breast pads with the plastic liners as these can retain moisture against your nipple and slow healing. If necessary, use a nipple shield if the pain is unbearable for nursing – be cautioned though that doing so can further decrease supply, and it may create a dependency for baby to only want to latch to the shield. But, it is better to use the shield and be able to forge on, than to stop because the pain is too much. If one nipple is worse than the other try different nursing holds to see if there is a hold that allows a better latch on that nipple. Offer the other breast first for a couple of nursings in a row to allow baby to get the initial vigorous nursing done on the less tender nipple.
- Address the medical issue if possible – If the medical issue affecting your baby can be corrected, treated or managed do so as quickly as you can.
Medical Causes of Low Milk Supply: The Sleepers
Theses babies have medical issues that cause them to be weak, drowsy, low in energy or sleep excessively. Some examples include premie, heart or lung defect, malnourishment, and jaundice. Anything that reduces the frequency or length of breastfeeding will result in lower milk supply as the body cuts production in response to milk being left in the breasts.
Here’s what to do:
- If possible, wake baby every three hours from the start of one breastfeeding session to the start of the next one and breastfeed. Engage baby with talking and playing to keep him awake and as actively nursing for as long as possible. Offer both breasts every breastfeeding session. Aim for a minimum of 10 minutes of active nursing on each side. Then pump after each nursing for ten minutes on both sides or until milk stops flowing, whichever is longer. See the article, Sleepy Breastfeeding for specific tips on how to breastfeed sleepy babies.
- Try giving baby half a tube of breast milk from a monoject to invigorate them for the breastfeeding session. See the article SNS System.
- If waking baby every three hours is not possible, wake baby often for breastfeeding and follow the directions in step one. Additionally, you’ll need to pump every 3 hours as measured from the start of the prior breastfeeding or pumping session. Pump for 20 minutes on each side or until milk stops flowing, whichever is longer.
Medical Causes of Low Milk Supply:Those That Can’t Breastfeed
Some babies are born with medical issues that prevent them from breastfeeding initially. Some examples are premature babies, babies in the intensive care unit, intubated babies or babies with feeding tubes. In this case, you’ll need to pump for 20 minutes on each side or until milk stops flowing, whichever is longer every 2-3 hours during the day and two or three times during the night. If your baby was just born, I recommend pumping three times during the night for the first two weeks to be sure your milk is well established. See the Importance of Breastfeeding in the first 2 weeks article. Once your baby is able to breastfeed, begin to do so immediately so that he can begin to imprint and become familiar with the breast. If baby has been bottle feeding consider using the monoject technique from the SNS System article.
There are many Causes of Low Milk Supply and we looked at three groups of medical causes in this article. For more causes of low milk supply see our virtual lactation consultant.