8 Things That Could Secretly Be Decreasing Your Milk Supply
Sometimes it seems as if your milk supply suddenly drops overnight. One day you have a good supply and the next you don’t. But that is typically not the case, and in most instances, something was going on for a while that was slowly decreasing the amount of milk you were producing.
Milk supply is something on many breastfeeders' minds. You do everything you can to make sure your supply is well established and that you keep making what you need for your baby. We know that making milk is all about demand (your baby or the pump) and supply (your body responding to the demand by making more milk). Frequent and effective milk removal is key! Your well-drained breasts will make milk at a faster rate than your full breasts, so removing milk often is important. I talk more about how milk production works and increasing your supply in this post. If you notice your supply dipping, then figuring out what might be the cause is really important so that you can address the root of the issue.
Here are 8 things that might be decreasing your milk supply (that you may not even realize):
Baby doesn’t have an optimal latch or has unaddressed oral issues.
Since our babies are smart they will make latching work any way they can in order to get milk. If they have any oral issues, such as a tongue tie, then they will compensate for the way they latch in order to eat. This compensatory pattern can make getting milk less effective and over time this can lead to your milk supply down-regulating. Full-term babies are born with a strong instinct to suck and this serves them well for feeding. But around 3-4 months the suck reflex integrates, meaning sucking is no longer automatic but now a choice. If they didn't learn how to properly suck due to oral dysfunction then feeding (that had been previously a reflexive activity) now becomes difficult for them. This is a common time to see breast or bottle refusal from a baby that was previously eating seemingly without issue. This 3-4 month timeframe is also a common time for breastfeeders to report a dip in supply because the less-than-optimal feeding finally catches up with them. If you have concerns about your baby’s latch scheduling a consult with an IBCLC who can assess your baby’s latch and oral function is your best course of action.
Baby is fed on a schedule or their time at the breast is limited.
Babies and your milk supply are at their best when you feed your baby per their cues instead of by the clock. Human milk is low in fat and protein and high in carbohydrates. This makes it quick and easy to digest and is also the reason infants feed so frequently. Milk production is based on this fact- if you don’t remove the milk frequently then your body slows down production in order to save energy (making milk costs your body a lot of energy). Breast milk also has components in it that help our babies regulate satiety. Limiting feeding frequency or time at the breast disrupts this balance and in turn, can slow down your milk production. Feeding your full-term, healthy baby based on their hunger cues is the best way to maintain a good long-term milk supply.
Your breast pump is ineffective or not the right pump for you.
Pumping isn’t easy and there are so many different pumps on the market now. Unfortunately, all pumps are not created equal. It can be difficult to pick out a pump and then figure out how to use it. Do you know what all the buttons on your breast pump mean? Have you tried different cycles and suction levels to see how you respond best to your pump? Some breastfeeders can use any pump and get milk out and maintain a good supply. Some on the other hand do not respond well to certain pumps. Wearable pumps have become popular because they allow more mobility during pumping but for many, they do not do as good of a job at draining the breasts as compared to a double electric pump with standard flanges and tubing. Before you go out and buy a new breast pump, make sure you check the flange size (see #4) and make sure you are replacing your consumable pump parts as recommended by the pump manufacturer.
You are using the wrong flange size for pumping.
The majority of clients I work with are using the wrong flange size. Pumping should never hurt and using the incorrect flange size can do major damage to your nipples and areola and impact how much milk you are able to pump. Swelling and inflammation from the wrong size can reduce blood flow to your nipples and block milk ducts which can lead to further issues such as plugged milk ducts, mastitis, and vasospasms. Over time, if you are not effectively draining your breasts then your body gets that signal to slow down milk production. This blog post goes over more detailed information on pain while pumping and finding the correct flange size.
You are skipping or completely stopped removing milk during the night.
This could be because you started sleep training, your baby is sleeping longer stretches at night on their own, or if exclusive pumping you are not waking to pump. This goes back to the basics of milk production- removing milk less frequently and allowing your breasts to become full signals your body to slow down. Your body also has higher levels of the milk-making hormone prolactin at night, therefore your body is making more milk at this time. If your baby’s new sleep pattern has reduced the number of total times you are emptying your breasts each day then your supply can be affected. The amount of milk your breasts can store before they are full is different for everyone. If you have a smaller breast storage capacity then you need to remove milk more often than someone with a larger storage capacity.
You started a new medication.
Many women are given birth control at their 6-week postpartum check-up. If this is the best family planning method for you, then you want to avoid contraception containing estrogen. But keep in mind, even if your birth control is progestin-only you should still monitor your milk supply when you begin contraception. Everyone has different responses to birth control and even those methods without estrogen can impact milk supply for some people. There are also some OTC allergy and cold & flu medications that can impact your milk supply, such as those containing pseudoephedrine. It is always best to consult with your physician, pharmacist, or an IBCLC before starting any medication to make sure it is compatible with breastfeeding.
An underlying medical issue that was never addressed or a new health issue (such as a thyroid disorder, PCOS, or diabetes).
Hormones play a crucial role in milk production, so anything that disrupts your hormonal balance has the potential to affect your milk supply. The thyroid regulates the two major hormones in lactation; oxytocin and prolactin. Research shows that hypothyroidism increases the risk of delayed milk production and low milk supply. Insulin is also a really important hormone for milk production, and we know that during lactation the breasts become highly sensitive to insulin. For those with insulin resistance, such as diabetics or as often found with PCOS, this can impact milk production. One in 10 women of childbearing age is affected by PCOS, 1 in 8 women has thyroid issues, and rates of insulin resistance, pre-diabetes, and Type 2 diabetes are on the rise. If you have an underlying health condition or suspect you do, it is a good idea to work with an IBCLC who will take your full health history and if needed refer you for additional lab work. This is especially important before taking any supplements or herbals that promote increasing milk supply, as often they may have the opposite effect for those with underlying hormonal issues.
Persistent stress, depression, or anxiety.
Up to 1 in 7 women will experience postpartum depression. Postpartum depression and anxiety can impact your diet, sleep, and ability to care for your baby. All these things in turn can impact your milk supply. Oxytocin is the hormone that is responsible for your milk let-down or the release of milk. It is also a powerful hormone that helps you bond with your baby. Research has shown that “Acute stress also has negative effects on lactation. If the sympathetic nervous system is highly active, it has an inhibiting effect on the hypothalamus and, hence, the pituitary gland. This causes a reduction in the release of oxytocin and prolactin.”
If you are struggling with your mental health postpartum you are not alone and you should not suffer alone. Taking care of yourself is important so you can take care of your baby. Postpartum Support International (PSI) has resources available online, peer support groups, and a directory of mental health professionals specializing in postpartum mental health.
This is not personal medical advice, nor is it a substitute for professional medical advice or treatment. If you are concerned about your milk supply or are experiencing a decrease in milk production then getting one-on-one support from an IBCLC is recommended. We offer individualized care virtually worldwide and in person in the Atlanta area.
