Generally it will take 4-6 weeks until the milk supply is established, meaning that supply and demand are just right for the baby. Ocassionally women have such an abundant milk supply that baby struggles to control the flow and starts gagging, spluttering, coughing or clamping down in an attempt to slow the flow. Practising the best possible latch and various positions that let the baby sit more upright will be most helpful. In some cases it can look like an over supply but the underlying reason for engorgement and coughing or gagging can be a Tongue Tie when baby's tongue is unable to move the milk efficiently to the back of the throat. Inefficient peristaltic and an incomplete vacuum around the areola can lead to inability to cope with a fast flow.
It requires a professional assessment to establish if there is in fact a low milk supply or if mums have the perseption they should have more milk. The fact that breasts don't leak, soft breasts, frequent feeds, the amount of expressed breastmilk or a lack of feeling a let down does not mean that there is an issue with the milk supply.
Here are a few signs of a low milk supply:
- The baby is being fed on demand (unrestricted and is offered both breasts) and is not gaining weight on breastmilk alone
- a lack of wet and dirty nappies
Following things can cause or contribute to a low milk supply:
- Supplementing. Breastmilk is made by supply & demand. The more baby feeds, the more milk is being produced. Every time the baby is being given a bottle and the breasts are not emptied the body sends a signal to the brain to produce less.
The same is true for scheduled feeding. The milk supply can decrease if the baby is not allowed to cluster feed to bring the supply up during growth spurts. It is of utmost importance to feed a baby responsively whenever the baby demands.
- Limiting the feed to one breast. This is only a good option for mothers with abundand or over supply. Otherwise this can lead to low milk supply. The same applies to limiting the length of a feed. Timing the feed and taking the baby off the breast prematurely can cause the baby to miss out on the milk with higher fat content that is available to the baby towards the end of the feed.
- Nipple confusion. The use of bottles can confuse the breastfed baby. Babies quickly get used to a teat and the different sucking mechanics required while bottle feeding and can lead to less efficient sucking on the breast.
- Use of dummies. The use of dummies can reduce the time the baby spends on the breast. By giving a dummy it is very possible to miss those first feeding cues and this might lead to longer feeding intervals. This is why we don't recommend the dummy use for the first 4 weeks or until breastfeeding is fully established.
- Nipple shields. In some cases nipple shields have to be used to successfully breastfeed but should only be used if entirely necessary and weaned off as soon as possible. The latch is never as deep as without a shield and this can lead to decreased milk transfer.
- Sleepy baby. It is normal for newborns to be sleepy, especially when they are jaundiced. It is important to wake baby up for feeds if they don't do so naturally, every 2 hours in the day and every 4 hours at night in order to establish a good milk supply.
- Health or anatomical problems with baby (including jaunice, tongue tie, etc.) can prevent baby from removing milk adequately from the breast
- Mother's health (uncontrolled anemia or hypothyroidism, retained placenta, postpartum hemorrhage…), previous breast surgery/injury, hormonal problems (e.g. PCOS), obesity, medications (contraceptive pill or other medications know to decrease supply), drinking of herbal Teas such as peppermint or sage, or smoking also have the potential to affect milk supply.