Mothers and Babies at Risk for Low Milk

on March 03, 2014 in Breastfeeding, Mothers and Babies at Risk for Low Milk

 

Probably the number one reason that mothers abandon breastfeeding is not having enough milk.  There are many reasons that this can occur.  Most often, specific babies are at risk for poor feeding and certain mothers are at risk for developing low milk supply.  In the best hospitals and birth centers, these mothers and babies are often identified prior to discharge to prevent excessive weight loss or poor weight gain in the newborn.  But all too often, they are not.

Some times, long labors and being given many bags of IV fluids delay the onset of the mother’s milk production.  This is most common following being induced, or being given pitocin to strengthen contractions, or being given extra fluids before having epidural anesthesia, and for the many mothers who then go on to have a cesarean birth after laboring for hours. When milk production is delayed, the newborn may nurse sluggishly and fail to stimulate good milk production.  Once it is realized that milk production is delayed, the newborn often have lost an excessive amount of weight.

When milk production is delayed beyond 72-94 hours (the 3rd or 4th day following delivery), a mother should begin manual expression and/or pumping using a “clinical grade” rental pump after each and every nursing. This milk can be used to supplement the baby along with any necessary formula, if the baby has lost 10% or more of his birth weight.  This will help prevent dehydration, jaundice and continued poor feedings at the breast.

There are other more predictable situations that may also cause low milk production and find the baby to be losing too much weight.   Babies that are born 3 or more weeks early, often feed poorly, and fail to stimulate adequate milk production.  While mothers of these babies may be reassured, that a 35-37 weeks is just like a term baby, these newborns often fail to nurse vigorously and stimulate abundant milk flow.  Mothers of these babies will do best by pumping after each and every nursing.  This is often referred to as “insurance pumping”.

Babies who struggle to latch or are unable to latch, due to some oral abnormality, such as being tongue-tied, a recessed lower jaw, or who have a very high palate, or have a cleft palate may also fail to stimulate a good milk supply.  These mothers should also perform “insurance pumping” until the baby is nursing well, although newborns born with cleft palates may never be able to effectively drain the breast well.

Babies that are born to mothers with large nipples, as large or larger than a quarter may not be able to latch well behind the nipple, and get enough milk.  Babies whose mothers with inverted or double nipples may have difficulty achieving an effective latch.  Mothers who have had previous breast surgery involving an incision around the areola including breast augmentations and breast reductions, may also require “insurance pumping” to bring in a full milk supply due to the severing of important nerves that signal milk production and milk release.

A condition known as “breast hypoplasia” is the lack of necessary glandular tissue and the mother fails to bring in a full milk supply on the 3rd or 4th day post partum.  Mother with breast hypoplasia, have little to no growth during pregnancy, have a wide flat space between their breasts, and breasts that are “tubular” in shape.  Often this condition is not recognized by doctors and hospital personnel and the baby losses and excessive amount of weight and then fails to gain very much weight.  You can read the study that my colleagues and I wrote and published about this condition several years ago.  It is full of a great deal of information about this difficult condition.  Go to http://www.sonic.net/~mollyf/igt/ to read the complete article and the outcomes of mothers who used pumping and herbs and sometimes medications to achieve higher milk production.

Some mothers who have been diagnosed with PCOS, polycystic ovary syndrome, may or may not have low milk supply.  Mothers with low milk supply and PCOS may do well by taking Metformin, a medication for this condition.  Another herb, More Milk Special Blend can also help.

All of the mothers mentioned above need to use a “clinical grade” rental pump to use at home until the baby is nursing well and the supply becomes well established.  Personal grade pumps may fail to stimulate milk production as well as a “clinical grade” pump. Some hospitals offer these pumps at the time of discharge. If not, you can ask at the hospital where you can find a good pump for rent in your area before leaving the hospital.

It is important in these cases to nurse, pump and supplement within a reasonable time frame.  I suggest getting this done within a 45-minute period.  When the process goes much longer than this, and the entire process can take too long and the number of breast emptyings becomes too few every 24 hours.  If the baby simply hangs on to the breast for a very long time and you still need to pump and supplement, one feeding runs into the next.  I refer to this as the “gerbil wheel” !  And being on a gerbil wheel is tiring and frustrating.  This is not only overwhelming but it is ineffective.  Nurse the baby for only about 20-30 minutes or the time the baby is no longer drinking well.  Pump or express by hand for about 10-15 minutes, as long as the milk is flowing well.  If the method of supplementing is too long, longer than 5-10 minutes, it may be time to consider a bottle or a faster flowing nipple.  Aim for eight breast emptyings each 24 hours to stimulate more milk production.

There are some herbs that help increase low milk production.  Herbal teas are a weak form of an herb and taking the herb in a capsule form or an elixier is best.  Many mothers use fenugreek seeds in capsule form to help stimulate milk production.  But my favorite is More Milk Plus by Mother Lover Herbals.  This preparation contains both fenugreek as well as three other milk stimulating herbs.  You can go to Mother Love’s website and find a local distributor or order it directly from Mother Love.  For mothers who have had previous breast surgery, PCOS, or have breast hypoplasia, Mother Love has another product, More Milk Special Blend that also contains goat’s rue.  Another herb used successfully by some mothers is GoLacta, an herb from Asia.  This herb is made from malunggay leaves grown in volcanic soils.

Domperidone (Motilium) is a medication that has been successfully used for mothers with low milk production.  Available every where in the world, this medication is only available through compounding pharmacies with a prescription.  The usual dose is 30 mgms three times a day and up to 120 mgms per day.  Domperidone is also available without a prescription from inhousepharmacy.vu but the shipping of the medication takes 10-14 days. While another medication, Reglan (Metaclopromide) is available by prescription in the US, it has significant side effects for some women and when used longer than 2 weeks can lead to depression which may not be reversible by simply stopping the drug.

Try and work with an experienced lactation consultant for more help.  She may be able to identify underlying causes for the baby’s low milk intake or your supply issues.  Through the Affordable Care Act, lactation services must be covered through insurance without a co-pay.  If you are a WIC participant, you may be able to see a lactation consultant there for help.

Once the milk is in and the baby begins gaining weight, at least an ounce a day, the supplementing can be slowly decreased.  Keeping a close eye on the baby’s weights will be reassuring during this transition time to full time feedings at the breast without supplementation.