When Your Milk Is Not Enough
The majority of mothers make enough milk for their babies, especially when they get the “best start” through skin-to-skin in the first hour with cue-based frequent feeds. But some mothers who have had complicated pregnancies, complicated deliveries or early deliveries can have problems supplying their babies with enough milk.
How do I know if my baby is getting enough milk?
- Babies in the first 24 hours only need small amounts of colostrum as they learn to feed. Their stomach is the size of a cherry the first few days of life.
- One of the most important things you can do is to make sure you learn how to attach your baby correctly and use hand expression before and/or after feeds. Hand expression early on increases colostrum and later milk production.
- It is normal for babies to lose weight, with an average of five to seven percent of their birth weight.
- Babies will usually be back to their birth weight by two weeks of age.
- While the colostrum is switching to transition milk, it is normal behavior for the babies to want to feed frequently, especially at night. This is termed cluster feeding.
- In the hospital, the team will keep up with daily weights, pees, poops and jaundice numbers. This will help guide if your baby is getting enough.
- A lactation consultant in the hospital should watch you feed your baby and can tell you if there is evidence of milk transfer.
Risk factors for moms who may not make enough milk
- Little or no breast size enlargement during pregnancy (cup size) with possible glandular insufficiency.
- Problems such as polycystic ovary disease, untreated thyroid disease, infertility, diabetes, breast surgery (especially reduction), low supply with previous breastfeeding and premature birth.
Reasons why your baby may need a supplement
- Baby has a low sugar that is not responding to breastfeedings (glucose is monitored in high-risk babies).
- Baby has evidence of dehydration.
- Baby experiences weight loss greater than eight to ten percent.
- Baby is still having dark, sticky stools at day five.
- Baby has high bilirubin when there is little transfer of milk at the breast.
- Your milk does not come in by the fifth day.
- You had poor breast growth during pregnancy and suspect or find evidence of glandular insufficiency.
Anytime a supplement is given, it is very important for you to pump or hand express to preserve the milk supply. Supplementing without breast stimulation will result in decreased supply. Hand expression seems to work better than pumping when colostrum is being produced.
How much should my baby be supplemented?
Before a supplement, a lactation consultant and physician should meet with you and your baby and be in agreement for the supplement. Position, latch and transfer should be evaluated.
The estimated amount of supplement at each feed is as follows:
- First 24 hours: 2-10 mL/feed
- 24 to 48 hours: 5-15 mL/feed
- 48 to 72 hours: 15-30 mL/feed
- 72 to 96 hours: 30-60 mL/feed or 1-2 oz/feed
Once your milk is in and transfer improves, these supplements can be decreased with close follow up for weights.
Ways to supplement / When to stop
There are multiple ways to supplement breastfeeding:
- Supplemental nursing device at breast.
- Finger-feeding.
- Syringe feeding.
- Paced bottle feeding.
- View a video demonstration of paced bottle feeding here.
- The way that works best will depend on the circumstances, including how long the supplement is anticipated, baby condition, etc.
- This decision should be made with the lactation consultant, doctor and parental opinion.
- Feeding time for supplement should be no longer than 20 to 30 minutes.
- Supplementation should be a bridge until milk supply improves, latch improves or baby is older (in case of babies born preterm).
- You and your baby will need frequent weight visits to help make the decision of when to decrease/stop supplementation.
Click here for a video about an evidence-based way to increase your milk supply.