Most mothers make plenty of milk for their babies — nature designed breastfeeding to be a very hearty system. But by virtue of the work I do, I see my fair share of low milk supply cases (I see the babies who are having issues with breastfeeding!).
Many of the mothers I see are very committed to full breastfeeding, as well they should be! They want their baby to receive 100% breastmilk at the breast (no bottles or other devices). This is the goal, of course. The problem comes when a baby is not growing healthfully this way.
Now, it’s normal for all babies to lose a bit of weight in the first few days after birth. But by 3-4 days after birth, a mother’s milk should become more abundant (“come in”), and a newborn should start to gain, rather than lose weight. Most of us agree that it can sometimes take up to two weeks for a baby to get back to his or her birthweight. I like to see it moving in that direction by the end of the first week, but sometimes moms and babies need those first two weeks to work out kinks and get on track.
Lately, I am seeing doctors and other helpers let a baby stay underweight quite a bit even after those two weeks, often hardly gaining any weight for the first month. How is this possible? Well, I think many of these helpers are trying to protect the breastfeeding relationship. Supplementing with formula, for example, can quickly wreck a mother’s milk supply. They believe that all a mother has to do is breastfeed more often to increase her supply and fatten up the baby. This is usually the best way to increase milk supply, but if this strategy isn’t working by two weeks, or three weeks, or four weeks, something needs to be done!
Besides the obvious fact of “This baby is starving, please feed it!” it is super important to understand that a hungry, underfed baby will not breastfeed well. A low-weight baby will often conserve his or her energy and be sleepy or lethargic at the breast. Breastfeeding is hard work: you want a strong, energetic baby at your breast! Underfed babies are also often irritable, with tight, clenched bodies and mouths (also not good for breastfeeding). As IBCLC veteran, Linda Smith says, the first rule of solving breastfeeding problems is “Feed the Baby!”
If you need to supplement, there are many ways to make it work. The first, best choice is to pump your own milk and feed it to your baby. This not only ensures that your baby gets the healthiest food possible, but also helps increase your milk supply. If you aren’t able to pump enough milk, the next best choice is breastmilk from a donor (see resource list below). But if you have exhausted all your resources, you can give your baby a conservative amount of formula for a limited amount of time. Think of it as medicine to help your baby breastfeed. And there are several breastfeeding-friendly methods of feeding the baby the supplement, with or without bottles. See an IBCLC for help figuring out the best method for you and your baby. And if you aren’t able to pump enough of your own milk for your baby, an IBCLC can help you maximize your output.
Speaking of IBCLC’s, if your baby isn’t beginning to gain back his or her weight in the first week or two of life, please see an IBCLC right away! Breastfed babies are meant to gain oodles of weight in the first few weeks. If your baby isn’t, something is amiss. Besides latching issues and infrequent breastfeeding, common causes include tongue tie and certain hormonal imbalances in moms. Check out this website for more causes, and possible solutions. It is important to be assessed and advised by an IBCLC because milk supply issues are often nuanced and complex.
But the good thing is that most of these problems are solvable, and the earlier they are addressed the better. Go with your instincts: if your breastfeeding helper doesn’t seem to be addressing your issues knowledgeably or kindly, find someone else. And if you need to supplement your low-weight baby, don’t despair. Within a few days of supplementing, you will usually find (depending on the cause of the low supply) that your baby perks up and nurses more efficiently, thereby increasing your supply and making breastfeeding a more manageable and enjoyable experience. Under good guidance, supplementation usually doesn’t last forever, but when used properly, it can really save the day!
Low milk supply causes and treatments
Milk Sharing/Donor Milk Resources
Supplementing and Weaning from Supplements