Not enough milk?

You can tell if your baby's getting enough milk even though you can't tell how much is going in.

One of the most common reasons a mother weans her baby before she might want to is that she is worried that she doesn't have enough milk. Nearly all mothers are capable of producing enough breastmilk for their babies. Just as you have already nurtured your baby in your womb for nine months, so your body is designed to continue providing nourishment once your baby is born. Everything your baby needs to grow strong and healthy is in your milk. It is the normal food for your baby and you and your baby will work together to establish your milk supply and maintain it as your baby grows. Of course, there might be other reasons why baby is fussy or crying and you might want to check with your medical adviser if you have any concerns. Here are some ideas to help you work out if your supply really is low and some suggestions that will help you make more milk for your baby.

If your fully-breastfed baby shows two or more of the signs below then you most likely have enough milk.

• At least five heavily-wet disposable nappies (or six to eight very wet cloth nappies) in 24 hours provided no other fluids or solids are being given. A very young baby will usually have two or more soft bowel movements a day for several weeks. An older baby may have fewer than this. Small quantities of strong, dark urine or formed bowel motions indicate that the baby is in need of more breastmilk.
• Good skin colour and muscle tone.
• Your baby is alert and reasonably contented and does not constantly want to feed. Your baby will probably wake for night feeds. A few babies sleep through the night at an early age, while most will wake one or more times during the night for quite some time.
• Some weight gain and growth in length and head circumference.

Some other points to consider:

• Genetic patterns need to be taken into account when assessing a baby's growth. Slower weight gain may be more likely in a family where the parents are of small stature, but the baby will still show consistent growth over the first year.
• A baby's stomach is only as big as his fist and can only contain small amounts at a time. This means babies need to feed quite frequently to get all the milk they require.
• Some apparently contented babies are very undemanding and need to be woken for feeds so that they will continue to gain weight. Most breastfed babies feed at least eight to twelve times in 24 hours. If weight gain is a concern, your baby may need to be woken, particularly for a night feed, to ensure he is having a minimum of six feeds in 24 hours.
• On the other hand, some colicky babies seem far from content, and may feed frequently, yet continue to gain weight steadily. Commonly, these babies appear hungry frequently, but may actually be getting too much milk, too fast and have tummy ache. You can tell if this is the case if your baby has lots of wet and dirty nappies every day. See the Too Much Milk article on the website or refer to the Australian breastfeeding Association booklet Too Much.
• Between six weeks and six months, it is normal for babies to have fussy periods from time to time, when they ask to feed more frequently than usual. You may wonder if your milk supply is still meeting your baby's needs. These times used to be called 'growth spurts' or 'appetite increases', however studies have shown that exclusively-breastfed babies' intake of breastmilk does not increase significantly between one and six months of age. Although it is not known exactly why babies have periods like this, it is a very common event that may be linked to their development. It does not mean that you don't have enough milk. If you follow your baby's lead and breastfeed more frequently for a few days, you will probably find that your baby soon settles down again. Hot weather may also trigger an increase in a baby's feeding frequency.
• Most babies will feed best if they are put to the breast before they are crying hard. Crying is a very late hunger signal. Watch your baby; he may start to stir from sleep, maybe try to suck his fist or otherwise 'search' for food quite a while before crying. A lot of mums find that by offering the breast as soon as baby starts to stir can help baby to take a good feed. Some parents also will use kangaroo care (skin-to-skin cuddling by holding baby with bare chest against mother's bare chest) to help the baby relax into breastfeeding and this also boosts the mother's hormone levels to assist her milk supply. A blanket, shawl or shirt can be used to cover both of you to keep warm and baby can even be carried in some slings like this (see ABA's Simplicity Sling on the Mothers Direct website. See also the article on our website, called Baby-led attachment.

You and your baby work together to start the milk-making process and to maintain it at the right level to ensure it meets your baby's needs. If you are concerned that this may not be happening, you might like to check the following possible causes of low milk supply:

• not enough feeds, or feeds too short or interrupted
• poor positioning at the breast, or poor sucking (often causing sore nipples)
• changing sides too soon
• tension, pain or fatigue inhibiting your let-down reflex
• using complementary feeds (comps) or top-ups of artificial baby milk; and/or stretching out time intervals between feeds with a dummy
• introducing solids too early (before six months)
• hormonal change in the mother eg ovulation, menstruation, pregnancy or contraceptives
• some medications or drugs - whether prescribed, over-the-counter, recreational or herbal
• cigarette smoking
• illness in mother or baby
• very rarely, a physiological inability (that a mother is born with or, for example, as a result of previous breast surgery or injury)

The secret to boosting your milk supply is to fit in more feeds than is usual for your baby. More frequent and efficient milk removal by a well attached baby means more milk will be made. More frequent feeding means more milk.

Human babies are designed to need frequent feeds and by offering the breast at least every two or so hours during the day (and usually at least one night feed), your milk supply can increase quickly. Feeds don't have to be at regular intervals, you might find that you can fit in an extra breastfeed at any time if baby is awake and happy to accept it, or offer a 'top-up' fairly soon after a feed. There are many more ideas in the booklet Increasing Your Supply or talk to an Australian Breastfeeding Association counsellor to discuss your situation.

Very occasionally, a mother tries the ideas above and still finds that her milk supply is low. If you think this is the case with you, speak to a health professional who has a special interest in breastfeeding, as you may be able to try some medication to maximise your milk supply.

If you have been advised to wean because of a persistent low milk supply, think about whether breastfeeding may be important for you and your baby for reasons that have nothing to do with providing all her food. It is possible to combine breast and artificial baby milk successfully for quite a long time. Don't be embarrassed because you don't wish to wean. As long as your baby is happy to suck, you are always providing some nutrition, health protection, as well as much comfort and reassurance for your child. If you want to continue, be reassured that you can still meet your baby's nutritional and emotional needs by breastfeeding.

All of these possibilities and the practical means to overcome them are discussed in the ABA booklet Increasing Your Supply. This booklet also discusses how to use complementary feeds if they are medically necessary, debunks many myths, explains good positioning, and how the breast makes milk. By learning these things, you will have the basis to make sense of any advice you receive, and to make the decisions that best suit you and your baby. After all, you are the expert on your baby!

http://www.breastfeeding.asn.au/bfinfo/lowsupply.html