What is undersupply?
Technically it's where the mother isn't producing enough milk for the nutritional needs of the baby.
Why does it happen?
Lots of reasons including
- difficult delivery - postpartum haemorrhage, long labour, dehydration or ketosis in labour, caesarian section
- breast reduction or implants or undeveloped breasts
- white spot on the nipple and blocked ducts
- multiple births
- interrupted feeding in the early days - baby may be on NICU or not tried at the breast enough in the first few days postnatal
- some blood pressure medications
- trying to stick to a strict feeding and sleeping regime rather than demand feeding in the early days
- Breast feeding too frequently - snack feeding and poor sleep
- sucking/mechanical issues such as tongue tie or high palate
- polycystic ovarian syndrome
- cold and flu preparations especially those containing pseudo ephedrine
- calorie restricted diets
Signs and symptoms of undersupply
- baby not gaining weight as per centile charts, this can be a minimal or slower than usual weight gain. A classic definition of 'failure to thrive' is a baby crossing over 2 major centiles i.e. the 50th and 25th on the older NSW Health blue books or the 50th and the 15th centiles in the new NSW Health Blue Books.
- baby constantly hungry
- lots of dry or drier than usual nappies. Ideally there should be 5-6 very wet nappies in 24 hours. Urates can be a sign of undersupply (this is the brick red colour in the nappy that little boys do in the first week of life)
- a very unsettled baby even when being fed 3-4 hly
- poor night and day sleeping, often described as a cat napper and unable to sleep for long stretches at night time. Sometimes these babies will wake as many as 6-8 times at night for feeds and may only sleep for 40 mins to 1.5 hours and then need another feed and be unable to be resettled without this.
- baby may have a dry mouth
- a baby constantly pulling on and off the breast can indicate a supply issue (over and under)
- check positioning and attachment (see previous blog on breast feeding at https://nurtureparenting.com.au/breast-feeding-and-the-basics/
- can you hear/see baby swallowing correctly
- breast feed 2-4 hourly in the day, aim for 6-8 breast feeds in 24 hours
- are you eating and drinking enough? You need to feed yourself to feed your baby.
- try expressing half an hour after feeds to increase supply. It's good to try and do 10 minutes each side and try and do 5 minute blocks e.g. 5 min on left, 5 mins on right, 5 mins on left and finally 5 mins on right. Use an electric breast pump to maximise results. Medela do a good breast pump - Medela Swing
- express 4-6 times a day, including at least one night feed especially in the early hours. Prolactin increases at night (peaks at 2am) which increases supply for the next day
- skin to skin for as long as possible each day
- Herbal breast feeding tea such as Weleda (drink 3 cups a day) and herbs like fenugreek can help,
- see a good naturopath, the breast feeding association may be able to help you
- Lactation cookies - coming soon...
- Medication (a galactagogue) that you get on prescription from your GP called Motilium/Domperidone. It is a drug used to treat certain gastrointestinal disorders, which has the side effect of increased prolactin, and in turn, an increased milk supply. It is the only galactogogue available that has been scientifically evaluated through a randomized, double blind, placebo controlled study. This is taken for 3 weeks and also long term. Initially you take 3 tablets a day, then week 2 take 2 tablets a day, then 1 tablet in week 3. You may need to increase back to week 1 dosage if you notice a drop in supply. It is thought to be safe for the baby and the main side effect for the mother is a dry mouth. There has been recent alerts on Domperidone : http://goo.gl/j6AYy3 and its link to cardiac problems. The ABA has updated its policy regarding this (16/04/2014) http://goo.gl/3uZaKZ
- A supply line may help - see a lactation consultant for this.
- it is important to get on top of supply issues early to maximise success. The first 3-4 weeks of breast feeding are controlled by hormones after that it is based on supply and demand.