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Episode 78: Low Milk Supply: True or False?

August 10, 2022

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Welcome back to the Breastfeeding Talk Podcast. I’m your host, Jacqueline Kincer. And today I’m do talking about a really important topic. And that is perceived low milk supply or perceived insufficient milk. This is an incredibly common problem. And it’s actually one of the most frustrating things that we deal with as lactation consultants, because there are so many moms out there that claim to have a low milk supply, but they actually do not, they’ve just never learned what normal breastfeeding looks like or what normal milk supply looks like. And it’s an uphill battle, to be honest with you. It’s really a battle between lactation consultants and pediatricians. It’s a battle between lactation consultants and social media. It’s a battle between lactation consultants and breast pump companies. It’s a battle between lactation consultants and Pinterest, which is social media to but you know, it just in moms themselves, you know, moms have this sort of idea, it seems of how much milk they should be able to pump or what their baby’s behavior should be like. And I would say at the root of all of this is just a complete misunderstanding of what normal infant behavior looks like. And so that’s where we really need to start the education because there’s been this overwhelming push, you know, it’s not new either. I mean, think of you know, Dr. Spock, in the 60s, I believe is when that was going on. There’s been people way before that male doctors who have decided that they are experts on children and infants and infant feeding, when, of course, they don’t understand lactation, or mothering or any of that.

 

And there’s been this push that, you know, babies and children should be sort of, you know, seen but not heard, right. It’s, it’s an old belief, and it comes out in new ways. And so it’s even an old book at this point. But baby wise, you know, there’s a reason why the American Academy of Pediatrics has issued a statement against baby wise, because it’s harmful to infants, it goes completely contrary to everything we know about infant development and behavior, whether that’s feeding or sleep, and feeding and sleep are closely linked. But we’ve gotten to this culture of sleep consultants or sleep coaches or sleep trainers or you know, whatever sort of name they’re giving themselves, which by the way, is an absolutely unregulated industry. Most of these people are practicing healthcare without being licensed to do so. It’s actually really quite concerning. You cannot be a behaviorist, and and not have some sort of thorough training. Like think of it in this way. If you have a child that is diagnosed with ADHD, and they were to work with a behaviorist, whether that’s a therapist, sort of some sort of behavioral interventionist, a speech language pathologist, an occupational therapist, I’m naming people who are healthcare providers, you’re not?

 

Well, you should not really be going with somebody who claims to know how to coach or handle these situations, but they don’t have proper medical healthcare, scientific training to do so. And so what we see is that there’s always sleep people who have sort of self certified themselves, or perhaps they’ve taken some sort of educational course, that they got duped into paying 1000s of dollars for, and you know, that person was never qualified to, you know, train others to practice something. They’re not properly trained themselves. They don’t have some sort of healthcare backing, they don’t have the proper prerequisites. There’s no sort of, you know, practicum that’s happening where you actually work with people and there’s oversight. There’s no board that’s deciding on the standards or the exam or things like that. So I really want people to be cautious of industries like that. I’m starting to see breastfeeding coaches becoming a thing that’s very scary to me because we’re talking about infant feeding. That’s not something that we should be taking lightly. It’s not something that is is at all appropriate for someone to coach you through. We do not need Do you know feeding coaches?

 

We do not need sleep coaches, you might need a parenting coach pay parenting is not health care, parenting does not necessarily directly affect the medical status of your child. Right. So I don’t know, I think I just I get defensive a lot about this as a lactation consultant as somebody who is board certified, who has over 1000 clinical hours of training. And I look at these industries, and I see parents falling for it. And it’s interesting to me that parents would proactively choose someone with lesser credentials less or certification that charges more money than they would somebody who’s an actual health care provider with more training that charges less. And what I’m talking about is, if it’s $200, to work with an ibclc. But why is the sleep coach person charging 400 500 600, sometimes more. So there’s this weird discrepancy that’s going on where I’m just seeing the shift, you know, that parents think, okay, if I hire the sleep coach, that’s gonna fix everything, because there isn’t a feeding problem. The only reason why sleep ever gets disrupted, is because there’s something a deeper issue going on sleep as a symptom.

 

Sleep is very rarely a cause. And except for cases of central sleep apnea or other neurological disorders. But if that was the case, if the issue was truly sleep, and sleep was not a symptom of something else, you should be working with your doctor, your baby’s doctor. So I just always find this very fascinating. It’s not, you know, no one here is trying to be a gatekeeper. What we’re trying to do is we’re trying to say, get actual, like real help, that’s going to be effective, and not compromise your child’s health. Because a lot of these sleep, people don’t understand breastfeeding. They don’t understand breast milk. And they don’t understand normal infant development. And there’s no way that they could, because they don’t have a foundational education and training and supervised clinical practice to understand those things and drill down on that. But that whole industry of coaches around feeding and sleeping, all of that is contributing to the problem of perceived low milk supply.

 

Especially things like night nannies, or I don’t wanna say postpartum doulas. Usually, they’re pretty educated and passionate about breastfeeding. So they tend to be on the bigger spectrum things. But you know, this idea of you hire someone to come into your home, because you don’t want to deal with the baby throughout the night. Well, that’s not really conducive to breastfeeding. You know, you can pump and do that, but you’re handing over the care of your child to somebody who, you know, maybe they’re an RN. But being an RN does not mean that you have training in infant feeding, it does not mean that you are qualified to care for an infant independently, all through the night, multiple nights a week. So, you know, I just would like people do their homework is all I think there are some well trained people out there that have gone through the proper steps, but the majority of them have not. And that’s really important to recognize. So anyway, this whole idea of perceived low milk supply. So there’s a difference between someone who has true low milk supply, and someone who has perceived low milk supply. And this can be really difficult for the Layperson to determine. It can be just impossible, almost for a lot of people because your body has changed so rapidly in the course of pregnancy and now lactation, that becoming familiar with your breasts, and all of that, in addition to your baby, and learning this new human and all of their cues, and what x, y and z means.

 

That’s a lot. It’s a lot to take in at once and your brain is going through massive changes. And if you aren’t given the right information, to have a foundation to to take in your observations and compare them to knowledge, you can errantly take in those observations of what’s going on and make inaccurate conclusions like well, milk supply. So here’s a really good example. I’ve seen this a lot lately from even clients that we’ve had. And I’ve definitely seen it on Instagram interactions a lot where people will say, I’ve never had a letdown. That’s a fascinating idea to me. Because they’ll say, Well, I’ve been breastfeeding for six months or nine months, and I’ve never had a letdown. And then my next question is, so you’re dry nursing, because that’s what that means. Like if you’ve never ever had a let down, then you’re not producing more than a few drops of breast milk.

 

So I want to be really clear about this. And if this is you if you’ve thought this before, let’s explain the letdown is the laypersons name or sort of, you know, colloquialism for milk ejection reflex. The milk ejection reflex is something that’s initiated by oxytocin release to the breast tissue. That oxytocin release contracts the alveoli pushes milk from the alveoli, where it’s produced and stored through the milk ducts and out through the nipple pores. The only way that we can extract milk from the breast is either by a lot of suction or, you know, proper compression of the breast, which if there was no milk ejection reflex, or no let down, we would only get mere drops of milk. The only other way is through the milk ejection reflex. And that’s where you’re going to get the larger quantities of milk because it’s a process of milk flow from the breast. So if somebody says, I’ve been breastfeeding for nine months, and I’m like, okay, so you’re, what are you doing? You’re you’re drying or saying you’re using an SMS with formula or donor milk or your exclusively bottle feeding formula, but then putting your baby to the breast to latch for comfort. And they’re like, no non breastfeeding, but I’ve just never had a letdown. And I’m like, I don’t think you understand you cannot nurse you cannot produce milk and not have a letdown that doesn’t, is incompatible. That’s not how it works. People don’t understand I am not quite sure what it is. Sometimes when I hear people say this, what is it that you think is happening when you see the milk coming out of your nipple pores? That’s a letdown. I think that people have this idea might be wrong about this.

 

But it seems to me people have this idea that having a letdown means that you will one feel that sensation of a letdown. That’s simply not true, I would say that, you know, it’s kind of 5050 whether or not you feel you’re let down, you have a sensation in the breast when the milk ejection reflex happens. That has nothing to do with your lactation status. Meaning, that’s not an indicator of how much milk you make, it’s not an indicator of having a letdown. It’s not an indicator of anything other than just everybody is different. Some people feel the milk ejection reflex, other people don’t. And there’s really no rhyme or reason, it really doesn’t matter. So this idea that you think you should have a sensation I think is really pervasive. I think there’s this other idea that you should see milk just shooting out of your nipples. And I think that actually goes back to very famous artwork and statues from even, you know, the 1600s, where that would be a visual depiction in art, painting, statues, sculptures, all of these things, that this milk would just be pouring like a fountain from the breasts.

 

That can happen, it doesn’t always have to happen that way. And it’s again, not really an indicator of your milk supply in any way, shape, or form. So if milk is coming out of the breast in a decent amount quality, you’re having letdowns and you have more than one letdown per feeding. So even people that recognize that they’re having a letdown, they often don’t realize that the first one is the strongest, it’s the most flow because the breast is fullest at that point. But you’re going to have at least two or three others during that nursing session or pumping session, you just might not notice them. And the issue with pumps too, is that if pumps are providing constant suction, you know, you can see the letdown slows. But for some people, it’s really hard to differentiate the milk ejection reflex from beginning to end, because the pump is constantly providing that suction and with enough suction, you can remove milk, you know, it’s kind of hard to discern, for some people, I would say, I don’t know why people are so hung up on the letdown. If you’re making milk and your baby is drinking it and gaining weight, then that’s kind of all that matters.

 

We don’t really care about the behavior or characteristics of the letdown, especially as lactation consultants, because again, that doesn’t indicate anything about lactation from us now. Is it true that people with low milk supply will have a very underwhelming letdown? Yes, absolutely, they will still have a letdown. But it’s not going to be spring milk and things like that. But that doesn’t mean that just because your milk isn’t spring, or that you don’t have a large amount of milk coming out that you necessarily have low milk supply. But that’s generally not the biggest reason why parents think or moms think that they have low milk supply. The biggest reason is infant behavior. So it’s not even infant weight gain. So the biggest reason why moms think they’re not making enough milk is because they don’t understand what satiety cues of breastfed infants are. And what I mean by that is, if you don’t know what it looks like, for a breastfed baby to be full, then you will think that they are still hungry, and you will unnecessarily supplement that baby. And so then what happens is, you think the baby’s not full, or they just fed an hour ago, how could they possibly be hungry again, hence, that’s pretty common with newborns. And so then they’ll go to pump, they’ll panic and they’ll go to pump and they’ll go, Oh, my goodness, I’m hardly getting any milk.

 

Now, sometimes that’s true. Like they only get an ounce or less or something like that. Sometimes they get three ounces and they think that’s not enough. It is it’s especially if you just breastfed then you have an oversupply. So there’s this idea that you know, they should be pumping full bottles of milk every time. I don’t understand where that comes from, other than social media and things like that, but there’s also this idea that there’s you sort of forget, right? Your breasts are refilling with milk. But it takes time, you know, it’s not instant. And so if you nursed half an hour ago, an hour ago, an hour and a half ago, and then you pump, you’re just not going to get the full amount of milk that you would have had, you just waited and nursed again. So I wouldn’t expect you to have a lot of milk in the breast just yet, because you just m quote, unquote, emptied the breast, right. So there’s a perception there that happens. Or, you know, moms, you know, they will often listen to, you know, older family members that will say, well, let’s offer formula and see if the baby calms down. And then inevitably, the baby does. That doesn’t mean that formula was better. That doesn’t mean the baby didn’t get enough. It just means that if you overfill the baby’s tummy, they sort of pass out from sheer exhaustion.

 

Case in point who’s ever eaten too much at Thanksgiving dinner, and you get really tired afterwards, and you just feel like, Oh, I just cannot do anything right now. It’s not because of the tryptophan and Turkey, there are plenty of foods that have tryptophan in them. By the way, that’s not really why it’s not going to be a large enough quantity to truly make you more sleepy, unless you’re very sensitive to that particular hormone. The reason is, is because you’ve eaten so much food. And typically you’re eating a lot of carbs, right, they’re stuffing, and there’s mashed potatoes, you get a lot of these starches going on. And once those go in your tummy, and they start getting digested, they expand. And that feeling of fullness, it just drains the energy from the rest of your body, sometimes even mentally as well. And your body is trying to work a lot harder to quickly digest that food because it’s taking up too much space, you’re too full. So that’s why that same thing happens with babies. So if you’re filling up the baby’s tummy beyond the normal capacity, right, that doesn’t feel so good, it’s uncomfortable, you know, most babies will just kind of go to sleep and just let the digestive process happen.

 

And then they will sleep for a longer period of time, because larger quantities of food are going to be harder to digest. And formula is much harder to digest than breast milk, it takes a lot longer for it to break down, that is taking up more of that baby’s energy, especially if they’re newer a newborn. So they’re going to sleep longer. That does not mean better. So this idea that you know, my baby’s waking up again, or I just nurse them, why do they want to nurse again 10 minutes later, because that’s how a normal breastfed infant behaves. That’s what a newborn is supposed to be doing. If you’re not taught how long a normal healthy baby can go between feedings or typical sleep wake patterns are newborn are really like, you know, just kind of clue you in here. In case you’re unfamiliar, you know, 4045 minute sleep cycles. So especially in the early days, when your baby is a newborn during that first month of life, they’re going to be trying to increase your milk supply, they’re growing at the fastest rate they’ve ever grown in their lives. When they hit that first growth spurt around a week or two weeks old, they’re going to cluster feed, they’re going to want to nurse every 30 minutes now not for the entire 24 hours. But they’re probably going to have a few hours of that cluster feeding. Right now kind of watch your baby to so they nurse and then you know, they drink milk and they do that they take pauses, okay, so they’re going to pause, they’re going to relax, they’re going to breathe.

 

And because that letdown is slow, they need a little bit of a break. Much like when you eat dinner, or lunch or breakfast or anything, right. Hopefully, you’re not just shoveling food into your mouth and five minutes and then you’re done. Ideally, right? You take some bite to chew, you swallow, you take a pause, maybe you’re having a conversation with somebody, maybe you take a sip of water, maybe you just sit for a minute, you know, or you’re cutting your food again, before you go take the next bite. Right, your baby’s doing the same thing. They’re not designed to just chug, chug, chug, chug, chug, and then stop. That’s not how feeding is supposed to work. The problem is, is that we’ve become so ingrained and bottle feeding culture and most people are not doing bottle feeding properly. So we have these visuals of the baby just drinks the entire bottle, and then they’re done. And they’re good for four or five hours. No, that’s not how it’s supposed to work. That’s incorrect as well. So that’s not the standard. And it should not be the standard, the standard is breastfeeding. And we need to compare all other infant feeding and interventions to what a normal breastfed baby looks like. Because that is the biological standard. That’s optimum.

 

And that’s what you need to be comparing everything else against. So, yes, your baby is going to start, you know, rousing around that 4045 minute mark, especially as a newborn, and sometimes they’ll go back to sleep if they’re still tired and they’re their tummies. Okay, and whatever, right? Sometimes I’ll wake up again, breast milk takes about 90 minutes to fully digest and So that’s very quick, right? That’s longer than formula which can take maybe twice as long, it just sort of depends. And so yes, your baby is designed to eat frequently. They are designed to get smaller amounts more frequently, the goal is not to give your baby a five ounce bottle five times a day. That’s not enough feedings for the day. That’s not the goal. We’re not trying to stretch out your baby’s tummy and cram it all in. Feeding is not just for nutrition, K, breastfeeding happens for John development, for airway development, for immune development, for obviously nutritional all of those things for brain development, there’s an interaction with the mother that’s happening during breastfeeding. So you know, all of these things are a factor. But if you’re comparing it to a formula fed baby, to a baby, that for whatever reason, can go longer between feedings which may not be your baby, then you might think, Oh, I’m not making enough milk, my baby’s waking up too often, or what have you. The other reason is that babies will cry. And it doesn’t have to mean that they’re not getting enough food, I would actually say most babies that are not getting enough food. It can, it can be the baby that cries a lot. But it tends to I see more often than not that babies who aren’t getting enough food shut down.

 

They’re the quote unquote, good baby, they’re very quiet. Because they’re trying to conserve energy, they’re not getting enough calories. And so they’re typically not going to suddenly decide to expend more calories. Unless they’re in really crazy crisis like you, they haven’t been fed for 10 hours. I mean, they’re gonna, every baby is different. This is why it’s really important to work closely with a pediatrician and ibclc, who truly understands breastfeeding. Because if they don’t, you can get a misdiagnosis. And so babies cry for a lot of reasons, right? You know, could be wet diaper could be they’re hungry. But it also could be other things. It could be the way that feeding is going. colic is not a condition that a baby can have. It’s not a diagnosis, it is a grouping of symptoms. And there’s a cause to it and underlying cause a lot of the times it’s air swallowing, we see that a lot, especially with babies who have tongue ties, or lip ties, just oral ties in general. It could be you know, that there’s food intolerances. Although I see that a lot less than I would see oral ties, it could just be you know, the latch is shallow, and so the baby is struggling to get enough milk or something like that. It tends to be a breastfeeding issue. And that’s why we see colicky behavior. It could also be things like structural issues like birth trauma, cranial issues with the baby that’s causing a headache, it’s causing, you know, discomfort in their body, there’s a misalignment, they have torticollis. You know, things like that babies who hate tummy time who hate the car seat.

Often these babies really need some bodywork, some infant chiropractic, osteopathy, physical therapy, those are all modalities that we see improve things like colic. So there’s always some underlying reason why that’s happening. It’s not just your babies, a bad baby may cry a lot. So they have colic. That’s not what’s going on. And so these misunderstandings, it’s really a result of incomplete or absent education, or just miss education about normal infant behavior. Or there’s like just this, I wouldn’t say there’s like a lack of availability of breastfeeding support, because breastfeeding support is available, I would say there’s a lack of availability of good breastfeeding support. But with our virtual capabilities these days, practices like mine are out there, we can see anybody in the world as long as you have, you know, an device that can use video and connect to the internet. So realistically, it’s not that there’s really a lack of breastfeeding support. And at a minimum, you can get breastfeeding education. Right. So maybe you don’t have the opportunity to work with an ibclc. Because that’s financially prohibitive, what have you. But you could pick up a book on breastfeeding, you could get a free book from your library.

 

Libraries these days have virtual books. So if you don’t have a physical library near you, you can get a library card, usually virtually these days. And then you can check out that book for free, like there are resources out there. And if you even just read the womanly art of breastfeeding, and that was the only breastfeeding book you’ve ever read. You would have enough baseline education to understand normal infant breastfeeding and behavior. There are things out there whether or not people choose to use them that that’s kind of another issue. Right? So there’s been studies on this and the number one reason why people give up breastfeeding is low milk supply, but lumped in with low milk supply is perceived low milk supply, because these studies are really asking the parents for the reason why they gave up. So there’s not then a deeper investigation of did they truly have low milk supply or not? And the reason why there’s not is because well, we can’t go back and get that data like There’s no way, I just don’t know of anybody who’s actually measuring someone’s milk supply on a continual basis from birth until they cease lactating.

 

So there just is no way to truly, truly measure that unless we go back and look at some medical records. But that’s not going to be consistent across the board. So it’s really difficult to study, unless you enroll someone from the very, very, very beginning. So the best determinants that we have for breastfeeding success are things like social cultural influences. So that could be you know, like a grandmother, you know, or just even social media, right? Things like that. And then also just how breastfeeding got off to a good start. So if you were able to get your baby to the breast in the first hour after birth, if you were able to do that skin, you generally have more confidence about breastfeeding, and you feel like you can overcome certain issues, you generally feel like you are making more milk more than someone who didn’t have that. And so there’s a lot of factors, women who have to go back to work after they’ve given birth, no matter what the timeframe is, generally, there is a perception of low milk supply there. And that leads to a lot of breastfeeding sensation.

 

And that’s kind of a whole other issue. Because is it often harder for moms to pump than it is to nurse? Yes, it is. And then pumping is generally not optimized. So most people are using the completely wrong flange size. I talked about that in last week’s episode a bit. And they’re also not maximizing the settings on their pumps. So they don’t really know which settings are best for them. They may not have great education on what types of breast pumps are going to work best for them. So I see people being really reliant on the hands free pumps these days. And I understand why. But if you’re going to use that pump exclusively, and let’s say you go back to work full time, I would not think that you’re going to be able to maintain a full milk supply long term, because they’re just not as effective. You cannot get that precise fit to the nipple, there isn’t a long enough drop suction. So there’s certain physics with pumps and how they work that really need to be dialed in. And you can get this information from a skilled ibclc. Right, you can do like a pumping consult, we offer those lots of lactation consultants do you want to make sure you work with someone who’s truly well versed in pumping. And so this is often hard to get as well. So it’s kind of like a niche within a niche. So we see that happen a lot. It’s also pediatricians, right.

 

So let’s say you come to the pediatrician, and they’re not educated on breastfeeding. And so they’ll say, Well, how often is the baby feeding? And you’re like, oh, like every two hours, and they’re like, Whoa, really? Whoa, little Johnny must not be getting enough. Maybe we should try some formula and see if they back off. And you’re over here thinking, okay, but the weight gain is fine. And they’re two weeks old, like, isn’t that kind of normal, but now you have someone with an MD behind their name, and scrubs or a white coat and they’re telling you, let’s give your baby formula. Well, why would you want to go against that you have a doctor telling you that your baby needs formula. Most of the time people are gonna go okay, yeah, I will follow that recommendation. Now, I’m not saying that all pediatrician recommendations are bad and that you shouldn’t follow them. That’s not what I’m saying at all. But if they really aren’t educated and breastfeeding and normal infant feeding and normal infant behavior, which sadly, a lot of them are not, then you’re more likely to think, oh gosh, well, my baby wasn’t getting enough. I wasn’t making enough milk.

 

And the other thing is baby is not getting enough. So I’ve seen this, I would say it’s not it happens a lot. I would not say it’s the majority of the cases. But there’s a difference between milk transfer, which is how much milk your baby can drink when nursing at the breast versus milk production. So this happens a lot of the time in the early days of breastfeeding where maybe you’re nursing your baby at the breast and they’re doing pretty well. There might be some red flags, but you’re not quite recognizing them yet. Or you’re not thinking there enough of a problem because your baby’s gaining weight, and then three months hits and all of a sudden, your baby’s crying, they’re frustrated at the breast, you’re not seeing as many, you know, dirty diapers and the pediatrician is going your baby’s not gaining as much weight and you’re like what happened, my milk just suddenly started drying up, well didn’t suddenly start drying up. What happened was that your body switched from hormonal or endocrine control of milk production to autocrine, which is local control. So how much milk is being removed from the breast. And we see this a lot with oral ties, or babies that were never taught how to latch deeply from the get go. And so they don’t have a good latch. And so their ability to transfer milk from the breast is not good.

 

Their oral function is subpar. And so if you start out with kind of an over abundant milk production, which is normal in those first first few months postpartum and now your, your baby, your baby in the beginning, they can just sort of you know, be waterboarded and drink a bunch of milk and gain weight very quickly. But Now your body has turned off that faucet. And your body is saying, Okay, it’s time for the baby to tell us how much milk to make. Right, which it’s always part of the formula in terms of how much milk you’re going to make. But it becomes really the complete picture at that point. And so if your baby’s oral function isn’t good, they can’t generate adequate section, they don’t nurse for a long enough period of time or whatever’s going on. Now your body doesn’t get the same signals, and it goes, Oh, well, the baby doesn’t need that much milk, what’s not make that much anymore. And so we see that happen. And that is a true drop in milk supply. But it’s not an indicator that you have low milk supply, meaning, it was really an indicator that there was a problem with milk transfer, it wasn’t necessarily a problem with milk supply until it became a problem with milk supply, if that makes sense. So it didn’t start off being the root cause is that you weren’t making enough, that came later because milk transfer was an issue.

 

And most commonly, we do see this because of oral ties and other oral issues. And so it crops up later, but a lot of people just end up giving up breastfeeding at that point. And a lot of pediatricians sort of just, you know, start encouraging, adding that formula on and they started to encourage early introduction of solids, which is not recommended, but some still do it for months, and things like that. So if you’re starting to replace breast milk feedings with other foods or other milks, yes, your milk supply is going to decrease unless you’re working hard to maintain that through pumping. So there’s a lot of factors that go into this. And I think it’s really quite unfortunate, because really, what we’re talking about here is that there’s a baseline distrust of a woman in her own body. And you know, moms will even even think you know, whether or not they leak milk has some indicator of milk supply, much like the letdown, it doesn’t, that just has to do with your nipple poor porosity, like it does not have anything to do with your milk supply. Or if you feel in gorged or not or a sensation of your milk coming in. Some people feel this, some people don’t. In general, I’m really inclined to say that endorsement is not normal, it’s not something that you should expect, because your baby should be removing milk from the breasts, your breasts should suddenly become bigger and heavier, but they may not feel super full. And they shouldn’t, they shouldn’t be so full that your skin is taut, and shiny and hard and that your breasts like the milk is not flowing. That’s a sign that your baby is not transferring milk well. Right.

 

So um, you know whether or not you’ve had an gorge moment that has no bearing on your milk supply, whether or not you leave whether or not you have a letdown. But these things often contribute to that moms are looking for physical signs, right when your baby is nursing at the breast, and you cannot see how much milk is inside the breast and you cannot see how much milk is going from the breast to your baby’s mouth, you cannot see how much milk is filling your baby’s tummy. It can create anxiety, right? It can create this idea of you know, just doubt it can see doubt. And you can you can think Well, gosh, I don’t know, if my baby’s getting enough. I don’t know if I’m making enough milk. And that can then lead you down this rabbit hole of making a conclusion that you’re not right. So fustiness, all of these things, they all contribute. And that’s not to say that low milk supply isn’t real. It’s absolutely real. I’m not here to say that if you’re experiencing some of these things, I’m talking about that you’re wrong, you are making enough milk.

 

That’s not what I’m here to say. The only person who can realistically determine that for you is a very skilled ibclc or some doctors. So I don’t you know, I wouldn’t say across the board, everybody can, you know, there are factors. But true low milk supply is more rare than perceived low milk supply. And that’s problematic, right? Because what ends up happening is that you kind of have to two things. And both of these are problematic. One is that a mom will just stop breastfeeding, right? So then they’ll make the switch to formula. And that’s that, well, that’s not the ideal outcome. The other is that the mom will spend a lot of money on things that really she shouldn’t be spending money on, but she doesn’t know, right? So she’ll go buy a new breast pump, or she’ll try different flanges that maybe still aren’t the right size, or she’ll buy, you know, a lactation massager or cookies or shakes and all this stuff. And it’s it’s not that those things aren’t necessarily helpful they might be, but I see this over purchasing happen. And so by the time you’ve spent another $200 on a pump, and $30 on a package of cookies, you’re $20 or whatever it is and or $60 on a lactation shake or whatever and then it still hasn’t really given you the result that you’ve hoped for. Because either you don’t have low milk supply or those things weren’t ever going to work or they weren’t be they weren’t being used properly to increase your supply. Well, by the time you’ve shelled out three 400 500 bucks. And now you’re looking at a lactation consultant that’s $200, you’re like, Oh, well, I can’t afford that.

 

Well, I’m here to tell you that had you gotten the direct help, maybe all of the tools and supplies you had on hand, were all that you ever needed. Maybe you didn’t need to spend money on anything else, maybe you do. But at least get the recommendation for the correct thing to put your money into. Right? If you have money to spare, then fine, go for it, you know, but I would say that using the wrong product, will often lead to a further decrease in milk supply. And the reason for that is that your body is pretty responsive. So if you’re really not doing an effective job at removing milk from the breasts, like in terms of efficiency, during that time of milk removal, and then doing it often enough, if you’re not maintaining that, your body very quickly just decides, Okay, there’s not a demand. So I don’t need to make this much and I will down regulate that. As milk supply gets down regulated, it becomes harder and harder, especially the longer time goes on to recover that level of milk production that you previously had. It doesn’t mean you’re screwed, it doesn’t mean it’s too late. But what it does mean is that if you’re waiting for a purchased solution to take effect for you, and nothing’s overnight, right, why don’t I say nothing, some things are overnight, I’ve absolutely seen where I’ve gotten someone fitted with the right flanges, and they went from pumping drops to two ounces instantly, absolutely see that I see people take my supplements, and you know, they’re like later that night, you know, they’re like leaking milk they’re making so much again, milk leaking is not a sign of milk production.

 

But just as an example, I’ve heard from lots of people, you know, or going from a very ineffective cheap breast pump, to a hospital rental pump and immediately seeing that increase in milk output. So there’s so many factors. And I would say that if you don’t know where to start, start with an ibclc. Right, start with one who is actually really skilled. And I don’t want to say that new ibclcs are not skilled. Absolutely, depending on where they got their clinical hours, they might come right out of the gate with incredible skills, more so than other people definitely look for one outside of the hospital if you’re not in the hospital anymore, because you want to work with someone who has training with people who are later on in lactation with babies that are not just a few days old, right, you want to work with someone who has that relevant skill set to help you, my first option would not be to go to a sleep coach, it would not be to necessarily even go for bodywork, I would start with ibclc, who can weed out what’s going on. But also even doing something like a weighted feet, you know, pretty much every ibclc that you see in person is going to have a proper breastfeeding scale. So you nurse the baby out the breast, and then you you know, you weigh them, sorry, you weigh them, you nurse them at the breast and then you weigh them again. And you see how much milk did they take in from the breast? That can be it’s one data point, it’s not the end all be all. Okay, this changes from feeding to feeding. But it can be a really good indicator, if that weight only changes by point two ounces, well, we know we’ve got a problem. If the baby gets two ounces, we’re like, okay, the baby can get milk from the breast. Let’s see what it looks like other times of the day, let’s see what it looks like over the next few days. Let’s keep an eye on weight gain and milk and taken all of that. If the baby gets five ounces, then we’re like, I don’t know what you’re worried about.

 

Right? So there’s that, you know, and I’m talking mostly about nursing in terms of that, let’s talk about pumping and switch gears on that there’s still perceived low milk supply with pumping, which you would kind of think wouldn’t happen, right? Because the proof is in the pudding. Like, if your milk output is measured, then you should know whether or not you have low milk supply. But moms again, I think it’s really because of these socio cultural influences. They don’t really know what normal milk production looks like. So you know, in the early days, very early days, like first few days, you know, it’s going to be you know, a teaspoon a tablespoon at a time, that’s going to continually increase once you’re about 10 days, 14 days postpartum. Now, you know, it really should be more like two to three ounces per feeding. And then you know, we’re kind of maybe increasing from there slightly. Breast milk fed babies. I’ve said this before, I’ll say it again, they do not need more than five ounces at a time. There’s no way a newborn should be taking that amount. I’m talking about maybe a four or five, six month old baby, you know, even older, right? But it’s not like formula, breast milk caloric density changes over time, that nutrient content is dynamic, and it grows with the baby. Yes, even if you’re exclusively pumping formula is the same thing over and over again. If you’ll notice, you know, there are different stages of formula, right but there’s not like formula for newborn formula for a two month old formula for a three month old. That’s not how it works.

 

You’re feeding your baby like the same formula from month one to month. oh nine. Okay, so it’s it’s not going to do that. So that’s why you have to give more and more volume. That’s why a nine month old baby is going to take an eight ounce bottle of formula, they should not be taking an eight ounce bottle of breast milk. I want to be really, really clear about that. Okay, now I don’t want to say it’s an exact cut off, right? If a baby occasionally takes five and a half ounces, okay, so be it, you know, but this has a lot to do with bottle feeding practices. So especially in daycares, daycares are the worst culprits. And I think this is one of the biggest reasons why we see moms have perceived low milk supply once they go back to work. So you’re pumping, you’re like, cool. I’m getting three, four ounces at a time. This is great, awesome, whatever. And the daycare is going oh, yeah, but your baby is drinking four or five ounces at a time. And you’re like, oh, no, I’m not making enough. I can’t keep up. Well, the daycare is probably feeding your baby way too quickly. And way too fast. The other thing that they’re probably doing, you know, because they’re not doing pace, bottle feeding, or maybe the bottle nipple flow is too fast. Maybe the bottle nipple shape is not the right shape. You know, they’re just not doing good bottle feeding practices. They’re laying the baby on their back, those sorts of things. So all of those things can contribute to overfeeding with the bottle. The other issue that I will say is that daycares, often scheduled feedings so they’re not responsive, they do not engage in responsive feeding with each individual baby.

 

And so what happens is, if you’re waiting, if you’re making that baby wait too long to feed, when they go to feed, they’re incredibly hungry, and they are going to gulp and guzzle that milk down. So much like we’ve all been there, right? Like you’re hungry, you’re starving, you know, especially if you’re breastfeeding, right, we’ve had those moments. And you shoveled, like, you’re just like I’m so hungry, and you eat like this massive quantity of food. And then like 1015 20 minutes later, it kind of kicks in where you’re like, Ooh, I overate. That’s what happens to your baby, when feedings are spaced out a naturally instead of following their cues. So if that’s happening, your baby will take larger quantities of food, they will stretch out their tummies, they will eat faster, but then they will eat so quickly that their tummies don’t have that time to send that signal to their brain that says I’m full or I’m getting full. So please slow down or please stop. And then you get into the cycle of overfeeding. And then you’re not able to increase your milk supply, because you already had a full milk supply. So I mean, you can’t just give your body an oversupply. It’s not that easy. Some people, they do have an oversupply. But if you’re beyond those first couple weeks of lactation, you can’t just go and create an oversupply. That’s not how it works. And so it’s really disappointing, right? Because you’re like, Well, I’m not keeping up. Now I have to supplement. And the more you supplement, the less you’re motivated to breastfeed less you’re motivated to pump because you’re like, Well, you know, why am I doing this, I’m not even making enough anymore, is this even worth it pumping is a pain in the butt, I have to take time I’m missing my break time I’m doing this, you know, it’s have to wash all these parts, I have to clean everything, I have to take it to the daycare. I mean, it’s a whole thing. It’s not easy. So there’s so many factors. And I just want to acknowledge all of those factors and say, perceive low milk supply is a problem, because we don’t want moms to think they’re not making enough milk when that’s not factually true.

 

But the other thing is that low milk supply can also be created because of perceived low milk supply. And that’s really not your fault. So when I talk about not having adequate education, or under understanding normal infant behavior, or what normal infant breastfeeding looks like, that’s not me putting the blame on you, as the Mom, it’s me putting the blame on society, on health care systems, on daycare systems, you know, these people should be the best educated in this, these are the ones that are responsible for taking care of infants, right? Not social media, of course, but you know, in laws, well meaning family members, you know, elders, sisters, what have you. And then social media, all of these influences are things that you’re trying to take in. And it’s a lot of overwhelming information for you as a mom, on top of everything you’re learning about your body and your baby. And so you’re trying to make the best decision possible. I do not fault you for that. Okay, I absolutely do not. It is a lot to wade through, I absolutely can see why a lot of women are like, you know, what, has just like mentally exhausting. I don’t have the wherewithal, I don’t have the capacity to engage in this type of learning right now. Forget it. I totally get that, especially if you’re already dealing with anxiety, or depression or you’ve had some trauma, or you know, you just have a lot of high level stress in your life. Of course, of course, breastfeeding is going to be one of those first things to go. I get that. I totally get that and I’m here to say that you’ve been done a disservice.

 

Right? Like, to me there’s nothing more upsetting than women who were given factually untrue. information. That’s not your fault. You got that information from someone you trusted, and you rightfully believed it. I don’t think that we should have to go through our lives questioning every single thing that comes our way. I don’t think that’s healthy, I think that we should, there should ideally be some level of trust that we can have in our fellow citizens around us, no matter their level of authority in our lives. And we should be able to have some baseline level of trust. So hopefully, you’ve gotten some good breastfeeding information along the way, if you’re listening to this podcast, I know you have. So that’s one of the biggest things about this podcast for me is that I want to clear the air. There are so many misconceptions out there, about breastfeeding about lactation that it’s so frustrating, like this episode is born out of frustration, frustration for you, right frustration for so many moms that we work with, even you know, especially with like the advanced lactation formula supplement that we have, I really see where there will be a lot of moms that will say, you know, well, I didn’t see an increase. And I’m like, Yeah, but I mean, what was your milk output? Or you know, your baby’s behavior before?

 

Like, why did you decide to take it, and then you come to find out, they didn’t have low milk supply, they often have perceived insufficient milk. And so I’m like, Well, yeah, the supplement isn’t really going to work for that. And so you know, it’s not their fault, though, right, because somewhere along the line, some information came to them that said, You’re not making enough, it’s usually not a decision a mom just makes in her head, nobody wants to think that they’re not making enough milk. So anyway, all of that, just to say, I totally get it. It can also be really tricky. When you just don’t know, I’ve been there. You can have low milk supply sneak up on you, you can, you can have the opposite, where you’re perceiving that you have a low milk or a full milk supply. And all of a sudden, you have that one doctor visit, and you’re like, Oh, my baby did not gain any weight in the last month. And moms really beat themselves up about that. But I’m like, No, that’s your pediatrician should have been able to educate you on these things. Right? Like you should have gotten better education and support all the way through, you know, from pregnancy, you know, through birth and beyond. And so it’s really something that we see a lot to be honest with you. I even see pediatricians sort of denying it going, well, the baby didn’t give me as much weight, but they’re still fine. And I’m like, you know, I’m actually more concerned. And so we see it go both ways. We absolutely do. And then you’ve got this fetish vest movement that came in, you know, several years ago now and entered the conversation about, you know, not making enough milk in the early days. Yes, there are absolutely cases of that, especially with certain birth interventions, especially with babies that need NICU care and things like that, right. So you don’t get breastfeeding off to a good start.

 

And yeah, baby, that baby absolutely needs to be supplemented. But that does not mean that that has to derail your ability to produce a full milk supply, or breastfeed your baby, those things can be recovered, but you’re usually going to need support outside of the hospital. And so I feel like this podcast is basically just trying to tell everybody, please work with a skilled ibclc if you’re unsure, which is really the message that I wish more moms received, it does not have to be us. You know, I just really am like, passionate about this, because I see the grief on the other end of things I hear from moms all of the time. Like, for instance, I’ll go and let’s say I’m, you know, getting my hair done, okay. And so, you know, the hairdresser is like, hey, what do you do for work? Or do you work? I’ll be like, Yeah, I do. I’m a lactation consultant, or like, oh, my gosh, you know, breastfeeding, man, I’m just, I wanted to so badly. And here’s what happened, and they give me like, their whole life story. You know, and they tell me about their birth. It’s like, you know, we fill up the whole hair appointment talking about it. And because it’s so personal, right? It’s so personal to a mom. And it’s primal. It’s this biological drive, right? For a lot of women, there’s a biological drive to have children. So that same drive is inherent with breastfeeding, whether or not you realize it, I mean, a lot of this is just hormonal. It’s not like a mental choice. So you know, it’s kind of like for a lot of people that get PMS every time they have their menstrual cycle. It’s not a conscious choice. It’s the result of hormones. So these things happen. And there’s a lot of moms out there, they tell me their stories, you know, I just meet them in passing. What do you do?

 

You know, and there’s the story, even dads like my, my insurance broker for like my commercial business insurance stuff. He’s so funny when we first connected on the phone and he was like, Oh, my goodness, he’s like, my mom was a law Lecce league leader. He’s like, I grew up, you know, all around breastfeeding and natural birth stuff. And he was like, huge. My mom had a VBAC when I was 10. And my little brother was born and he like, told me this whole story, because I just said what I do for a profession, and so these things are personal to a lot of people. You know, even I’m pretty sure like my I have like an injury attorney for this accident that I was in a few years ago. And you know, I think he even said something like You know, hey, my wife, oh, she breastfed our kids, but she could only do it for, you know, so long. And it’s, you know, it’s a good story or kind of a bad story. There’s either this grief and sort of sadness around how it didn’t work out, or there’s this pride of, you know, wow, hey, my mom breastfed me till she was five, like, Wow, that’s awesome. You know, that’s, like, unheard of back in the 80s, or whatever.

 

So I always get to hear these fascinating stories. And I will say, there’s more grief than not, you know, and then there’s a lot of unknowns. Most of the time, what I hear are unknowns. So, you know, my mom, you know, she went to the doctor, and he told her, you’re not making enough milk. So that was it. She just, you know, that day she switched to formula. Now, maybe that was true, but maybe it wasn’t true. And then this, you know, so this, you know, Mother, right grandmother at this point is, you know, she doesn’t know, she has no idea. And so that’s I think the hardest part is that moms often don’t know, the real reasons why breastfeeding fails. And they don’t know why it’s going wrong to begin with. And that’s really the root cause here, this is not an easy problem to fix at all. So if you are out there, and you think that you have perceived low milk supply, or you think that you’re like, No, I absolutely am not making enough milk, there’s a couple options, right. And one is you can just sort of keep doing what you’re doing, you can get help, or you can decide to stop doing, what you’re doing and wean. And so those are really the options. And you kind of have to decide like what’s best for you. You know, what do you have the capacity for right now? What do you really want? You know, how important are your breastfeeding goals? Are? Can you adjust those breastfeeding goals and things like that? These are all questions to ask before you decide which avenue you want to go down, and what type of help you want to receive.

 

So I think those are all just important questions to consider about breastfeeding in general, is when you’re pregnant, if you’re listening to this, and you’re preparing to have a baby, maybe it’s your first baby. Maybe it’s a second, third, fourth 10th. Baby, you know, who knows? And you’re thinking about this, like, what are your breastfeeding goals? And what’s your backup plan? If that goal seems like it might be in jeopardy? What will you do if you’re told your baby’s not making enough milk? Like, what’s the contingency? Are your breasts aren’t making enough milk? What’s your contingency plan? What will you do if your baby can’t latch? What’s your contingency plan? Like, just think through the scenarios not to be a Negative Nelly, not to say, you know, I’m counting on the worst case scenario, but it’s kind of like create a breastfeeding plan, much like you would create a birth plan. So let’s say you’re like, I want to have an all natural birth, no medications, I want to labor, I want to, you know, use the birth job, I want to use the yoga ball, I want to be in the shower, I want to you know, whatever be able to be freely moving in all positions.

 

Okay, that’s great. What happens? If that’s not a possibility? Now what? So are you willing to get the Pitocin, but you want to hold off on the epidural or vice versa? Like, you know, so just you’ll have these options that are presented to you prepare for those don’t count on them happening, right, but just be prepared. So kind of the same thing with breastfeeding. You know, if you’re given a nipple shield in the hospital, because your baby’s having a hard time latching? Will you continue to do that? What is your plan to wean off of that nipple shield? Or do you want to continue to use that your entire breastfeeding journey, just start to think about those things. If you’re listening to this podcast and you’re preparing to breastfeed, that’s what I would say is just start to think about what happens if things go wrong. And if you want to get support, which ibclcs Are you going to look at I work with, I would pick more than one, I would have three, have a local option, have a virtual option, you know, maybe two of each of those, right, but have more than one option lined up? Where are free breastfeeding support groups that you can at least go to at a minimum or their weight check clinics, ask your pediatrician do that do the prenatal interview with the pediatrician and ask what how are they supportive of their breastfeeding? You know, how many patients and their practice do they see exclusively breastfeeding? What do they recommend when there are feeding problems? What’s their go to? You know, do they do they get visits from Formula representatives? ask them these questions?

 

You know, I would just have these conversations learn more about you know what it is that you’re trying to do a breastfeeding it’s important to you put together a plan ask start asking these questions, right look online, you know, where can I go to get support? Can I get support from ibclcs outside of an appointment? You know, things like our program, the nurturer collective where we’ve got, you know, multiple ibclcs in there, it’s online. We’ve got an incredible support group. We do live calls. We’ve got all this like, you know, on demand video content and guides that you can read through it anytime to get answers you You know, just what’s a trusted resource line those up, you don’t have to engage with those things right now. But have a list and have that list so that when you’re in the moment and you’re scrambling, and you’re not spiraling, right, you’re like, Okay, something I need help which one of these options is going to be my first start? Every state in the United States, if you guys did not know, this has a breastfeeding hotline. Most of these, I don’t know if I can say all of them are operated 24 hours a day, seven days a week. And so if you call and you describe that problem that you’re having, sometimes you know, they’re busy, they’ll have to give you a call back, that’s okay. They usually have a way to leave a message, they can direct you to the right resource. So if you don’t know where to start, I would start with either the lacI league hotline, which is free or your state, if you’re in the US breastfeeding hotline, just Google it, you know, if you’re in Alabama, like Alabama, state breastfeeding hotline que just Google it and you’ll find it and call that number and just say, hey, here’s what’s going on. And I’m not really sure where the best places to get help. And those people can help you with local resources. So if you want in person help, that’s available. So anyway, I just wanted to share that with you guys. And just talk a bit about perceived low milk supply. I’d love to hear from you. If this has happened to you, or you think it might be happening to you, you know, definitely share this episode, take a screenshot, share it in your stories, you know, send us a DM if this episode resonated with you if you learned something, and please, please leave a review. We’d love when you leave reviews that helps the podcast get found. So it increases our ranking and helps to put relevant keywords in there. So when people go and search for a podcast on a particular topic, like breastfeeding, they might even type in milk supply or something like that. They will find this episode and all of those reviews and comments help. So thank you for listening, and I’ll see you on the next episode.

In this episode, Jacqueline talks about a common and frustrating problem that a lot of moms have, perceived low milk supply.

Many moms will think they have a low milk supply, but actually they are just fine and are often lacking some education on what normal breastfeeding/pumping looks like.

This episode clears it all up for you—whether you’re a new mom, a seasoned mom, or just new to breastfeeding.

Jacqueline shares the top reasons that moms think they have a low milk supply, and what an actual low milk supply would look like. She also shares breastfeeding resources, and gives tips on when to seek professional help.

In this episode, you’ll hear:

  • How online ‘coaches’ are popping up more on social media and the safety concern for your babies medical wellbeing
  • All about the letdown/Milk Ejection Reflex
  • Knowing how to read your baby’s hunger cues and when to work with a professional
  • Why moms think they have a low milk supply and what a low milk supply actually would look like
  • Milk transfer vs. milk production
  • Problems and myths around perceived low milk supply

A glance at this episode:

  • [7:06] The difference between coaches and medical providers.
  • [8:13] The rumor behind not having a letdown when nursing and how this is highly inaccurate
  • [13:51] The most common reason moms think they have a low milk supply
  • [21:40] Working with a professional to identify why your baby is crying
  • [25:22] The best ways we have for breastfeeding success
  • [28:31] Milk transfer vs. milk production
  • [34:39] Problems that arise from perceived low milk supply
  • [38:36] Perceived low milk supply with pumping
  • [47:20] Myths around low milk supply

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