The Boob Group
Why Is My Milk Supply Decreasing?

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Please be advised, this transcription was performed by a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

ROBIN KAPLAN: There is nothing worse than feeling like you have finally figured out this parenting and breastfeeding thing only to be sidelined with a huge challenge. Your milk supply has started to decrease. There are so many reasons why this can happen. So, we thought: “We try to put the pieces of the puzzle together for you today.”

I would like to introduce a brand new expert to our show. Danielle Blair, an International Board Certified Lactation Consultant and owner of Gaithersburg Breastfeeding in Maryland. Today, we’re talking about: “Why my milk supply is decreasing?” This is The Boob Group Episode 104.

[Theme Music/Intro]

ROBIN KAPLAN: Welcome to The Boob Group broadcasting from the Birth Education Centre of San Diego. The Boob Group is your weekly online on-the-go support group for all things related to breastfeeding. I’m your host Robin Kaplan. I’m also an International Board Certified Lactation Consultant and owner of the San Diego Breastfeeding Centre.

Did you know that you can become involved in our episodes even when you can’t make it into the studio? We love when our Facebook friends post questions for our experts and share their favourite Boob Group episodes. Plus, you can become more involved in our recording days through our Virtual Panellists Program.

Our producer Mj will tell us a little bit more about this program in just a few minutes. So, today we’re joined by two lovely panellists in the studio. Ladies, will you please introduce yourselves.

JULIE SANDERS: I am Julie Sanders. I’m 31. I am an engineer and I have one girl, a hiccupping baby here and she is five months old.

ROBIN KAPLAN: Awesome and we have?

AMIE BRANNON: I’m Amie Brannon. I am almost 29 and I have a 4 year old daughter and an 8 month old son.

ROBIN KAPLAN: Awesome, all right and Mj will you please introduce yourself as our producer as well as our Virtual Panellists Program.

MJ FISHER: Yes, I am Mj. I am 37 and I am mom to Jason who’s going to be three in June. I’m a stay-at-home mom and then I get to produce this show which I love helping other moms. One of my jobs is to run the Virtual Panellists Program which is a way for you out there to join the conversation and be part of our show if you can’t be on the studio with us.

We are posting the same questions that we are asking our in-studio panellists; so you get to share your experiences and opinions or tips and just engage and support with other moms. We may even read your comment while we record. It’s really a sneak preview of our show before it releases.

We post tips and information as we record and as the experts give to us. It’s an extension of our show and us supporting each other. So, check out www.TheBoobGroup.com under the community tab for more information on the VP Program and possible perks for participation.

ROBIN KAPLAN: All right, thanks Mj.

MJ FISHER: Yes.

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ROBIN KAPLAN: So, this is posted on our Facebook page.

This is from Delilah. She wrote:

Hello ladies. I just want to say thank you for all the support and information that you provide to us. You are my resources and everything related to breastfeeding and baby concerns. Now, my process has been smooth and when things go crazy, I had hope that my baby and I will be okay. -Delilah

Thanks Delilah. That was so nice. We really appreciate it.

[Theme Music]

ROBIN KAPLAN: So, today on The Boob Group we’re discussing: “Reasons why a mom’s milk supply might start to decrease.” Our expert Danielle Blair is an International Board Certified Lactation Consultant and owner of Gaithersburg Breastfeeding in Maryland. Thanks for joining us Danielle and welcome to the show.

DANIELLE BLAIR: Thank you Robin.

ROBIN KAPLAN: Sure. So, Danielle before we start talking about: “Reasons why a mom’s milk’s supply would decrease,” let’s first talk about ways to establish a full milk supply. So, what are the key components to bring in mom’s fuller supply in the early postpartum weeks?

DANIELLE BLAIR: Probably the best thing to do is to breastfeed and early and often starting as soon after birth is possible. Babies do need to eat about 8 to 12 times a day in the early weeks. The breasts need to have milk removed as many times each day to produce enough milk for your baby as well.

You can help your baby remove more milk by doing breast compressions during feedings and absolutely if baby isn’t breastfeeding well, first off – get help. Secondly, remove milk by hand expression or pumping to help establish your supply.

ROBIN KAPLAN: Okay and how much breast milk does a baby needed at two weeks and how is this change over time and does it ever plateau?

DANIELLE BLAIR: Babies at two weeks are still working to get mom’s milk supply at full capacity. Most babies with age take somewhere between 15 and 20 ounces of breast milk per day. By the end of the first month, most babies need 25 ounces or more per day to grow well. Of course, it varies from baby to baby. But, milk production does level off in the end of that first month and comes to where it remain stable until about the six months mark.

ROBIN KAPLAN: Okay and how do growth spurts help keep up mom’s milk supply?

DANIELLE BLAIR: Well, during growth spurts which are age when baby’s nursing very frequently. It tends to happen about every few weeks or in the early days and can last two to three days. During these days, babies nurse frequently which gives mom’s milk supply a temporary boost. If babies are allowed to have these frequent nursing off from mom and can find that the milk supply starts to drop.

ROBIN KAPLAN: Okay, so ladies in the studio, what did you do to bring in your fullest supply in those early post partum weeks? Julie?

JULIE SANDERS: I guess I just nursed often. I didn’t really in those very early weeks have a concept of when I was full or not full or how much milk I was producing because I was just breastfeeding so I was just feed her when she’s hungry.

She ended up having a lip tie and a tongue tie; so she wasn’t nursing very effectively as it turned out. So, she nursed about twice as often as it was normal. But after that, she’s still just I guess I felt full. So, there were times when she would kind of go through just have a day where she was nursing like crazy and effectively draining me.

That did get scary sometimes when I feel like: “I don’t have any more milk to give her. What do I do?” So, I’d take things like Fenugreek which my doula actually brought me a bottle over during a postpartum visit and he’d take the ton of this. So, that I guess helped because I didn’t end up experiencing too much of those kinds of nights where I was sure if I had enough. But, then that ended up making me really hungry all the time. So, I just stopped taking it.

ROBIN KAPLAN: All right, how about you Amie?

AMIE BRANNON: Well, my first I had a really hard time getting it established. She had a hard time during the breast at first. So, I would feed her and still be hard and engorged and I couldn’t figure out what was going out until I had a week after she was born. I finally got into CLC and that helped immensely.

We still because it took so long getting her really established. I have supplement with my first the whole time. With my second, I had kind of moved on and I wasn’t afraid to feed him as often. I still do supplement for a little bit because he wasn’t gaining weight as fast as the paediatrician or the lactation consultant wanted him too. But, that was only for about a month. Then I got it established by just deciding that if he cried, I was going to feed him.

There would be days when to go to the grocery store, I would feed him before we left and we get to the grocery store and I feed him in the car and then we’d go on grocery shop. I’d feed him when we got back to the car and then I feed him again after I unloaded all the groceries. I just have to give up and say: “Okay, if you cry I’m feeding you. I don’t care what anybody else might say the problem is. If you just ate and you’re hungry again, let’s go for it.”

ROBIN KAPLAN: Yes, that’s awesome. It seemed to work out well then?

AMIE BRANNON: He’s doing great right now.

ROBIN KAPLAN: That’s awesome. So, Danielle I have seen throughout my practice sometimes babies have lip or tongue ties that they coast through those first few months gaining well especially if mom has a really robust supply. Then mom’s supply dips around three months. What can cause this?

DANIELLE BLAIR: Well, the first she is off to delivery the milk production is hormonally driven. It happens whether the baby is breastfeeding well or not. So, they tend to – if they’re able to latch and at least remove some milk, they tend to do okay and get a little bit to eat.

What happens is overtime; the baby has to do a little more work to keep that milk supply up. So, he might be happily drinking the milk that’s just flowing out of mom’s breast. But, he’s not sending the right messages to her body by suckling effectively. This can cause a dip in supply over time.

Many babies with tongue and lip tie are able to get almost enough in those early weeks. But then, they do have trouble long term. So, if the milk’s not removed, the breasts get the message to slow down production and certainly this can happen early in the breastfeeding.

Some babies already have caused the low supply at even just a couple of weeks. But, for some of these babies were mom’s does have a robust supply, it can take a little longer to present if there’s a supply problem.

ROBIN KAPLAN: Okay and what about those highly destructible times around the 4 to 6 month mark where baby every time they see something shiny they turned around and pull – they’re pulling off and unlatching and checking everything out. Can this cause a mom’s supply to dip and if it does, what can she do to protect her milk supply during this time?

DANIELLE BLAIR: I love when babies are so busy exploring the world around them that they can’t see them finish eating. It’s a wonderful time but sometimes mom’s are surprised to find that even though they’ve been out and about and nursing in public and on-the-go. But, they suddenly need to go just find a quiet room with few distractions so that her baby can nurse effectively.

This certainly doesn’t mean: “Every feeding needs to happen like this.” It is something that can help. Although moms find nursing more frequently like what Amie described. Nursing more frequently for shorter durations can help as well.

Certainly last of all, I think I’ve mentioned earlier: “Even some breast compressions to help squeeze a little more milk out of the breast that feedings can help keep your supply going.”

ROBIN KAPLAN: Yes and definitely this is not a great time in night wean either when babies are distracted since they often – I remember working with a mom who’s baby transferred about 2/3 of what they needed in the 24-hour period between the hours of I think it was 10 pm and 6 AM.

He just tanked up during the middle of the night and was poky all day because he was so excited about everything that was going on. So, I can’t imagine what would have happen if she had tried to night wean at that point.

DANIELLE BLAIR: Absolutely.

ROBIN KAPLAN: Yes, ladies what was breastfeeding like for you guys during these distractible periods? Did you find that your supply took a hit it all or were you just kind of nursing a lot more frequently kind of like you were just describing Amie?

AMIE BRANNON: I think by that point, I just wasn’t tracking necessarily my supply but they do. But, when he was hungry he would eat and if he was still gaining weight then I couldn’t stress about it. I just had to remind myself that: “A good supply was one that fed my baby.” I didn’t have to pump a lot to say that I had a great supply.

ROBIN KAPLAN: That’s a really great thought. I liked that a lot. How about you Julie? How old is Isla now?

JULIE SANDERS: Five months and she’s right in the middle of this.

ROBIN KAPLAN: She’s right in the middle of it.

JULIE SANDERS: She’d pretty much hit it right up at the four month mark on the nose. I was attending a breastfeeding support group every week to find out how much she was eating and I took her once right at four months.

I couldn’t and can’t eat anything because she walked in that room for the first while I was watch in there for the first time and there was all these moms and babies in this bright room. It was so interesting. It was just like: “This is a new problem.”

Actually, I have an app on my phone that tracks how much she’s eating. So, I started looking at that kind of throughout the day to see – what’s the total amount of time that she’s been eating because like you were saying about the baby was tanking up in the middle of the night.

As long as she’s nursing a good amount of time since I can’t track how much, then however over the course of the day that’s fine. So, when she would only nurse for three minutes then I would nurse for more often and just trying to not go by the clock but just kind of checked in her more often and see.

ROBIN KAPLAN: Check her behaviour and see how she was acting.

JULIE SANDERS: Yes.

ROBIN KAPLAN: The nice thing about babies that are about 4 to 6 months old too like: “They know what they kind of need as well.” At least that’s what I find. So, if they’re hungry, they’re going to tell you and if they just want to play and come back to eating later, they’ll definitely come back to eating later.

All right, well when we come back, we will discuss with DANIELLE BLAIR: “Some other common reasons why a mom’s supply might dip such as going back to work and the return of aunt flow.” So, we will be right back.

[Theme Music]

ROBIN KAPLAN: All right, welcome back to the show. We are here with Danielle Blair, an International Board Certified Lactation Consultant and we’re talking about: “Reasons why a mom’s supply might dip pass those kinds of first couple of weeks.”

So, Danielle, how can a mom protect her milk supply when she goes back to work? What are some common pitfalls that you see?

DANIELLE BLAIR: Well, going back to work is a challenging time for keeping up the milk supply. During the work day, many mothers find that frequent pumping breaks can help. Typically, we advise moms to pump at least as often as baby would normally feed during the day if possible.

Again, using some hands on pumping techniques which should basically those breast compressions that we talked about earlier while pumping can help keep the supply up as well. As difficult as it can be to wake up for night feedings – as we described earlier, a lot of babies do take in a lot of their overall milk during the night time hours.

So, working mothers often find that continuing to nurse at night and allowing frequent feeds when they are at home with the baby on the weekend is a really great way to keep their supply where it needs to be.

ROBIN KAPLAN: Okay and I know Julie is back at work. So Julie, what are you doing to protect your milk supply while you’re back?

JULIE SANDERS: I try and eat all of the foods that supposedly keep my supply up as much as possible. I have oatmeal for breakfast every morning and a bunch of other things. I just try and make sure I’d keep track how much I pump and make sure obviously I need to pump what she’s eating or that can be a problem.

I also made sure to have a good frozen stash of breast milk for when it does dip that I can have that as a resource and not have to panic. On the flip side, sometimes I have tons of my supply swings up and I’ll have extra. So, I can kind of back fill. I have to take out of the freezer. So, I try and just not panic and be patient with myself.

If there was a problem where I was noticing that I was constantly dipping into my stash then I would probably see a lactation consultant or find out what ways to keep my supply up that I would be able to pump enough to feed her.

ROBIN KAPLAN: Do you see a discrepancy in your pumping output when you’re at work?

JULIE SANDERS: Yes, well I guess I don’t know what normal range is. I’d say: “It can range anywhere from 10 ounces to 15 ounces a day.” She takes about 12 ounces – 10 to 12 while she’s at day care. So, it just really depends on like you’re saying: “A hormonal changes and how much stress do I have that day.”

I also notice time of day too. My morning pumping session I’ll get a really good amount. Sometimes I’ll get half of what I get for the whole day. I would get that for the first pumping session. Then two hours later, I get nothing.

ROBIN KAPLAN: It’s really great to know how you’re body fluctuates like that too because then you can expect: “Okay, I’d probably won’t get as much the next time and not to stress about it.” So, very cool.

Danielle, what about night weaning? Can this affect a mom’s overall milk supply and does it depend on the age of the baby or what if the baby is actually sleeping longer stretches at night on his own?

DANIELLE BLAIR: Very good question. Again, we can’t say enough that some babies do need to continue nursing at night to keep that supply up. However the reason that supply in some cases is higher at night is that: “The hormones responsible for milk production at higher at night.” So, more milk is being produced during that time.

If mom goes too long stretch without removing the milk either through nursing or pumping then mom’s breasts can get the message to slow down production. So, generally it can be hard to keep up for a full milk supply if mom’s doing more than six hours or so without milk removal. That certainly applies to babies six months and under.

However, older babies are starting to take food from other sources and maybe able to sleep a little bit longer without negatively impacting mom’s supply. So, if your baby is sleeping longer, stretch its own – if you find that your supply is starting to dip a little bit, you can try feeding a little more frequently during the day.

If you really need too, you can add in a pumping session particularly for moms who are back at work. That can be a way to help give yourself a little boost and keep your mind that each woman is build differently. Some women are able to go longer stretches without removing milk, without having a negative impact on milk supply.

ROBIN KAPLAN: Okay and how can a mom protect her milk supply when offering her baby solid foods?

DANIELLE BLAIR: Well, I usually advice my clients to offer their breast first and count solid as practice and not worry too much about the amount of solids that babies are eating versus smearing all over the high chair tray. Really from 6 to 12 months, even though babies can have some bottles breast milk should still be a primary source of nutrition for optimum growth.

A lot of moms do tend to find that a serving size of baby food should be an entire jar when the reality as a serving size for most younger babies is more like about a tablespoon. So, that jar of baby food can be three or four meals in many cases.

ROBIN KAPLAN: Okay, Amie what did you notice when you started offering solids?

AMIE BRANNON: My boy love solids. My goodness, we have pancakes for breakfast and he just fasterfully – he had about 2 ½. That sweet potato and [inaudible] – we had those the other night and he had peck those things away.

ROBIN KAPLAN: That’s awesome. So, do you nurse him before you sit him down?

AMIE BRANNON: That’s actually the hard part is because I have to be cooking dinner right up until it’s time to eat. So, a lot of the times I tried but he’s distracted and his sister’s there and his daddy’s home. He just wants to go play. He’ll eat and he still nurses to sleep so he’ll get a long nurse right before he goes to bed. So, he’s been okay.

But, it is tricky when he first started then he would – he’d wear himself out, he didn’t want to nurse and I started wearing especially when he started getting breakfast foods as well. So, I worried about it and now, like I’ve said earlier: “I had found myself the right amount of breast milk was what he needed to eat.”

If I just offered it as often as he seemed to need it then he would take what he needed.

ROBIN KAPLAN: Cool. Danielle, how does a mom’s calorie intake affect her supply? How many calories should a mom eat to kind of keep up a really robust supply?

DANIELLE BLAIR: Generally, most of us here in the United States take in plenty of calories to maintain lactation were not living in famine conditions in most cases. But, most of us are anxious to fit back into our pre-pregnancy jeans. So, given the body time to heal after pregnancy and time to establish a good milk supply before restricting calories can be really helpful.

Most women burn about 300 or 500 calories a day producing milk for a single baby. So, in order for someone to take in enough nutrition to function and produce milk; she should be eating a minimum of 15 to 1800 calories per day. For most women, it really should be a minimum of 1800.

Any individual’s activity levels, back stores and certainly the quality of our nutrition can have an effect on how many calories we need to produce enough milk. But definitely, expect to be a little bit hungrier and be able to get away with the eating a few extra things while you’re nursing.

ROBIN KAPLAN: Yes which is always fun.

MJ FISHER: It’s not been a problem I had is getting enough calories.

ROBIN KAPLAN: Danielle, how can a return of the mom’s period decrease her supply and I find that it’s usually temporary that you finding the same thing and how can she protect it against this kind of temporary dip?

DANIELLE BLAIR: I think what your nervous Robin is very common. Women do notice a little dip of supply the first few days of their period. Babies might respond by just nursing a little more frequently which sounds great. But, it can be a little challenging if you’re having nipple tenderness during your period.

So, trying to help the baby nurse more frequently maybe for shorter time can help; certainly, for moms who are relying on pumping to keep up the supply. Adding an extra session and on those few days may help keep the supply up as well. I think I heard someone mentioned earlier: “Eating oatmeal for breakfast can give you a little boost. It’s not going to double the supply but it can help.”

ROBIN KAPLAN: Absolutely. Has anyone gotten their period back yet? Anyone notice? Look at that. That’s awesome keeping it away. I know with the moms that I often consult with; I see this in a lot of posts. Often times posted on private Facebook groups of breastfeeding moms saying that: “Their supply take a hit in-between like ovulation and getting their period.”

So, I remember reading somewhere. I think it was in one of our breastfeeding books when we were becoming lactation consultants that it was saying that: “If you take a mixture of”

DANIELLE BLAIR: Calcium and magnesium.

ROBIN KAPLAN: Yes, thank you. Calcium and magnesium that was I was looking for. So, a mixture of calcium and magnesium can often help in-between ovulation period of time and then actually bleeding to help kind of boost in the supply as well as just some extra frequent feeding which can like you said: “Sometimes be a little uncomfortable when you’re tender.”

AMIE BRANNON: I have heard ovulation in that period between ovulation and bleeding, your body does to tend to burn more calories. So, if you’re at the cusp of having enough that maybe a cause is that your body is working to whatever ovulation burns and then the milk production as well. It just needs to stretch a little.

ROBIN KAPLAN: That’s a really good point. Mj, we have a virtual panellist who wants to share something.

MJ FISHER: Yes, actually Sarah Welsh said exactly what you’re saying here.

But, clockwork a week before her period – she would get a drop in supply. Her son would nurse more often to make up for it. Then, she would start taking calcium and magnesium and it stops dropping as much. -Sarah

AMIE BRANNON: So, that’s a good tip I didn’t know about that.

ROBIN KAPLAN: That’s awesome. I’m on the San Diego Breastfeeding Centre blog on our website. We actually have the exact dosage for it because I can never remember it. So, I just refer everybody there to it. We actually have it at the bottom of our web page as well in The Boob Group for this episode too.

So, all right and so last question Danielle, how can pregnancy cause a dip in mom’s milk supply and is this temporary or will mom’s supply remain low throughout her pregnancy and what can she do to just keep it up?

DANIELLE BLAIR: Well, many women do see a pretty significant dip in supply during the second trimester of pregnancy as the milk reverse to colostrums. That volume is quite a bit lower than what is typical when you’re not pregnant. So, a lot of older babies will either naturally weaned during this time or nurse less. The milk taste a little different. It’s saltier. There’s sodium concentrations are much higher.

The supply can come back later in the pregnancy as most approaches. Near birth, the milk production starts kicking in again for the new baby. Of course, in general by the time of second pregnancy is occurring; the older baby is old enough to be receiving some other food. But in fact, it’s not the case.

In some cases, if the baby, if the nursing is under six months of age when you become pregnant, it’s possible that there may need to be some supplementation with additional milk. But, during the pregnancy allowing frequent nursing; making sure mom’s getting plenty of food.

She needs to sustain not just lactation with an extra 3 to 500 calorie the day. But, that pregnancy with an extra 300 calories or so a day; so mom needs to make sure she’s eating lots and lots – eating for three for real.

ROBIN KAPLAN: All right, well thank you so much Danielle for sharing this incredibly value information about: “How to overcome our dips in supply.” So, for our Boob Group Club members our conversation will continue after the end of the show as Danielle will discuss: “How mom can keep up her supply during a nursing strike.”

So, for more information about our Boob Group Club, please visit our website at www.TheBoobGroup.com .

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AMBER MCCANN: Hi Boob Group listeners. I’m Amber McCann. I’m an International Board Certified Lactation Consultant and the owner of Nourished Breastfeeding Support just outside of Washington DC. I’m here to answer some of your most common questions when it comes to finding quality breastfeeding resources online such as: “I think my breasts just don’t work. I’ve tried everything.”

Have you ever heard of insufficient glandular tissue or hypoplasia? Neither had I until just a few years ago and I eat, sleep and breathe to breastfeeding. Recently, my good friend and expert on this condition Diana Cassar-Uhl was on The Boob Group Episode called: “Breastfeeding and Hypoplasia.” It is episode number 20 if you want to check it out.

Sometimes she says that Boob Fairy just didn’t arrive. This condition is where a woman’s breast didn’t develop as they should. It is devastating for many women and many go through weeks and months after the birth of their babies trying to figure out what their bodies don’t function as they should.

But with the power of social media, they’re coming together brainstorming solutions and finding support. I love www.diaryofalactationfailure.blogspot.com. Again that’s www.diaryofalactationfailure.blogspot.com. This blog highlights this condition and in a really empowering way – the messages that breastfeeding doesn’t have to be all or nothing and that every ounce counts comes through loud and clear.

If this sounds like you, you don’t have to be alone. Take some time to connect at www.diaryofalactationfailure.blogspot.com. Thank you for listening, I’m Amber McCann. I’d love for you to check out my website at www.nourishbreastfeeding.com.

For information on my business and a little bit more about where to get connected with great online breastfeeding support – or you can join in my Facebook Page as www.facebook.com/noursihbreastfeeding.

Be sure to listen to The Boob Group each week for more fantastic conversations about breastfeeding and how to find great breastfeeding support.

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ROBIN KAPLAN: This wraps up our show for today. We appreciate you listening to The Boob Group.

Don’t forget to check out our sister shows:

• Preggie Pals for expecting parents
• Our show – Parent Savers for moms and dads with newborns, infants and toddlers
• Our brand new show – Twin Talks for parents of multiples.

Thanks for listening to The Boob Group, your judgement-free breastfeeding resource.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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