Breastfeeding: Do some women simply not have enough milk?
I have a four-week-old baby and looked forward to breastfeeding him. I saw a lactation specialist and joined a pro-breastfeeding pediatric practice, but all to no avail. My milk "came in" late -- around the sixth day -- and my breasts were never engorged . I battled from day one, pumping frequently with an electric pump. My baby is extremely hungry and I nurse him about every two hours. He has very long feedings and clutches my breasts, seeming frantic. He never sleeps for more than an hour during the day. This evening I pumped and barely expressed half an ounce from each breast. As a result I have had to supplement. Do some women simply not have enough milk?
Question:Debbi Donovan
Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more
I'm very sorry to hear that you have experienced such difficulty nursing your new baby. It can be so disappointing when you feel like you have done everything to make breastfeeding work, and it still doesn't seem to be enough.
It is very rare for a woman not to have enough milk to nurse her baby. Most of the time, an insufficient milk supply stems from issues with breastfeeding management. So many factors can come into play with an insufficient milk supply:
- The amount of time your baby feeds at your breast (including length of feeds and number of feeds)
- Positioning and attachment
- Your baby's suck
- Your baby's anatomy -- a tight or short frenulum (tongue-tie)
- Breast surgery
- Severe postpartum hemorrhage
- Insufficient glandular tissue in the mother (rare)
Some babies are not great sleepers! When my first child was born I remember expecting him to sleep much of the time, just waking for feeds. I was startled when he wanted to nurse round the clock. He didn't sound at all like the babies I had read about.
All babies are different. Breastfed babies do need to nurse frequently in those early weeks. Frequent feeds help prevent engorgement, increase your milk supply, and satisfy not only your baby's nutritional and sucking needs, but also his need for intimacy with you. It is quite normal for babies of this age to feed at least 12 times a day, with many feeding more often than this in the first six weeks of life. It is recommended that feeds not be timed. Allow your baby to nurse on one side until relaxed and satisfied, and then offer the other side. Most young babies spend at least 30 to 40 minutes at your breast nursing. Remember that breastmilk is digested in less than two hours, so a baby requires frequent feeds.
When you say your milk didn't come in until day six or seven, I am assuming that your milk was transitioning from colostrum to more mature (and more abundant) milk at that time. In the early days, your breasts produce colostrum. It is the perfect food for your baby, and is often produced in small quantities. Sometimes a mom will worry about her supply if she tries to express at that time and only is able to express a few drops. Early feeds may only be measured in teaspoons. Some mothers begin expressing their milk at this time because their baby hasn't yet got the hang of breastfeeding and are shocked when they express such a small quantity of colostrum. Expressing only very small quantities at this time is within the normal range.
When you are experiencing problems with breastfeeding and your baby is not growing properly or having sufficient output, it is extremely important to seek qualified help. Weaning a baby from the breast is not necessary. This is definitely the time for some intervention. The first thing to do is make sure the baby is being fed. Some babies do need a period of supplementation while you are working with an IBCLC on the breastfeeding relationship. When a baby is well nourished he is more likely to have the energy to have a good feed.
You mentioned that you saw a Lactation Specialist. It can be very confusing when choosing someone to help you to breastfeed. Lactation specialist, lactation consultants, certified breastfeeding educator are all titles you might hear. Though many of these women are very skilled, they may not have any credentials or may have only attended a certifying workshop. I would recommend visiting a Board Certified Lactation Consultant (IBCLC). Board certification gives you the assurance that the person you are seeing has met the standards of the International Board of Lactation Consultant Examiners. It is crucial for members of your health care team to work together to help you continue to breastfeed and increase your milk supply without compromising the health of your baby.
You may find it very helpful to attend a La Leche League meeting and talk with other nursing mothers. To obtain the location of a group in your area, call 800-LA-LECHE. The mother-to-mother support at an LLL meeting can be invaluable.
I really want to remind you of the importance of the act of breastfeeding as well as the milk you produce. If you are unable to provide for 100 percent of your baby's nutritional needs at your breast, you both will still benefit greatly from the closeness. Very best wishes to you and your family!
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