There's no getting around it.  Milk production is based on a true supply and demand system.  When a baby or pump removes milk from the breast, signals are sent to the body to make more milk!   When a baby or substandard pump is not removing the appropriate volume of milk from the breasts, signals are sent to the body to decrease the amount of milk your body is making.

 

There are a number of things you can check at home to make sure you have a sufficient supply:

   

    - Is your baby having the appropriate number of wet and dirty diapers each day?

   

    - Is your baby growing appropriately?  Just because your baby is small does not mean your supply is low.  Was your baby on the 3rd percentile on the growth chart, but is still remaining on the 3rd percentile as time goes on?  If your baby was on the 50th and is dropping to the 40th, 30th, etc., then there may be a valid reason to suspect lower supply.

   

    - Does your baby seem satisfied when he comes off the breast and is they growing accurately?  These are all good signs!

 

Causes for concern:

 

    - Sleepy newborn babies that don't wake often enough to nurse.  Make sure your baby is eating sufficiently 8-12 times in a 24 hour period of time.  Stimulate the baby by taking off clothes, touching gently during the nursing session, etc.  This stage does not usually last for a long period of time, but if not taken care of can cause supply issues.  If you have a sleepy baby, waking them up to empty the breasts on a regular basis is perfectly acceptable and needed.

 

   -  Sore, cracked or bleeding nipples.  If your nipples are not doing well, there is a good chance the baby is not getting enough, which will affect both supply and the baby's growth.  A nipple is meant to be supple, pliable and elastic. When you experience sore nipples, you will likely see cracked and bleeding shortly thereafter due to repeated trauma placed on the nipple.  Your baby is essentially chomping and/or sucking incorrectly on your nipple in an attempt to get more milk.  A lactation consultant can help correct the baby's latch to eliminate mother's pain and assist the baby in transferring more milk from the breasts. 

 

   -  Excessive pacifier use.  The American Academy of Pediatrics recommends postponing pacifier use until breastfeeding is well established. Think about it this way, if a baby is contently sucking on a pacifier, they may miss a feeding during the day.  I personally recommend waiting a minimum of 4 weeks before introducing a pacifier or a bottle.

 

   -  Supplementing with formula.  If your baby is receiving one or more bottle(s) of formula a day, you are sending a signal to your body that it doesn't need to produce milk for those feedings.  However, this being said, if your child's physician is requesting a supplementation each day to increase growth, etc., it is important to stay on this schedule. 

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 - Premature or late preterm / early term infants.  They may not have the tone or ability to take the full feed yet.  Protecting your milk supply with a hospital grade breast pump and allowing a little gift of time is what you may need at this time.  Mothers and infants typically do better being supported by a lactation consultant during this time.

 

       There are ways to help the milk supply during this time. For each missed feeding, using a hospital grade breast pump or superior personal use pump can kick the supply chain into action by stimulating your breasts and telling them to make more.  In addition, your pumped breast milk can be used to supplement your baby. For example, if your physician is requesting an additional 2 oz. of supplement per day, this can be either breast milk or formula.  You can work with your physician and lactation consultant to decrease the amount of formula given by increasing the amount of breast milk produced if your goal is to exclusively breastfeed.  Supplementation can be expressed breast milk OR formula in most cases; your physician is typically looking for volume, not type. 

 

   -  Are you scheduling your baby's feeding schedule?  Think about it this way.  Do you ALWAYS eat at the exact same time for breakfast, lunch, dinner and snacks?   Sometimes, we get hungry shortly after lunch or we snack on popcorn right after dinner because there's a movie on the TV.  A baby is no different.  Also, babies are notorious for cluster feedings in the evening.  Just something to think about when you desperately want that schedule; it may not benefit either of you in the end.

 

   - Other issues.  If none of these issues seem to be the problem, there could be anatomical issues with the baby such as a tongue-tie or a health problem that you, as a nursing parent, were not aware could affect milk supply.  A lactation consultant can help determine the reasoning behind a low milk supply and work with you to increase your supply.