Not Making Enough Breastmilk? When Appropriate Milk Production does not Equal Adequate Milk Intake

When appropriate milk production does not equal adequate milk requirements for your baby, it can be extremely frustrating for both of you. You may be told you are not making enough breastmilk, but your body is making the exact amount it is supposed to be making.

Normal milk production involves removing colostrum from birth until about 72 hours when transitional milk should start to appear. But how soon transitional milk appears depends on how often colostrum has been removed. Aim for at least 12 times every 24 hours in the first 3 days. If milk doesn’t significantly increase within 72 hours, you have delayed milk production and should seek help from a qualified lactation professional.

If you work diligently to eliminate engorgement, caused by both fluid overload and milk overload, and continue removing milk at least 8-12 times/24 hours without allowing your breasts to become full, in most cases you should achieve full, mature milk production by day 10.

Milk production involves stimulating and activating the milk-making hormone, prolactin, as well as stimulating and activating the hormone oxytocin, the milk-releasing hormone. But it also is determined by dopamine, which needs to drop for prolactin to rise, and the feedback inhibitor of lactation (FIL), which is a protein that causes milk production to decrease whenever your breasts get full.

Reasons your baby may require more milk than you are producing include:

·       Not removing milk often enough in the first couple of days. This happens especially if your baby is sleepy and you don’t perform hand expression at least 12 times/24 hours. It usually catches you off guard the second night when your baby is much more alert than they had been in the first 24 hours.

·       Having a baby with breathing difficulties. A full-term baby can use up all their fat stores within 3 hours if they are having breathing issues. Those fat stores were meant to tide things over until your milk transitions to more copious amounts around 72 hours.

·       Having a late preterm baby (born between 34 and the end of 36 weeks gestation). These babies lack fat stores and have immature neurological pathways, requiring more milk than colostrum alone can usually provide.

·       Your baby has increasing bilirubin levels requiring treatment. While this does not mean you are not producing what your baby needs, it often means that your baby is not feeding enough.

The best way to eliminate or mitigate this mismatch is to perform hand expression at least 12 times/24 hours, starting within the first 2 hours after birth, until your milk production increases, then often enough to keep your breasts from becoming full. Full breasts decrease milk production.

Late preterm babies also require that you pump and stimulate your nipples, as their physical characteristics limit the assistance you receive from them in increasing prolactin and oxytocin.

Whenever there is a mismatch between appropriate and adequate milk production, pumping followed by hand expression should occur.