Sunday, 17 July 2011

Perceived low milk supply and Frequent feeding.....

So here is my first written article as a Certified Lactation Consultant.... appriciate your thoughts ;)

Are you feeding again? You mustn’t have enough milk? Maybe I don’t have enough?

These are frequently heard comments and thoughts by mums who are simply experiencing normal newborn feeding behaviours. Many mothers are quick to jump to the conclusion they must have a low milk supply. There are however quite a few factors to consider when we look at feeding frequency; the capacity of the breast to hold milk is one that could do with more consideration. It could be easy for a mother to think she has a low milk supply when in fact her breast capacity is simply that of a smaller volume. The mother with a small breast capacity is very capable of making the perfect amount of breastmilk for her baby but because the breast holds a smaller volume of milk the baby requires feeding at the breast much more frequently[1].

The mother, if not understanding of this, may easily mistake her baby who wants to feed as frequently as he does (hourly or 2nd hourly) as a hungry baby whose nutritional needs are not being met. In fact the opposite is true. Case in point, my 3rd child baby Rhys, he was a healthy 3.4kg born, lost only 100g on day 4 and was well and truly over his birth weight at one week. At 4 weeks he is a whole kilo over his birth weight. Rhys has had unrestricted access to the breast since birth, at 4 weeks of age he had developed a pattern to his days where he cluster feeds all morning, has a bigger sleep towards the early afternoon then cluster feeds in the evening, when he goes to bed to feed about 2nd hourly overnight. A very normal feeding pattern of a breastfeeding infant[2].
On one of these mornings the thought came to me, that if I were a new mum who didn’t know any better I would truly believe I did not have enough milk for my little man, I brushed this thought off instantly as I watched him gulp his milk, even if the gulping only lasted a minute or so, and relished in his contentedness and his toes that now were stretching his once loose bonds suit to its limits.
My concern was for those new mums that don’t understand normal infant feeding habits, or breastmilk production and intake by the baby. For if they did understand or at least expect these behaviours perhaps new mums might be more forgiving of their 2nd hourly (or more frequent) feeding babes and not try to manage or fix them.

When the baby feeds as frequently as it wants the breast doesn’t have to hold large volumes of milk, because the breast is frequently being emptied the breastmilk production is at its most[3]. Furthermore, these babies have the potential to have more than adequate weight gain as they are frequently feeding on milk that has a higher fat content. As we know,  the smaller volume of milk in the breast the higher the fat content contained in the milk[4].

With my first children, premature twins I was constantly doubting my supply; I took herbs and medication to help my milk production and attended a residential program at a sleep school. As I look back now, armed with new knowledge and experience, I most probably didn’t ever have a low supply; my babies just weren’t ready to be put on the 3rd hourly feeding schedule that I was so earnestly encouraged to put them on by most of the well meaning health professionals.
If I were in the head space to be able to feed them as frequently as they needed feeding they would have had their milk intake adequately met exclusively by myself and not needed complementary feeding with formula and would have managed to gain weight at a steady pace. How could I not see that  by simply putting babies back to the breast for a “top up” was the same as giving the extra milk via the bottle? I’ve since learnt that it isn’t the same, it can be better.
By topping baby up at the breast, mum foregoes all the bottle and pumping/formula paraphernalia and associated complications, baby is stimulating mum’s milk supply, baby is happy and contented from the breastfeed and the suckling. It may be the case for some mums (certainly for baby Rhys) for “a feed” to consist more or less of 6 breasts; babe happily finishing one side, to  switch to the other and repeat this over and over and even over again. Note here BABY initiates the swap by indicating he is finished the one side.

“He’ll get a tummy ache if you feed him again!” Does this frequent switching lead to aches and pains, wind or even colic as so commonly thought? My response is no, not if as I first mentioned the breast capacity is smaller. Now if a mum with copious amounts of milk, frequently switches sides during a feed, baby will receive lots of high lactose thinner milk that comes at the start of a feed (sometimes known as foremilk) this milk can lead to a windy baby as gases are produced in the bowel from the breakdown of the lactose[5]. It is therefore very important for the baby feeding on this (full) breast to drink as much as possible from that first side so that as the volume reduces the fat content increases and baby gets that good creamy milk at the end of the feed. This baby may frequently only feed on one side, or have a little of the other and be contented for some time.
So in the breast that holds smaller amounts of milk, baby gets the fattier milk more quickly therefore avoiding lactose overload that may lead to a windy upset baby. As the breast is always making milk and is never truly empty, you can go on switching sides as many times as baby indicates, till eventually you have a satiated milk drunk babe.
After a big session of cluster feeding like this babe may just treat you to a nice big sleep, longer than the hour or so that he or she might do usually. Maybe.

I wish mums the wisdom to have faith in their bodies ability to nurture their babies, their body or baby may not fit the cultural norm of fourth hourly feeding, neither simply weren’t meant to. Formula is a scientific creation that is exactly the same every time (provided it’s made up correctly), baby drinks the same amount and drinks it at the same time. Breastmilk doesn’t work that way, it’s a living fluid, it changes composition day by day, feed by feed and as indicated previously throughout a feed[6]. This is why scheduled feeds and breastfeeding just don’t go hand in hand, you might be able to get your breastfed baby on to a schedule but it could be an uphill battle that is essentially going against nature. What a lot of energy to win that fight! If you just go with it, your newborn might be feeding round the clock, but I can nearly guarantee you that your 3 month old will be feeding less frequently, and your 6 month old less than that and your 1 year old less again and so on. Provided they have unrestricted access to the breast you can safely be assured their needs are being met. Beside, this time is ever so fleeting, do you want him anywhere else other than at your breast?

[1] Riordan J, Breastfeeding and Human Lactation p. 123
[2] Day J, Breastfeeding Naturally p. 46-47
[3] Riordan J, Breastfeeding and Human Lactation p. 267
[4] Lawrence R and Lawrence R, Breastfeeding A Guide For The Medical Profession,p.120
[5] Day J, Breastfeeding Naturally p. 139
[6] Wilson Clay and Hoover, The Breastfeeding Atlas, p. 30


  1. Great article Lou! I wish I had heard this when feeding my first. Unfortunately, I was told by "everyone" that there must be something wrong as my baby wanted to feed frequently. If I knew then what I know now..... I'll be sharing this article.

  2. I think that this should be printed out and distributed to all new mothers at hospitals, birthing centres, everywhere. Midwives and doulas should carry copies to distribute to mothers and mothers to be. I know that 'lack of supply' seems to be a common reason that new mothers switch to formula and I feel that this article could really make a difference. I really do.


  3. Bec Coddington18 July 2011 at 18:36

    What a great article. I feel so sad when I hear mums say they had to stop feeding because they didn't have enough milk... if only they'd had the right advice and more confidence in their bodies their breastfeeding experience could have been so different!

  4. What a really great piece Lou, are you really as old as you say you are? You clever wise woman you..
    BTW you are doing such an awesome job at educating others about the beauty of breastfeeding, you have a real knack, I take my hat off too you. Love it! <3

  5. Another mum who wishes she'd learned this during her first pregnancy!!
    I wish not only that every new mother could read this, but every person who gives advice to that new mother could too! Doctors, nurses, midwives, chemists...if only they were all using as much common sense as provided here!

  6. Thanks every one for your positive comments... now how do we get it out there and to all those in need and those handing out 'advice'. hmmmmm

  7. Crosbi Stevens21 July 2011 at 20:27

    Awesome article Lou, thank god I'll have you by my side with wise advice when the time comes xxxx

  8. Fantastic article. As soon as I started reading about Rhys's feeding patterns I thought 'Oh my god, that's me!!!'. My baby sounds very much like Rhys. I am happy to accept his feeding patterns, but I find it very difficult finding time to sleep/eat/dress myself, and get quite distressed. I have a wonderful husband but no other real support and am home alone most of the day. Any tips to cope physically and emotionally with such demanding feeding? My baby is 6 weeks old now and I am starting to feel I can't possibly go on like this for much longer! :(

  9. This is a lovely article and advice that should be given to all new mothers, but as a mother who desperately wanted to solely breastfeed her two children and struggled desperately with low milk supply, I just want to acknowledge that it does happen. Both my children were fed on demand (hourly for 40mins with the first and 3 hourly for 30mins with the 2nd) in the first weeks of their lives and both continued to lose or stay at the same weight. My first was simply comp-fed every feed with formula as that is all the advice I received and a first time sleep deprived new mum is not in any shape to seek out much other information. In preparation for the arrival of my second child I read books, spoke with two lactation consultants and was far more prepared. My second was successfully soley breastfed until about 3 months with the assistance of diet, herbs and prescription medication. She had only one comp-feed per day until she self-weaned at 9 months. I truely believe breast is best but strongly advise all expectant mothers to get as much information as possible before their baby comes. I was lucky to have a wonderful and understanding homecare nurse with my second child who was also a trained lactation consultant combined with a very supportive and informed GP.

    It is very important to promote breastfeeding but just as important not to make mothers feel like failures if they have difficulty or are unable to do so.

  10. @ Anonymous 28/7/11 0314 - thanks for your comment i want to adddress your concerns and you've inspired me for a blog post this afternoon, ill write while bub feeds and dozes (not sleeps lol whats that?), stay tunned.

    @anonymous 28/7/11 0407 Thanks for your feedback. You were lucky with the support around you and good on you taking the responsibility to seek help through out pregnancy and beyond. I hope you are truely proud of your efforts to make sure your babies got the most of their mummas milk.

    I want to point our a couple of things in your post, please dont take it negativly or see me as being insensitive, its just there is so much misinformation out there i dont want to just let it slide incase a new mum reads and take on board wrong info.

    Firstly no health prossesional or ibclc i know sets out to make mums feel like a failure. It is a duty of our profession to make all aware of the facts and falicies of breastfeeding. Breast in fact is NOT best, breastfeeding is normal, the default. If a mother truely believes she has done all she can and has made an informed decision to breastfeed no longer, she should hold her head high. If however it hasnt been an educated decision, if it wasnt truely thought out there may be guilt, mothers should own this guilt, it should not be at the hands of health professionals.
    You know i think too a bit of mummy guilt can always be a good thing, it teaches us to do things differently the next day or the next time or the next baby.

    The number one reason women give for giving up breastfeeding is lack of supply, as the title suggests, this is usually always percieved lack of supply. The ammount of women who physiologically cannot make milk for their baby is as low as 1% of women.
    Low supply is very much a real thing but usually comes from the managment of breastfeeding, shecduled feeds, poor attachment etc, if milk isnt being removed properly or frequently enough, enough milk just wont be made.

    Demand feeding, or i like to call it feeding to need, is just that, responding to your babies hunger or comfort cues, the miniute you put a time on this,its no longer baby led, its scheduled, so to say i feed 3rd hrly for 30mins should not be considered demand feeding, very few new babies would grow well on such a schedule and supply would ultimatly suffer

    Lastly it would be considered from a health professionals stand point abnormal for an infant of 9mths to self wean, there would usually always be more to the story. Self weaning begins somewhere from the age of 18mths and is almost always a slow process over many months or years.

    Heres a couple of links to some related articles...
    on breastfeeding and guilt:

    on weaning:

    Thank you for taking time to share your story and concerns, untill next time


  11. Sadly- sometimes Mothers concerns are right that feeding patterns are tooo frequent, though sometimes its not due to not having enough milk- I spent over two months trying desperately to souly breast feed my daughter who was ALWAYS grizzly and ALWAYS hungry, when I mean always hungry I mean past the usual 1-2 hourly feeds - my daughter was feeding every half an hour for 15 mins- 15 mins after she would finish approximately 1/2 hour from the start of her last feed she would be hungry again- the community nurses and the doctors had seen it and also saw my exaustion. They suggested either denying her the feed and scheduling it so that it wouldnt happen as often and letting her cry it out. I wasnt too keen on this idea as I am for demand feeding and letting my baby cry when she seemed hungry and acted hungry (this was my 2nd child and I have had many years experience in childcare I was good at being able to tell hunger signs apart from other signs) seemed cruel. I didnt want to stop breastfeeding her but it was getting to the point where I was so exausted it was starting to effect my supply and I was depressed etc. So my Mother made a suggestion that I hadnt really thought of - she said 'Well you know from her wee's that she is getting enough milk from you but what if because of your very limited diet due to all of your allergies you just aren't producing a particular thing she wants because you have no way of getting that in your diet' - This made a LOT of sense- at this stage the number of things I could eat was equal to 1/2 and A4 size paper and the things I couldnt eat was equal to about the size of a book or more. So I asked my Mum well what am I going to do about it it's not like I can eat any of the things Im allergic too. So my Mother said why dont you just give her 1 bottle or even 1/2 a bottle of formula a day if she doesnt settle with your milk.
    Tell you what it worked wonders- she became a happier baby and we got rest - she went from 1 feed every half and hour to 1 feed every hour or two instead. Somedays I would give her a formula other days no formula at all just breast milk. I managed to breast feed this way until she was 6 months when she started eating solids and taking less from me- then by 7-8 months she had weaned herself off (despite all my efforts trying to coax her to continue- I wanted to feed until she was at least 12 months) - I continued expressing for a while, so she had at least a bottle of expressed milk a day but once it all dried up and my stored milk ran out she had a formula a day and lots of water and solid foods.
    So although I love this article and agree whole heartedly I think and know from personal experience there are a LOT more reasons than low milk supply that a baby could be feeding more than usual and I think without a doubt the medical proffesionals need to be giving more support to woman who are struggling with these issues in order for them to successfully continue to breastfeed- I for one wasnt given helpful advice or support during this time and had it not been for my mother I would have given up, who knows how many woman have given up due to the lack of support out there and the lack of knowledge that maybe just maybe there could be another underlying reason the baby is feeding and grizzly so frequently rather than low milk supply, Mums exaustion, Mums experience or babies age.
    But LOVE the article keep it up

  12. @ Anonymous Mar 16, 2012 03:58 AM

    Hi there thanks for taking the time to comment. Im so happy for you that you found a method of feeding that worked. I bet it was such a welcome relief to have baby more settled and allowing you more rest.

    I want to touch on a couple of things in your post simply to carify a couple of missinformed bits of information, as this is an article i hope lots of new and potentially vunerable mums or dads will read.

    You're very correct in stating that there are many reasons for frequent feeding other than low supply, most commonly its simply normal newborn behavior. This is the main point of the article.

    I want to make clear for any mums questioning the nutritional quality of their milk. Appart for some very rare genetic metabolic diseases your milk is absoloutly perfectly suited to your baby in every way possible. The most nutrient deprived malnorished third world mother can make perfectly nutritional milk for her baby.

    If you read my last comment in the thread above i touch on normal weaning age for breastfed babies. I wonder if with the right professional support your breastfeeding relationship could have been preserverd longer with such support, if you wanted it too. Research and practice continues to demonstrate that the use of bottles in breastfed babies can significantly reduce the duration of the overall breastfeeding relationship.

    New mums know that there is professional help out there and its finding a care provider who is sypmathetic to your situation and helps you in the way you need help. Hunt them out they are there.

    Thanks again you remind us that we are all striving to do the best that we can do for our babies and families.