Booby trapped! What low milk supply is and why you probably don't have it

I frequent a cloth diapering forum, which has a subforum for breastfeeding support. Hardly a single day goes by without someone starting a thread that goes something like this:

Subject: I have low milk supply!!!

I think I have low milk supply! I only get 2 oz. when I try to pump, and it is super discouraging. My son is nursing around the clock, he wants to eat every hour and a half for almost 30 minutes each, so I don't think he's getting enough milk. We've been giving him formula after feedings, and he guzzles it all down, so obviously he's still hungry. My breasts don't feel full, I don't think there is anything in them! He is only three weeks old and I don't want to throw in the towel yet. Help!

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You may be surprised to learn that nothing mentioned above is indicative of a low milk supply.

From my online research, I learned that while some women truly are physically incapable of producing enough milk, this phenomenon has a low occurrence, around 2-5%. Low milk supply is a real malady, but there are many, many women (and their doctors!) who think they have a low supply when they truly don't! And if I hadn't known better, I'm pretty sure I would have come to the same conclusion about myself. I've gone through everything described in the fake thread posting... and yet I stuck around and somehow produced enough milk to triple my baby's weight in less than a year.

If your baby is getting adequate milk, you should be able to observe the following:

• Plenty of wet and dirty diapers
• Consistent weight gain 
• Signs that baby is consuming milk when nursing-- you should hear swallowing, see their little ears moving, and perhaps notice a little milk dribbling out the corners of baby's mouth.

If these three things are happening, then rest assured that you don't have a milk supply issue. Conversely, if your child is losing weight and showing signs of dehydration, that is your clue that something is wrong. But what about all the problems in the fake message board thread above? Let's go by them one by one, but not before my big PSA.

If there is one thing I want you to get out of this post, it is this: supplementing with formula is one of the most destructive things you can do to your milk supply. The human breast is so amazingly efficient that it regulates how much milk it produces by supply and demand. Every time your baby nurses, your body releases hormones that tell it to produce more milk. Every time your baby does not nurse, your body tells itself to make less. So you can see how counterproductive it is to replace or supplement any feeding with formula!!! If you feel that your supply is dipping, you need to nurse baby MORE, not LESS, in order to tell your breasts to make more milk! Replacing feedings with formula tells your body that it doesn't need to make more milk, so then your supply drops, and then you supplement with more formula-- and before you know it, this has turned into a cycle that ultimately ends in dried-up breasts and exclusive formula-feeding. Human milk is an incredibly fatty, nutrient-dense substance, and there is absolutely nothing in formula that makes it nutritionally superior to breast milk. Unfortunately, there is a lot of ignorance among doctors about this. If your doctor tells you to supplement, run the other way and get the opinion of an ICBLC-certified lactation consultant first! When Oscar was discharged from the hospital, they sent me home with a giant can of Similac and strict instructions to supplement him "because he's so large". I never touched it, and lo and behold, Oscar grew just fine on human milk alone.

Whew. Huff. Okay, my rant is over. It's just that I see sooooo many women fall for this particular "booby trap" and destroy their breastfeeding relationship from this single piece of bad advice. But what about babies that drink a whole bottle of formula after a nursing session? I'm going to let you in on a little secret: even babies have the ability to overeat. Also, many bottle nipples have an overly easy flow that lets the milk just gush out, giving the baby two choices: guzzle it all down as it comes, or choke on it and have it streaming down their face. Many babies simply can't stop eating from the gravitational force of the milk.

Another less-than-helpful idea is that of scheduled feedings. Like adults, babies are simply hungrier more times than others. If you've ever read Oscar's birth story, you know the giant beef I have with scheduled feedings. Babies simply eat when they are hungry, and if you want the best supply and the healthiest baby possible, you will feed when he shows signs of hunger instead of waiting until the baby's scheduled 3 o'clock feeding two hours later. When people ask what Oscar's feeding schedule looks like, I just tell them that sometimes, Oscar eats once every three hours; other times, he eats three times in one hour. It all depends.  Along the same lines, resist the temptation to look at the clock during a feeding. Whether they nurse for ten minutes or forty-five is usually more of a temperament thing, not an indicator of supply.

Frequency of nursing is a bad indicator of supply. You may have times when your baby feeds endlessly around the clock, and it feels like all he wants to do do is nurse, nurse, nurse. Usually, something else is going on. A big culprit is growth spurts! The first growth spurt happens around the two-or three-week mark. This is when a lot of moms start panicking about their milk supply, like the one in the fake message-board post. Keep in mind that all this extra nursing during a growth spurt is a GOOD thing, because baby is preparing mom's breast to keep up with the caloric requirements of a larger baby! Babies can also nurse nonstop when they are teething. It helps relieve pressure on those sore gums, and having mom close is a big comfort. There can be other things in play, too. When Oscar came back from the NICU, he was practically attached to the breast for nearly two weeks. I think he just really craved his mommy's touch and needed to reconnect with me.

All I gotta say is, Thank God for Netflix.

Pumping is also not a reliable gauge of whether your baby is getting enough milk. First off, a baby is the most efficient breast-emptier out there, way better than the best industrial pump. What you get from a pump isn't necessarily all your baby can get from the breast himself. Second, breastmilk in a bottle and formula in a bottle are not the same thing. Formula is not as nutrient-dense as breastmilk; therefore you have to feed a baby a higher volume of formula than breastmilk to get the same nutritional value. This is especially true for an older baby, because human milk actually gets more fatty as a baby ages. Third, some women just don't respond well to artificial pumps. It can be more difficult to experience let-down when you're attached to an awkward plastic gadget rather than your warm, cuddly baby. I personally hardly get anything from a pump at all (we're talking less than a teaspoon), and I suspect a lot of that has to do with the emotional fallout of those first two weeks of stressful pumping around the NICU drama. Fourth, a lot of variables can affect what you get at a pump. The time of day, where you are in your fertility cycle, what kind of pump you're using, and a whole host of other factors can determine what you get at any given pumping session.

But my breasts aren't full! This one had me panicked in the early days. By six weeks, mom's milk supply is usually stabilized. The breasts have figured out  through supply-and-demand how much your baby eats every day, so they don't need to overfill. Having extremely empty-feeling breasts at the end of the day for me is a daily occurrence, and completely normal. The breasts kind of recharge themselves during the early A.M. hours, and over the course of the day, they gradually become depleted. Evening is when the breast milk stores reach an all-time low, and, of course, is usually when the baby wants to nurse the most because he's tired and crabby!

So there's my giant whale of a post about milk supply. Hope you learned something, and maybe put some fears to rest! I don't claim to be the all-knowing breastfeeding expert, but if you have questions, feel free to email me at maria.the.uncommon (at) gmail (dot) com. Kellymom.com also has some excellent resources, especially this page, and your local La Leche League group is a great way to get some face-to-face help.