Low supply from birth

Can you tell me about having a low milk supply?

About 5% to 15% of mothers do not have enough milk to meet their babies’ needs and have never had enough milk. This can be called primary lactation insufficiency or milk not coming in and there are a variety of causes. Depending on the cause, it can be difficult to increase the milk supply in this situation and the baby must be supplemented with milk or the baby will grow poorly. Even for mothers with a low supply, breastfeeding has many benefits for mother and baby.

A) Describing never having enough milk

Most mothers have a full milk supply. They have normal milk signs and babies that grow well yet many worry that there is not enough milk for their baby.

A small number of mothers simply do not have enough milk to meet the baby’s needs and have never had enough milk. This affects an estimated 5% to 15% of mothers (Lee and Kelleher 2016; Neifert 2001) and can be called:

  • Never having enough milk
  • Milk not coming in
  • Failure of lactation
  • Primary lactation insufficiency

This is different from having a reduced milk supply (a milk supply that is full right after birth but decreases within weeks or months). Milk can also come in late.

There are numerous causes for never having enough milk that can be related to:

  • Problems caused by labour or delivery.
  • Hormonal problems.
  • Breast problems such as surgery or lack of development.
  • Illness in the mother around the time of delivery.
  • Genetic conditions.

Unfortunately, it may be difficult to increase a milk supply in this situation and babies may need to be supplemented with milk for the entire time that they are breastfeeding or they will grow poorly. Depending on the cause of the low milk supply, a mother may or may not be able to increase her milk supply or have a normal milk supply with the next baby.

Some mothers worry that there is something wrong with the quality of their milk. However, it is the amount and not the quality that is the problem.

If you think that your milk supply is low, please see your health-care providers and ensure that your baby is growing well. Breastfeeding specialists can be very helpful in this situation.

B) Signs of never having enough milk

Poor initial weight gain caused by a low milk supply with no known cause

Sometimes it is possible to predict that a mother will likely not have enough milk. For example, she may have had extensive breast surgery. In other situations, mothers may have a number of signs that point to a low milk supply.

1) Poor growth of the baby

Mothers who have a low milk supply will find that their babies can latch and suck well but grow poorly without milk supplements. This is usually evident in the first week after birth. 

2) The appearance of the breasts

If a mother has a low milk supply from birth the breasts may look small or unusual or be very different in size. If she is light-skinned, her breasts may have few or no blue veins.

3) Milk signs

Mothers may have poor milk signs such as:

  • Their breasts do not grow much during pregnancy.
  • Their breasts do not fill much when the milk comes in.
  • The milk comes in late (on Day 5 or later).
  • Their breasts rarely leak.
  • The baby rarely chokes while breastfeeding.
  • The baby is not heard swallowing.
  • They only express small amounts.

C) The amount of milk made

Mothers who never have enough milk may produce very little milk, a nearly normal amount, or something in between.

Very rarely, a mother may have absolutely no milk after a difficult delivery. We have seen this once in our clinic. These mothers need to see their health-care providers as they may have had serious damage to the pituitary gland, a condition known as Sheehan syndrome.

There are several ways to assess how much milk a mother is making. The amount of breast milk will influence how much milk supplement the baby needs.

Mothers who have a low milk supply may wonder if it is worthwhile to continue to breastfeed. Even with a low milk supply, breastfeeding has many benefits for mother and baby.

References

Lee S, Kelleher SL. Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology. Am J Physiol Endocrinol Metab. 2016 Aug 1;311(2):E405-22
 
Neifert MR. Prevention of breastfeeding tragedies. PediatrClin North Am 2001; 48:273–97