Clare Byam-Cook answers our question on low milk supply and formula
The World Health Organisation recommends exclusive breastfeeding for six months, and it’s right that health professionals continue to give out this message. But the reality is, breastfeeding is not always as easy as everyone makes out and so around 50 per cent of new mothers give up within six weeks. Low milk supply is a common problem, but mothers are put under so much pressure to avoid giving formula that a significant number are suffering as a result.
I regularly see babies who are underweight and miserable, their mothers are tearful and exhausted and they are often accompanied by anxious fathers who have no idea how to help.
I believe there is a balance to be struck between reaching for the formula at the first hint of low milk supply and holding out for so long that the baby loses too much weight.
Where to start
During the first few days after birth it is normal for a baby to need to feed frequently (every two to three hours) in order to get enough colostrum and to stimulate the production of milk. Once your milk is fully in, feeding should become less frequent if baby is feeding well. If there is not enough milk, the baby will be unsettled and need constant feeding until the supply improves. During this time, you need to make sure you are eating, drinking and resting as much as possible, along with feeding regularly and possibly taking supplements (such as fenugreek capsules). If this succeeds in improving your milk supply, baby will become more settled and start gaining weight.
Time for a top-up?
It is perfectly fine to offer your baby a top-up after a feed if you suspect she is still hungry. If she is full, she will refuse to take it, but if she’s still hungry she will take as much milk out of the bottle as she would have liked to have taken out the breast. It’s important to offer as much milk as your baby wants rather than limiting it – only by doing this can you see exactly how much she needs. You should then use a breast pump to see how much milk she is leaving in the breast – if there is none left, it will confirm that your supply is low. If there is some left you need to investigate the reasons why she is not feeding effectively.
What often happens…
The mother is doing everything right, but her breasts do not respond with increased milk production. It is normal for breastfed babies to lose up to 10 per cent of their birth weight in the first few days but anything more than that is worrying. With this in mind, it doesn’t make sense for a midwife to weigh a baby, note that she has lost more than 10 per cent of her birth weight and yet still advise the mother to avoid formula. This is why I want to highlight that we need to keep a sense of proportion.
A mother should always be encouraged to persevere if she is suffering from temporary problems such as sore nipples, a mild dose of mastitis, some difficulty in latching or a slightly low milk supply. But if these problems continue to such an extent that her baby is permanently hungry and not gaining weight and nothing is improving, is it in the best interests of the mother and child to continue exclusively breastfeeding? It’s important to realise that what works for one mother does not always work for another.
Note: If your supply remains low, it is fine to continue giving a combination of breast milk and formula top-ups for as long as you need.
Want more? Do you need a breastfeeding aid?