Breastfeeding can be difficult in the first few weeks for many women — but for some, the experience doesn’t get any easier. Moms who are dealing with a fussy baby before, during and after feedings can feel frustrated, exhausted and scared and wonder what’s going on. Is it possible that your body simply isn't making enough milk?
In a word, yes. For a small percentage of women, primary lactation failure due to medical reasons is a very real thing. Here are some of the more common medical conditions and reasons that can lead to a low milk supply.
Insufficient growth tissue
Women with IGT (also known as mammary hypoplasia) have breasts that may not have enough milk-making ducts to meet 100 percent of their baby’s needs. Mothers with this condition have breasts that grow very little during pregnancy, if at all, and on the third to fourth day postpartum, their breasts simply don’t fill with milk as they should.
The unfortunate reality of hypoplasia is that, although it is often easy to recognize in hindsight, sometimes the first clue that a mother has insufficient glandular tissue is difficulties with her milk supply. That is why being diagnosed and understanding this condition ahead of time is so important.
There are some visual markers for diagnosing hypoplasia that you can talk to your OB-GYN about before giving birth, including widely spaced breasts, breast asymmetry, presence of stretch marks on the breasts (in absence of breast growth) either during puberty or in pregnancy and tubular breast shape (an “empty sack” appearance). It’s important to note that some mothers with these physical markers have no trouble producing a normal milk supply. However, a breast assessment can help mothers connect with lactation professionals (prior to and immediately after giving birth) to get breastfeeding off to the best start possible.
Dr. Niran Al-Agba, a pediatrician and breastfeeding advocate in Washington state, believes that a nursing relationship is still very realistic even if you have IGT. “In my practice, I have worked with mothers who have IGT, but go on to successfully nurse and provide a range of their baby’s nutritional needs at the breast — some as long as three years — when they combine their own breast milk with the use of supplementation from a variety of sources,” says Al-Agba.
Hormonal or endocrine conditions
Polycystic ovarian syndrome, low thyroid and diabetes are just a few of the hormonal or endocrine conditions that can impact a mother’s milk supply. And while most mothers dealing with these conditions will be able to produce enough milk to feed their baby, there are still some who will not.
PCOS: This is one of the most common female endocrine disorders that can affect a woman’s hormone levels, periods, ovulation, fertility and ability to produce enough milk when breastfeeding.
Low thyroid: Hypothyroidism, or a low-functioning thyroid, can interfere with milk production. The thyroid helps in the regulation of both prolactin and oxytocin, two main hormones involved in breastfeeding.
Diabetes: Mothers who have low levels of insulin may have trouble producing enough milk. It’s believed that the human mammary gland becomes highly sensitive to insulin during lactation, and consequently, that can impact milk supply.
Previous breast surgeries
Breast reduction surgery tends to affect lactation capability the most, although augmentation, lift, diagnostic and nipple surgeries also can reduce the amount of milk a mother can make. The condition of her ducts is very important as well as the state of the nerves that affect milk release. The main concern is whether or not milk ducts and major nerves were cut or damaged. “I wish women who had breast reduction or augmentation were informed before the procedure that it could significantly impact their ability to breastfeed,” says Al-Agba.
Hormonal birth control and certain medications
Estrogen-containing contraceptives have been linked to low milk supply and a shorter duration of breastfeeding, which is why progestin-only contraceptives are the preferred choice for breastfeeding mothers (when something hormonal is desired or necessary).
Additionally, certain prescription drugs and over-the-counter medications can interfere with the let-down reflex and breast milk production. Pseudoephedrine (the active ingredient in Sudafed and similar cold medications), methergine, bromocriptine or large amounts of sage, parsley or peppermint can affect your milk supply.
Can you still breastfeed?
Even if you identify with one of the conditions listed, it’s important to remember that breastfeeding is more than just producing food. Mothers who don't produce adequate milk can still enter into a nursing relationship with their baby. Al-Agba advises moms who have one of these conditions to have realistic expectations — even a little bit of nursing is a good thing. “Infants benefit from one day, one week or one month of nursing — don’t get hung up on the numbers,” says Al-Agba.
Supplementing with formula via bottle feeding, using donated breast milk or feeding baby at the breast with the aid of a supplemental nursing system (filled with formula or donated milk) are all options a mother has when deciding what’s best for her and baby. “Give yourself permission to supplement without making it about you failing as a mother,” explains Al-Agba. “Instead, look at it as maximally meeting the needs of your child.”