Maternal Conditions Related to Low Milk Production

Causes of Low Milk Production

More often than not, concerns about milk production are simple misunderstandings of normal newborn behavior or breastfeeding management issues that can be fixed. Rarely, a woman may have a physical or hormonal condition that makes it difficult to build or maintain milk production.

 

Maternal Conditions Related to Low Milk Production

Insufficient Glandular Tissue: during puberty, progesterone and estrogen signal the growth and development of the mammary (breast) glands. Active growth of ductal tissue takes place during each menstrual cycle. Some women may have breasts that seem to be fully developed but have a limited capacity to produce milk because fatty tissue is present, but glandular tissue is not sufficient. During a normal pregnancy, glandular tissue continues to develop, and there is usually (but not always) a noticeable change in breast size, increased sensitivity or tenderness, visible veining on the breast, and darkening of the areolas.

Symptoms

Tubular shaped breasts

Underdeveloped breasts

Widely spaced breasts (more than 1.5” apart)

Breast asymmetry (one breast noticeably larger than the other)

Large or puffy areolas

Absence of noticeable breast changes during pregnancy or after birth

Breast Surgery: milk ducts may be cut, and nerves can be damaged as a result of surgery. The milk ducts may “re-grow” (recanalize) during pregnancy as the breast changes rapidly in preparation for lactation. Mothers who are unable to produce enough milk to meet the needs of a first baby may have better milk production with the next child as a result of breast development that occurs with each pregnancy. Sometimes, chest surgery or injury may result in nerve damage that affects the milk ejection reflex, or rarely, it may cause damage to the glandular tissue of the breast and result in a decreased capacity to produce milk. Mothers who have had breast, nipple, or chest surgery or injury may find the evidence-based. 

Hormones: many mothers with a hormonal imbalance such as Polycystic Ovary Syndrome (PCOS) have reported trouble producing enough milk for their babies. To date, PCOS, other hormonal disorders, and related conditions such as insulin resistance and infertility are not well-understood in terms of how they may affect milk-production. Some women may produce excess milk, while others struggle to meet their babies’ needs. 

Impaired Thyroid Function: Hypothyroidism is common in women and may affect “4-10% of women” in the postpartum period. Both Hyperthyroidism and hypothyroidism result in irregular production of the hormones T3 and T4 which act on the metabolism of the body. Women who are experiencing low milk production may benefit from having their thyroid hormone levels tested so that problems may be treated. Many mothers with these conditions will have improved milk production when their symptoms begin to resolve.

Hormonal Birth Control:  The use of combined estrogen/progesterone hormonal birth control is associated with low milk production. Many breastfeeding mothers are prescribed progestin-only hormonal birth control because it does not typically decrease milk production. However, it can be associated with a decrease in milk production in some women especially if started before 6 weeks postpartum. Women who are planning to breastfeed should discuss alternative forms of birth control with their health-care providers.

Retained Placenta: The detachment of the placenta signals a cascade of hormones that cause the milk to “come in” after the baby is born. Even a tiny piece of placenta left attached to the wall of the uterus may cause the mother’s body to “think” it is still pregnant. When the placenta does not completely detach as it should, progesterone levels stay too high to allow copious milk production. When the placenta is shed or removed, the mother’s milk production is likely to increase. Retained placenta can be very serious. Health-care providers will explain warning signs to watch for, such as very heavy postpartum bleeding. 

Excessive Blood Loss: When an abnormal amount of blood is lost during childbirth or through postpartum hemorrhaging, the system that triggers the release of prolactin (the “milk making” hormone) in the pituitary gland may be interrupted, and inhibit milk production. 

Infant Conditions Related to Low Milk Production

Latch: A baby who is not attached well and positioned comfortably at the breast may be unable to transfer milk efficiently. An ineffective latch may result in:

damaged nipples

disorganized sucking

fussiness at the breast

A common solution for pain during breastfeeding is to ensure baby is positioned comfortably, stabilized, and given assistance to latch deeply. Sometimes, however, a change in position and a deeper latch do not resolve pain, and there may be a structural problem such as tongue tie, lip tie, or high palate. When breastfeeding discomfort continues despite position and attachment changes, an IBCLC can help with assessment, recommendations for feeding, or referral, if necessary, to other professionals that can assist with treatment.

Suck Dysfunction: If baby is not able to suck effectively and remove milk from the breast, the result may be low milk production. Suck dysfunction is associated with some medical conditions, early birth, low muscle tone, and other problems which should be addressed by a IBCLC or other health-care provider. Some of these babies may tire at the breast while feeding, while others may use their tongues ineffectively or have trouble coordinating the behaviors associated with feeding Sometimes, position changes that increase “positional stability” for the infant may be helpful. Some babies improve dramatically with age, but in many cases, close attention from a IBCLC or other health-care provider is also necessary.