True undersupply - ongoing
Some women will experience a true undersupply of their breast milk. Most cases of true undersupply are only temporary and can usually be readily reversible. This may be something that changes in a few days, or something that takes a 1 to 3 weeks to improve (for example, after expressing for many weeks because your baby was sick and/or premature in the intensive care nursery).
Factors that may contribute to experiencing a true undersupply can be:
- Incorrect positioning on the breast, sore nipples and/or engorgement. Infrequent feeding or limiting the length of feeds, or using a nipple shield.
- Ongoing stress and exhaustion, trying to do too much, or balance too many responsibilities.
- Not eating food enough and/or drinking enough water (6 to 8 glasses per day). Rapid weight loss due to strict dieting.
- Becoming ill for a period of time, leading to not eating well or drinking enough fluids. Excessive vomiting and diarrhoea.
- A sudden increase in physical activity. Exercising vigorously and regularly. Sporadic bouts of very physical exercise can also temporarily reduce breast milk supply.
- Feeling anxious about your feeding (because of pain or discomfort, not feeling relaxed, feeling pressure to succeed with your breastfeeding or embarrassed about feeding). If the let-down is not happening for most feeds, this can lead to an undersupply of breast milk. You can read more in let-down.
- Ongoing emotional distress, grief, depression or intense homesickness.
- Continual expressing. If your baby is unwell, or unable to feed and you need to express all your milk for many weeks. This may not stimulate as good a supply for some women (compared to if your baby is actually breastfeeding).
- Hormonal changes. Sometimes when a woman starts menstruating, starts the contraceptive pill or conceives a subsequent pregnancy, her supply will decrease.
- Smoking. Some women who smoke heavily may find that their milk supply is good in the first few weeks, but gradually decreases over time.
- Some prescribed medications and drugs (such as some anti-depressants), as well as some herbal and natural therapies can suppress your milk supply.
- Having had previous breast surgery. If breast surgery involved the total removal of the nipple to resituate it, this may mean that breastfeeding is limited, or not possible. Some breast reduction techniques just move the nipple, leaving the blood and nerve supply intact (as well as the milk ducting system), making breastfeeding achievable. If you have good sensation in your nipples, it is likely that the nerve supply and milk ducting system are still intact. You may wish to find out what technique was used by your surgeon. If you have had extensive breast surgery, then you may experience an undersupply.
- Unknown. It may be that even though you feel you are doing everything right, your supply is still low. It is believed that about 1% of women have physiological problems (usually related to their metabolism) that prevents them from producing enough milk to feed their baby.