Addressing Low Milk Supply: Clinical Interventions for Lactation Specialists

Ileana Berrios, MS, IBCLC

Low milk supply is a common concern among breastfeeding parents and a significant reason for early weaning. As lactation specialists, our role is to identify the root causes, provide evidence-based interventions, and empower families to achieve their feeding goals. This blog explores strategies to address low milk supply, highlighting clinical approaches and actionable guidance.

Understanding Low Milk Supply

Before implementing interventions, it is crucial to determine whether the milk supply is truly low. Perceived low supply often stems from misunderstanding normal breastfeeding behaviors, such as cluster feeding or frequent feeds. Actual low supply may result from:

1. Maternal Factors:

• Hormonal or endocrine issues (e.g., PCOS, thyroid disorders, retained placental fragments)

• Insufficient glandular tissue (IGT)

• Breast or chest surgeries

• Medications interfering with lactation

2. Infant Factors:

• Ineffective latch or suck

• Oral restrictions (e.g., tongue-tie or lip-tie)

• Prematurity or health conditions impacting feeding ability

3. Feeding Management Issues:

• Infrequent or ineffective removal of milk

• Over-reliance on supplementation without breast stimulation

Clinical Interventions

1. Optimize Milk Removal

Effective milk removal is foundational for increasing supply. Strategies include:

• Assessing and Improving Latch: Conduct a thorough assessment of latch and positioning, making adjustments to maximize milk transfer.

• Encouraging Frequent Feeds: Advise feeding at least 8–12 times per 24 hours, including overnight.

• Pumping Support:

• For parents supplementing or separated from their baby, double electric pumping after feedings is recommended. Proper flange sizing is imperative when pumping. Ensure that the parent is using the correct flange size.

• Suggest hands-on pumping techniques to maximize output.

• Addressing Oral Restrictions: Collaborate with pediatric dentists, ENT specialists, or speech-language pathologists to assess and manage conditions like tongue-tie.

2. Galactagogues

Pharmacological and herbal galactagogues can support milk production in specific cases. Common options include:

• Domperidone or Metoclopramide: Prescribed in cases of prolactin deficiency under medical supervision.

• Herbal Supplements: Goat’s rue or milk thistle may be considered, but evidence is mixed. Monitor for potential side effects or contraindications. Speak to your medical provider before taking any herbal supplements, as this can interrupt medication or current medical issues.

3. Address Underlying Medical Conditions

Work closely with healthcare providers to identify and manage maternal conditions impacting milk supply. For example:

• Endocrine Disorders: Collaborate with endocrinologists for optimized thyroid or hormonal treatment.

• Anemia or Nutritional Deficiencies: Recommend dietary improvements or supplementation.

4. Protect Breastfeeding Relationships During Supplementation

When supplementation is necessary, ensure breastfeeding remains a priority by:

• Using a supplemental nursing system (SNS) to deliver milk to the breast.

• Educating parents on paced bottle feeding to avoid nipple confusion.

• Gradually reducing supplementation as milk supply improves.

5. Emotional Support and Realistic Expectations

Low supply can be emotionally distressing for parents. Validate their efforts and provide reassurance. Encourage them to set realistic feeding goals and celebrate every drop of milk produced. For parents with persistent low supply, emphasize the value of a partial breastfeeding relationship alongside supplementation.

Monitoring Progress and Reassessing

Track milk supply and infant weight gain regularly. Adjust care plans as needed and collaborate with healthcare providers to address unresolved issues.

• Milk Output Measurement: Encourage parents to track pumping volumes to assess changes in supply.

• Weight Checks: Use pre- and post-feed weights to gauge milk transfer during feeding.

Evidence-Based Practice for Lactation Specialists

Research supports the importance of early and consistent breastfeeding practices to establish and maintain supply. Studies show that frequent milk removal in the first weeks postpartum lays the foundation for long-term supply. Additionally, early intervention by lactation specialists significantly improves outcomes for families experiencing low milk supply.

Call to Action for Lactation Specialists

Addressing low milk supply requires a multifaceted approach rooted in clinical expertise and compassionate care. Share your strategies and success stories with fellow professionals to expand our collective knowledge and support.

Together, we can help parents overcome lactation challenges and achieve their breastfeeding goals one step at a time.

References

• Walker, M. (2017). Breastfeeding Management for the Clinician: Using the Evidence. Jones & Bartlett Learning.

• Kent, J. C., et al. (2012). “Breast milk production in the first 4 weeks after birth of term infants.” Journal of Human Lactation.

• Lawrence, R. A., & Lawrence, R. M. (2022). Breastfeeding: A Guide for the Medical Profession. Elsevier.

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