Milk supply is one of the most talked-about (yet misunderstood) breastfeeding topics. A quick Google search can send even the most confident breastfeeding women into a spiral of confusion and self-doubt. "Is my body and milk really 'enough'?"
Once we dig below the surface, it’s not hard to see why this is such a contentious topic. Not only is breastmilk inherently difficult to measure and quantify, but there are plenty of big formula brands who stand to gain from gently swaying women away from breastfeeding. Add this to sleep deprivation, and natural feelings of self doubt and 'enough-ness' in early motherhood, and we have a recipe for low supply fears.
With so many myths and misconceptions flying around, tuning into our own bodies and experiences can be challenging. So, we’ve sifted through the research to get to the truth of why so many women wean early and whether low milk supply is as common as we’ve been led to believe.
Ready to discover the lies, secrets and truth about milk supply? Let’s dive in.
In this blog, we cover:
- Perceived low milk supply
- Why milk production isn’t linked to breast size
- Big formula vs. supply
- Can galactogogues and supplements increase supply?
- The link between diet and milk supply
- How mixed feeding and pumping can impact milk supply
- Milk supply and mental state
- How to boost milk supply
PERCEIVED LOW MILK SUPPLY
The most perpetuated myth in breastfeeding is that low supply is common. This myth is so pervasive, it made it into the World Health Organisation’s list of top myths about breastfeeding and has even earned its own acronyms in the scientific world: PLMS (perceived low milk supply) or PIMS (perceived insufficient milk supply). The medical community use these terms to describe women who 'feel' like they don't have enough milk for their babies, but actually do.
Contrary to popular belief, most women produce enough milk for their baby. This holds true even in extreme cases of malnourishment or immunosuppression.
When low supply becomes an issue, it’s usually related to insufficient demand (i.e. baby not feeding frequently enough), not insufficient ability to produce milk. In rare cases though, insufficient glandular tissue (IGT) can inhibit a woman’s ability to produce enough milk, regardless of how often they feed to stimulate the supply-demand loop. If you suspect you have IGT, you should talk to a health care practitioner.
But breastfeeding is a learned skill that requires practice, patience and support to get it right. If we don’t secure the right attachment or understand what a deep latch feels and sounds like, we can encounter roadblocks and problems in our breastfeeding journey. These problems can feel completely debilitating, and paired with sleep deprivation and the challenges of caring for a baby, can leave women feeling overwhelmed.
WHO recommends that babies are exclusively breastfed for the first six months of life (at minimum), but research tells us that many women discontinue breastfeeding in their first few weeks postpartum. One of the most common reasons for early weaning is PIMS (reported by 35% of women). Some studies reveal as many as 73% of mothers stop breastfeeding early due to perceived low milk production.
In many of these cases, women were using unreliable indicators (such as whether their baby is settling or crying) to come to the self-diagnosed conclusion they weren’t producing enough milk. With better prenatal and postnatal education, these mothers would have been better placed to focus on more reliable indicators (like how many wet nappies and stools a baby is producing each day). As a result, many women may choose to introduce formula before the six-month mark (only serving to slow down their milk production).
Perceived low milk supply is a major challenge for mothers globally, and can have flow-on effects beyond a first baby. Recent research reveals that women who experience PIMs with their first born are more likely to wean earlier with subsequent children, too.
The truth? Low milk supply is incredibly uncommon and the vast majority of mothers produce enough milk for their babies.
We know it’s common to misinterpret common breastfeeding experiences as signs of low supply. So, let’s set the some of the facts straight:
Myth: frequent feeding is a sign that your baby isn’t getting enough milk.
Fact: babies should feed up to 12 times every 24 hours in the early days. This period of frequent feeding is essential to helping us establish a good milk supply.
- Myth: soft breasts mean I’m not producing enough milk.
Fact: it can take anywhere from three to 12 weeks for our milk supply to stabilise, which can cause our breasts to not feel as full. As long as your baby continues to latch properly and feed well, they’ll be getting enough milk.
- Myth: a sudden increase in feeding frequency means my baby isn’t getting enough milk.
Fact: our babies will go through a number of developmental leaps during the first few weeks and months postpartum. It’s completely normal for babies to increase their feeding frequency over a number of days to help your supply increase, too.
- Myth: short feed times means my baby is leaving the breast hungry.
- Fact: after two or three months postpartum, your baby may become more efficient at feeding (meaning they’ll need less time at the breast). Sleepiness, digestive discomfort and other factors can also play a role in how long your baby feeds.
WHY MILK PRODUCTION ISN'T RELATED TO BREAST SIZE
Another big misconception about milk supply is that the bigger our breasts, the more milk we’ll produce. In fact, our breast size has nothing to do with the quantity of milk we can produce.
To bust this common myth, let’s run through the anatomy of our breasts. Our breasts are made up of three core components: fatty tissue, support tissue and milk-producing glands (containing clusters of alveoli). These hollow sacks are packed with milk-producing cells and store milk that has been produced.
Ducts move this milk from the alveoli towards the nipple once our let down reflex is triggered. Then, milk flows through our nipples via tiny duct openings to feed our baby.
That means our milk-producing glandular tissue is what dictates our milk production (not the size of our fatty tissue). Even if we have a smaller storage capacity in our breasts, we may simply need to feed or express more frequently than a woman with a larger storage capacity.
However, it’s important to note that a very small percentage of women do struggle to produce enough milk due to insufficient glandular tissue (or IGT, for short).
IGT can impact women with large and small breasts, and often occurs for women who present with a number of signs, including:
- Over 4cm of flat space between their breasts
- One breast is much larger than the other (known as breast asymmetry)
- Tubular shaped breasts
- Overly large, bulbous areola
- A lack of breast changes during pregnancy, after birth or in both scenarios
HOW BIG FORMULA PROFIT FROM SUPPLY DOUBT
We’re all doing our best to give our children the best start in life, and that will look different for everyone. This undoubtedly makes milk supply a delicate subject, with many mothers lacking clear definitive advice and wondering ( often worrying) that their baby isn’t getting enough milk.
Unfortunately, big players in the formula industry tap into this fear and anxiety among parents.
In fact, research has shown that formula giants are guilty of exploiting women’s fears around milk supply for commercial benefit, through misleading advertising, hospital sampling and biased funded research.
Here’s what we know: a 2021 study by the NYU School of Global Public Health investigated the language and messaging used in the website copy of baby formula manufacturers. Their research found that five of the US’s leading formula manufacturer’s websites actively discouraged breastfeeding (despite the well-documented health benefits for babies).
In fact, 40% of website content about breastfeeding focused on the challenges (such as low milk supply and the struggles of latching). Both the copywriting and imagery selected by formula companies painted a clear picture: that breastfeeding is “hard, painful work” for mums.
Another report by the Changing Markets Foundation offers a comprehensive look at the tactics used by leading formula companies that put profits above science when it comes to breastfeeding.
After reviewing over 400 formula products globally, the report found that unethical marketing practices have been happening for decades. A big focus among this misleading advertising has been “heightening a mother’s doubts by inferring that infant crying, fussiness and perceived hunger are due to an insufficient breastmilk supply,” rather than normal behaviour for young babies.
Even more concerning, studies from multiple countries have found a link between infant formula advertising and a drop in breastfeeding rates. In an attempt to counter this, the WHO created the International Code of Marketing Breast Milk Substitutes in 1981, and it stands to this day. It’s a voluntary code, and not legalised in most countries, so largely ignored by the formula giants.
We know that the global infant formula market has surpassed US$110 billion, meaning these companies have plenty to gain from lowering confidence about breastfeeding. Meanwhile breastfeeding is free, and without a marketing department. With this in mind, it’s no wonder these myths about milk supply are so persistent and prevalent in our culture.
CAN GALACTAGOGUES AND SUPPLEMENTS BOOST SUPPLY?
If you’ve ever looked into ways to boost milk supply, you’ve probably stumbled on the term galactogogues.
In a nutshell, galactagogues are any substances (from foods to herbs) that are claimed to increase breastmilk supply. Typically, they’re used to elevate prolactin levels as a method to enhance milk production during breastfeeding.
However, it’s important to state there is little to no evidence to support the effectiveness of these foods and herbs (and many haven’t been formally studied at all). With only low-certainty research available, it’s impossible to make a definitive conclusion about the impact of natural galactagogues on milk supply.
There are some of commonly used pharmacological and drug interventions that have been shown to boost milk supply. Domperidone and metoclopramide for example, act as opamine receptor antagonists, working to increase prolactin (the hormone that drives milk production). These medications are available on prescription and can help boost milk supply in some women.
THE LINK BETWEEN DIET AND MILK SUPPLY
We know that eating a healthy, balanced diet is key to overall wellbeing when breastfeeding. But there is still a lot we don’t know about the link between diet and breastmilk supply.
The best source we have is a 2017 report that reviewed all the available research exploring the connection between what we consume and our milk supply. While some studies found a link between consuming Vitamin C and milk concentrations of this vitamin in breastmilk, the findings are inconsistent and patchy.
Much more comprehensive research is needed to bring together nutrition, maternal health and milk supply. We simply don't fully understand these complex systems well enough yet to make specific diet recommendations for boosting supply.
What we do know is that women's bodies needs extra nutrients and calories during breastfeeding. Along with eating fresh fruit, vegetables, grains and protein, there is a range of nutrients to prioritise in our diet, including:
- Calcium is essential to our baby’s bone development (most Australian women get enough, but may have poor absorption due to lack of Vitamin D).
- Iodine assists with your baby’s brain and nervous system development.
- Vitamin B12 is also crucial to your mental wellbeing, cognitive health and nervous system regulation.
- Vitamin D is key to ensuring your body and baby absorbs the calcium they need to grow and develop.
- Omega 3 fatty acids are key to eye development and brain health in both mother and baby.
These nutrients are crucial to maternal and infant health, but to date, there is no specific link between consuming these nutrients and the quantity of our milk supply. Our breastfeeding vitamin Lacto is designed to ensure women get the nutrients they need to maintain their own physical and mental health while breastfeeding, not to boost supply.
HOW MIXED FEEDING AND PUMPING CAN IMPACT MILK SUPPLY
Mixed feeding involves the introduction of formula along with breastmilk. Typically, this approach is taken if a mother is having issues or challenges with breastfeeding, or if she is simply looking for some freedom from pumping when away from her baby.
It’s important to be aware of the impact formula feeding can have on your milk supply to ensure you’re making an informed decision about what’s best for you. We know that if mixed feeding is introduced in the first few weeks postpartum, our milk supply may not be fully established and start to drop, so it’s best to wait a month or two before introducing formula.
Mixed feeding can cause our milk production to slow down, especially if we transition multiple feeds per day to baby formula very quickly.
However, if your baby is older and you’ve been breastfeeding for a few months, your supply shouldn’t be adversely impacted.
The undeniable truth of supply, is that it's directly linked to demand. The more you feed or express, the more milk your body will produce.
Pumping regularly can be a practical way to stimulate more milk production, if you can’t always be with your baby to feed at the breast. If you’re concerned about your milk supply, pumping after breastfeeding can also help to stimulate supply.
MILK SUPPLY AND MENTAL STATE
As we’ve mentioned, the perception of low milk supply can take a big toll on us. It’s only natural to feel worried, anxious or concerned if you’re unsure whether your baby is getting enough milk. This can be made worse by the fact that we’re not always feeling our best emotionally and physically in those early days with a new bub.
We do know that there is a direct link between our mental health and our breastfeeding journey. Multiple studies have shown that women navigating postpartum depression are less likely to breastfeed, or may breastfeed for a shorter period of time.
Research has shown that women experiencing stress, sleep deprivation and fatigue during their early postpartum period don’t see a drop in breastmilk volume. While our mental health might take a toll on our persistence to breastfeed, it doesn’t directly impact our supply.
Our bodies have incredible resilience and the capacity to continue lactating, even when we’re not feeling our best.This doesn't mean we shouldn't take our mental state seriously and seek help. Breastfeeding is never more important that the psychological wellbeing of yourself and your family.
HOW TO BOOST MILK SUPPLY
Boosting our milk supply comes down to two key things: frequent feeding or pumping, and fully emptying our breasts of milk.
Here are a few practical steps you can take to support a healthy milk supply:
Skin-to-skin contact at the breast can help to spark the release of our milk-producing hormones and let-down reflex.
Breastfeeding every two or three hours (or roughly eight feeds per 24 hours).
Understanding how proper attachment and a deep latch should look, sound and feel.
- Expressing or pumping after breastfeeding to support milk production and proper drainage.
Plus, it’s important to know what signs indicate your baby is getting enough milk, which can include:
- They're producing at least six wet nappies every 24 hours.
- They’re having three or more bowel movements per day (for the first few weeks postpartum).
- They’re usually alert and content after feeding (but remember you might notice a period of fussiness when your baby is experiencing a growth spurt.
- They’re meeting their weight goals and length milestones.
The best thing you can do if you’re concerned about your milk supply is to speak with an experienced lactation consultant. They’ll be able to check your feeding positions, attachment and latch as well as assess the health and wellbeing of your baby.
THE TRUTH IS OUT THERE (AND WITHIN YOU)
Ultimately, there is a lot of myths and misinformation about breastmilk supply. It’s important to recognise where these myths stem from and who is perpetuating them (sometimes for commercial gain). In reality, the vast majority of women can produce enough milk for our babies and what they're lacking is support, not supply.