5 Red Flags for Low Milk Supply Every Expecting Parent Should Know.
Worrying about whether or not you will make enough milk for your baby is one of the most common worries that new-parent-to-be have. The good news is that most people have plenty of milk, and this quickly becomes something you don't have to worry about.
And while this is true, there is certainly a non-unsubstantial part of the population that either isn’t able to make enough milk to meet their baby’s caloric needs for the duration of their feeding experience or isn’t able to make enough milk, in the beginning, to avoid supplementation in the hospital or at home until their own supply reaches its full volume.
While it’s definitely not possible to predict who will or won’t have enough milk, here are 5 red flags for potential milk supply problems. That doesn’t mean that everyone with any of these markers will have any trouble making enough milk for their baby…it just means they are in a higher risk category, and if that’s you, getting help prenatally to come up with a game plan to assess your baby’s feeding progress is really important.
THE TLDR VERSION
Here are 5 red flags for milk supply. Just having one of these flags doesn't mean you won't have a sufficient milk supply, it just means you are at higher risk for delayed milk or a reduced supply. Working prenatally with a lactation consultant with expertise in supporting low supply can make sure you have a successful feeding experience.
1. Breast Surgery: The type of breast surgery matters; less invasive surgeries may have a lower impact on supply.
2. Infertility: Hormonal issues related to conception can affect milk production.
3. PCOS: Polycystic Ovarian Syndrome disrupts endocrine systems, potentially affecting milk supply.
4. Thyroid Concerns: Thyroid issues can impact milk production, but support can be effective.
5. Gestational Diabetes & Insulin Resistance: These increase the risk of supply concerns; managing insulin resistance is crucial.
🚩 #1: BREAST SURGERY
If you have had breast surgery then it's important to know that may impact your supply, and the type of surgery you had will have the biggest impact, even if your surgeon told you it wouldn’t.
The less invasive the surgery, the less likely it will impact your supply. Surgeries where you had a lump removed, may not cause an issue at all, and if they do, it may just be a problem for one side. Surgeries where you have substantial tissue removed, like a breast reduction, surgeries that make changes to the position of your breast, like a lift, or surgeries that change the shape cut around your areola (like an augmentation or areola reduction) would have the largest impact because they can both remove milk making tissue and/or cut the nerves that go from the nipple to the brain, and that can disrupt the hormonal release of milk.
Flag #2: SELF-CARE REMINDER:
Lots of women have breast surgeries and feed just fine. I fed three babies with breast augmentation. And even if your surgery prevents you from being able to make all of the milk your baby calorically needs, that doesn’t mean you can’t have the feeding relationship you want.
It also doesn’t mean that you made the wrong choice way back then….so no shame, judgment, or guilt is needed. It just means you need to be aware that your milk supply may be impacted, and work with a professional to monitor your milk closely for the first month until you are sure you are good to go.
🚩 #2: INFERTILITY
If you had a hard time conceiving due to hormonal issues, you are also at a higher risk of lowered milk production, because lots of the same endocrine systems that help in conception also work with milk production& no part of our body works in isolation. Lots and lots of women who go through IVF, IUI, or who took medications to stimulate ovulation make plenty of milk.
It's just something, again, to keep on your radar and find your lactation professional before you have your baby so you have someone you feel confident with to get support if you need it as soon as the baby comes.
🚩 #3: PCOS
Polycystic Ovarian Syndrome is a common cause of infertility, and so this flag goes hand-in-hand with the flag above, because of the disruptions to the endocrine system that often accompany PCOS. Lots of women with PCOS also have other hormonal challenges that accompany it, like the other red flags listed below, and making milk is a process that is driven by the release of hormones that can be impacted by an endocrine system that isn’t functioning optimally.
Again, because it’s worth repeating, plenty of women with PCOS have zero problems with milk supply, so don't panic if you are pregnant….just be aware and prepared.
🚩 #4 THYROID-RELATED CONCERNS
Lots of studies have shown that there is a correlation between thyroid conditions and milk supply. And in fact, TSH (a thyroid-related hormone) is something that is actually passed into breastmilk (here is an interesting study about that right here. so if your body isn't making enough of it, you want to make sure that it is.
The good news about Hypothyroid is that while studies have shown that sub-optimal function can impact our milk supply, that problem self-corrects when the thyroid is brought back into a state of optimal function, often with appropriate thyroid replacement hormones.
The other thing to know is that your thyroid levels can change quickly and significantly after birth, even if you were well managed in labor, so if you already have a thyroid-related diagnosis (hypothyroid, Hashimoto's, Graves disease…etc) and make sure you have a plan to get them checked again a few weeks after delivery.
HELPFUL TIPS:
Lots of people walk (read about this) around with undiagnosed thyroid conditions because the range that our standard labs tell us is the “hypothyroid disease” is relatively narrow, and many women have impaired function well before we get to that point, and the symptoms can be things like fatigue, which lots of adult women already have.
If you had concerns about your thyroid, but your doctor or OBGYN ran a thyroid test and it was fine, don’t dismiss your concerns right away. Lots of doctors only order 1 or 2 Thyroid tests to assess function, but here’s an article that explains why that’s not enough to truly understand what’s going on.
To get a better understanding of your thyroid you really need to work with a functional medicine doctor, a reproductive endocrinologist or a naturopath with experience in endocrine regulation to truly understand what’s going on. They will often help you order the labs you need to help get on a better path
🚩 #5: GESTATIONAL DIABETES AND/OR INSULIN RESISTANCE.
If you have gestational diabetes that’s a good clue for you that you likely have some level of Insulin Resistance, even if you did not have diabetes before pregnancy or your fasting blood sugar returns to normal after you have your baby.
Insulin resistance (IR) just means that your body isn’t efficient in taking up the insulin that your pancreas releases when you eat food, and so that insulin is hanging out in your blood-stream instead of being in the cells where it belongs, and Insulin Resistance as a condition is diagnosed when a blood test indicates that you have enough insulin hanging around to qualify for a diagnosis. If you want more info about IR, you can read it right here:
Insulin resistance isn’t like a light switch, though, where you suddenly have it or suddenly don’t. Instead, it’s like a slow march to that point, where we get ever-increasing amounts until we hit a threshold that our medical society finally recognizes as significant. If you have Gestational Diabetes, you are likely somewhere on that march, even if you never get to a point where it is officially diagnosed.
Anyone with gestational diabetes is in a higher risk category for an initial transition to mature milk and longer-term supply concerns. The good news is that there are also lots of things you can do to support your insulin resistance, including focusing on or maintaining dietary changes you made during pregnancy even if you are told you don’t need to do that anymore.
HELPFUL TIPS:
Here is something interesting…current research tells us that there is a strong correlation between your height-to-waist ratio and metabolic conditions. You can’t do this pregnant, obviously, but you can pull out a pair of your favorite pre-pregnancy jeans and get an approximate number there.
You simply divide your weight (in inches or cm) by your height (in inches or cm) and get the ratio. If it’s greater than 50%, you are at increased risk of metabolic conditions. More about that right here.
That doesn’t mean that ALL people who have insulin resistance have fat that accumulates around their waist, it just means that people who have adipose tissue around their waist have ONE symptom of IR.
TO RECAP
Just because I think it’s super easy when you are pregnant to worry about all-the-things, I want to reiterate that not every individual who has the flags on this page will have an issue with milk production. I breastfed 3 babies with both breast surgery AND insulin resistance, though I didn’t know the latter at the time.
The more you can help to get your body functioning as optimally as you can before your baby comes, the better it’s going to function AFTER your baby comes too.
The most important thing you can do if you have red flags here is to find a lactation consultant who you click with who also has experience with low supply ahead of time, so you can have a prenatal visit and come up with a game plan to monitor you, and your baby so you aren’t having to do all that heavy lifting once baby arrives, and your priorities will be just trying to put one foot in front of the other.
If you have a question about feeding that you would like to have answered, send your question(s) right here.
FOR MORE HELP
If you think you might have a low supply and want more information about how to navigate feeding, check out my Supporting Low Supply Webinar, and learn how to tell if you have a low supply, what you can do to help, and how you can feed your baby how you want, no matter what.
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