Primary or secondary causes for low supply?

[stgertrude]

I am writing this because, like many of you with low supply, I am desperately seeking answers and wish to be proactive when and if I have another child. My story is so similar to many of yours on this forum, yet I am frustrated because I cannot definitely figure out what went wrong. I feel like my body wasn't functioning right and want so badly to figure out why.

I've read a lot of posts about women who have either been diagnosed by a LC or have diagnosed themselves with IGT or breast hypoplasia. I've read that this is very rare, estimated at less than 1 per 1000 women, yet it seems like far more people believe they have this condition. I personally do not have many of the symptoms of IGT, yet I feel like it would explain why we had so many issues with low supply. Is it possible that IGT is on the rise or less visually apparent than previously thought?

I've also read a journal article that states that secondary lactation failure is on the rise all over the world, particularly in urban areas. One doctor speculates that the stresses women face immediately after birth inhibit their let-down reflex which often has a snowball effect beginning with the baby not gaining, the mother becoming more stressed and less confident, leading to more inhibited let downs, and a low supply that is difficult to rebuild particular after the first two weeks post partum.

I guess I'm just looking for people's thoughts on this. In the literature and breastfeeding journals I've read, primary lactation failure is cited as relatively uncommon, yet it seems like many of us (myself included) believe this may
be our problem. Secondary lactation failure (due to inefficient latchers/suckers, and other more 'fixable' issues) is more common, yet sometimes the line between primary and secondary lactation failure is not clear. I really wish there was a more definitive way to figure these things out!

[thepeach80]

The hard part w/ IGT is 1) it's hard to dx except in obvious cases. There are many women out there who probably suffer, but don't have the obvious hypoplastic breasts etc. 2) there are many women who don't care enough to find out why they don't make enough milk. They chalk it up to whatever and move on to formula so there's no way to know the real #s when it comes to that. What causes IGT though and is it on the rise are some deeper issues that might be in fact related to more modern times. More hormonal bc, earlier in life, for longer periods of time, more exposure to things in the air, more vaccines, who knows.

There are some things like PCOS and thyroid that can cause problems. I just had mine checked and am o.k. but will probably get it done again at my 6 wk check just to make sure. DRs who aren't proficient (or even LCs) in dx problems like tongue tie, weak suck (this was a big problem for Ilana and while I always thought it might be a problem no one ever mentioned it), high palette, etc.

[stgertrude]

I totally agree that modern pollutants and other things we are exposed to cannot possibly have a good effect on our bodies. Theres a study about girls living in an agricultural area of Mexico who have IGT/hypoplasia due to all the chemicals in their living environment. It's so scary to think of the weird side effects all those things are probably causing.

I guess I'd feel more confident that IGT was my problem if not for the fact that it *feels* like I have glands all over my breasts and I did experience breast changes (though not monumental enlargement) during pregnancy. Maybe this is my problem, but I'm not very sure that is my issue.

I'm so frustrated that there is not more research and time being devoted to lactation failure causes. You are so right that too many women, Drs and even LCs just act like it's no big deal and move on to formula. Obviously there are billions of dollars to be made from selling formula so this plays a big role, I'm sure.

When I had my little girl, I knew from the start her suck was weak, but didn't have anything to compare it to. I felt like she wasn't stimulating let downs, but whenever I mentioned it to my Dr. or LC, they stuck their finger in her mouth and said, "It feels like she has a good suck to me." I don't know if that was a very scientific method of figuring that out or not.

I guess I won't know for sure until I have another baby and see if the issues repeat themselves or not. I'm praying they don't, but part of the reason I'm posting on here is that I want to be prepared for anything.

[leigh09]

I have had low milk supply with both my childen and we have just started TTC #3. With my first, it totally took me by surprise. I thought I was prepared for nursing and heard every woman makes enough milk for their baby, just keep feeding him and he will get enough. He had absoultely no latch issues, he was simply starving and it took three LC's to finally realize low milk supply is a definate issue (I switched to a better clinic to get better help). I was simply being told to keep feeding, he was cluster feeding, he was a slow gainer, wake him up to nurse, feed him constantly, etc. Finally I was told PCOS was effecting my breastfeeding supplies and I had low milk supply.
With #2 I second-guessed myself and thought that maybe if I got good help right away, things would improve. She also had no latch issues, I started the herbs and domperidone (I live in Canada) right away and things were better but I still had low milk supply.

It is definately a primary issue with me. I had absolutely no changes in my breasts during either pregnancy and have never felt my milk come in. I am being much more proactive this time around if we get blessed to have a third baby.
I do agree many women simply don't care of causes of low milk supply and add that in my opinion, many doctors are the same way. If baby isn't gaining, simply give him or her formula rather than try to improve the breastfeeding.

[thepeach80]

If you've never had a nursing baby before, it would be hard to know about weak suck. W/ Ilana I could just pull her off the breast when she was nursing, no breaking the seal or anything. That could've never happened w/ the boys.

[stgertrude]

Peach80~ Your description of your daughter's weak suck was very much like my experience. I was completely unsure of what was normal and what wasn't so the fact I could easily pull my daughter off the breast didn't seem weird until later when I heard about the correlation between a strong latch and sucking.

I also did not go to a lactation consultant until she was nearly a month old, and it was too late. The LC meant well, but she didn't seem to know much about serious supply issues. My baby was underweight, so she spent more time pushing formula than she did looking for a reason for why my body wasn't producing. I vascillate between thinking my daughter's weak suck was the cause of my low supply and thinking my inability to produce milk caused her weak suck. It is so hard to know for sure.

[Megan73]

I wish I knew why I have low supply – it's a chicken-and-egg thing. Does he have a disorganized suck, never cues hunger and falls asleep at the breast because I have low supply or is that why I have low supply?
I had breast changes in pregnancy and my milk definitely came in. I get engorged when he sleeps through the night.
Yet several LCs have said his latch is fine – he just for some unknown reason doesn't transfer that well without help, in our case a Lact-Aid with 10 oz of supplement a day.
I think I'll never know why we've had problems, but I've made peace with our nursing relationship and knowing he gets about 2/3 breast milk and all his food and comfort at the breast.
I was talking to my LC today and she said that I should keep in mind that the odds are excellent my supply – if that's the problem – will be better with the next babe.
Why do so many women have supply issues? I think that in pre-industrial societies women lived in extended families – not isolated in the nuclear family – and were surrounded by other lactating women who could offer support and extra milk for babies who needed it.

[stgertrude]

Megan~ I completely went back and forth over the whole which came first question. My gut tells me it was probably a little of both; her weak suck from the start didn't help matters, and my body was not exactly a milk making machine. I've always been a perfectionist about things and this experience has humbled me greatly but also made me want to have a much better breastfeeding experience next time.

I completely agree that things must have been so much different in pre-industrialized times. Though my mom was a LLL leader many years ago, I had never really been around other breastfeeding women and didn't realize how delicate of a cycle it can be. I think women who are around other breastfeeding women all the time not only have the expertise of all of their peers and elders but also have the comfort of knowing that their babies will be fed with others' milk if they cannot produce right away. With me, I freaked out when I realized my baby wasn't actively swallowing, and it basically put me in panic mode, which couldn't have been good for supply.

I think the fact that you are making 2/3rds of your babies milk is fantastic. I'm pretty sure I was only around 1/2. I would also bet money on the fact that you will be producing more next time.

My mom keeps reminding me to stay positive about future breastfeeding and look at it more as an art than a science. I think that is easy for her to say because she had no supply issues, but I'm also trying to take it to heart. I have to stop analyzing why things didn't work out and put my efforts toward relaxing and believing in my body rather than cursing it for letting me down.

Happy nursing!

[MissyLissa]

I'm in the same situation of wondering what went wrong with my son. He was born 4 weeks early, would not latch on without a nipple shield, had a poor suck, has a high palette, I had inverted nipples, and I think I just don't let down well for a pump. So all of these things combined made it appear that I have/had extreme supply issues. Before and after feeding weights showed he only got 1/2 an ounce from me (except once when he got 1.5 ounces I had not pumped or nursed all night before so I was 'engorged') and pumping after each feeding only produced another 1/2 an ounce. I tried fenugreek, reglan, mother's milk tea, and oatmeal and nothing seemed to help. I also didn't experience many breast changes with that pregnancy so it's really hard to say what the root of our problems was. This pregnancy, however, my breasts are covered with blue veins, my nipples have become less inverted (I wouldn't say that they are completely fixed but they're better than they were), and my breasts are fuller, not enough to go up a cup size but I can still feel a difference in size. So, here's hoping that I can breastfeed this baby!! As I have researched my issues over the last almost two years I've come to the conclusion that my son probably had some serious transfer issues that the LCs didn't see because they were too busy helping other moms when I visited the clinic. He probably needed some kind of oral therapy to teach him how to suck. I have a friend who had a very similar experience to mine and she just had her second baby and she is EBFing!! No problems at all this time around! So there is hope for women like us!

[justthinkn]

It is so frustrating not knowing what went wrong... I feel like I just really figured out the background cause of my IGT (it seems likely that a freak double case of mastitis at 11 killed the developing tissue), and my husband had a hard time at first figuring out why that was so important to me. It's because I want to know what I do and don't have to worry about next time, in terms of trying to improve things!!

[Megan73]

Originally Posted by stgertrude

My mom keeps reminding me to stay positive about future breastfeeding and look at it more as an art than a science. I think that is easy for her to say because she had no supply issues, but I'm also trying to take it to heart. I have to stop analyzing why things didn't work out and put my efforts toward relaxing and believing in my body rather than cursing it for letting me down.
Happy nursing!

Thanks for the good wishes!
It IS emotionally difficult to struggle with nursing. I've often felt that my body has "let me down" and failed my baby and that there must be something just plain wrong with me. I hear you on needing to stop analyzing and feel hopeful that things will be different next time. But even if we have to struggle again, we've both learned that we will persevere to do the absolute best for our little ones.
I hope your next nursing experience is wonderful!

[Mom2Ian]

I had a low supply and don't know why. I'm not planning on having any more children, but it REALLY took me by surprise and I was devastated as I was bound and determined to breastfeed DS. In my case my pcp thinks it was because I was prescribed antibiotics for a UTI postpartum and it completely slowed then stopped my supply (in spite of BF on demand all the time, pumping in between, taking herbs and Reglan, lots of water, La Leche and Lactation consults etc etc etc) beginning from the very first signs of the supply getting lower. I finally was finished altogether when DS was 6 weeks old.

I wish there was more research too on this...my doc still is not sure completely what happened, it was just attributed to the antibiotic, which, if I had known it was going to do that (apparently it decreases supply in some women, but it completely dried me up within a week despite efforts mentioned above) I wouldn't have taken it. I also had mastitis at the time, so maybe that was a contributing factor? My DS is now 10 months old and I still deal with a lot of disappointment. I still feel guilty sometimes too, although that has gotten somewhat better over time.

What really bothers me is when people assume that anyone can breastfeed if they just try hard enough and are proactive or can relactate. I had never tried so hard at anything in my life and wasn't able to relactate at all.

I can completely understand wanting to know what happened since you are planning on having another child...I would be the same way...best of luck to you...

[stgertrude]

As I have researched my issues over the last almost two years I've come to the conclusion that my son probably had some serious transfer issues that the LCs didn't see because they were too busy helping other moms when I visited the clinic. He probably needed some kind of oral therapy to teach him how to suck. I have a friend who had a very similar experience to mine and she just had her second baby and she is EBFing!! No problems at all this time around! So there is hope for women like us! [/QUOTE]


I was once again reminded by my local LLL leader of the many ranges of experiences and level of commitment that different LCs have. I think some simply aren't familiar with complex issues affecting babies or mothers. I am in the process of seeking out an experienced IBCLC for next time.

I definitely think that my daughter had similar issues transferring milk. There were several times I remember feeling somewhat engorged in the early period, yet my daughter did not seem to be getting much milk from me. Since then I've seen that there is oral therapy available for babies who struggle with sucking, but this was not something I was aware of when I needed it the most. I love hearing stories about people who've gone on to EBF. It's refreshing to hear there is hope for us!!:

Also, thank you to Megan and MomtoIan for the kind wishes! I wish the same to both of you!!