BREASTFEEDING CONNECTION
MILK SUPPLY – PERCEPTION, REALITY, ASSESSMENT AND FEEDING OUTCOMES Qualitative and quantitative research indicates that maternal perception of insufficient milk supply can lead to supplementation of breastfeeds and shortened breastfeeding duration (Kent et al, 2012). If perception of milk supply is a potentially modifiable factor for breastfeeding continuance, is it important to assess the difference between perception and reality, and also to recognise the difference between a primary breast milk supply issue and a secondary issue? And, can low supply be turned into abundance in some situations? CAROL BARTLE POLICY ANALYST
Using words like low supply, as opposed to the terms inadequate, insufficient and failure can have an impact on how a woman feels about “breastfeeding and her breastfeeding body” (Burns et al, 2016) as choice of language can have a positive or negative impact. Knowing what factors can support lactation, breastfeeding initiation and breastfeeding establishment can assist women to meet their own breastfeeding goals. For example, Sandhi et al. (2020) found that high levels of maternal perceived breast milk supply were positively linked to skin-toskin contact or rooming-in, the experience of positive infant suckling behavior, and/ or self-efficacy in breastfeeding women. The study highlighted the importance of maternal perception of milk supply to positive breastfeeding outcomes. Galipeau et al. (2017) found that maternal self-efficacy had an impact on perception of low milk supply and suggested interventions should be directed at increasing maternal confidence. One of the most frequent reasons for not breastfeeding is described as a previous unsuccessful experience by Burns et al. (2020) and midwifery continuity of care and breastfeeding support, which includes peer counsellors, can increase women’s confidence and provide psychosocial benefits. Low milk supply can be related to what are termed primary issues, and these can be linked to the amount of glandular tissue in
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the breasts, hormonal issues, previous breast surgery, or a severe postpartum haemorrhage. Secondary issues can occur alone, or alongside primary issues, and when both occur it may be difficult, if not impossible, to resolve issues of low milk supply. Secondary issues usually occur in women who do not have a primary reason and are caused by factors interfering with the usual lactogenesis process which should usually result in ample milk supply. Birth interventions, sleepy babies who are exposed to labour medication, separation of mother and baby, latching problems, scheduling feeds, pacifier usage, using breast-milk substitutes, lack of information and support, and early hormonal contraception have all been implicated.
Using words like low supply, as opposed to the terms inadequate, insufficient and failure can have an impact on how a woman feels about “breastfeeding and her breastfeeding body”
Full milk production needs sufficient breast glandular tissue, synchronised balanced hormone production, intact nerve pathways and frequent effective removal of milk from the breast. In terms of real or perceived issues with milk supply many women think they do not have enough milk when in reality it has been reported that approximately 2 to 5% of women may have a ‘real’ problem with their supplies. Perceived can quickly become real, however and as suggested by Stuebe (2012) it may not really matter whether real and perceived are counted together as, “… mothers are suffering, whether they lack glandular tissue, and/or they lack self-efficacy and support.” Lactation, and its intimate companion breastfeeding, can be seriously compromised when a baby is not feeding directly at the breast which is why separation of mothers and babies can be damaging to breastfeeding. For a woman with an actual low milk supply, assessment and where possible rapid resolution of underlying issues, getting the best latch, using breast compression to support milk flow and implementing strategies to increase supply may be necessary. This will likely include at some point mixed strategies such as hand expression, breast compression, direct breastfeeding, supplementary nursing systems, using a breast pump, and in some cases galactagogues. Mother baby skin to skin contact is a first line action as is full evaluation of breastfeeds. Where women have had previous difficult breastfeeding experiences and /or low milk supply it is particularly important to ensure uninterrupted skin-to-skin contact after birth, minimal disturbance of mother and baby, and support for the baby to proceed through the nine stages after birth while in skin-to-skin contact (Widström et al, 2011). This supports pre-programmed behaviours for bonding and breastfeeding. Attention to time and space, observation, and avoidance of interruption are recommended for all mothers and babies (Widström et al, 2019). Supplementary nursing systems have been used successfully by many women for varying lengths of time and some women have continued to use them, with either donor milk or formula, for the duration of their breastfeeding journeys. Women who have low milk supplies, which have not increased to be able to fully meet their babies’ needs, may have planned to exclusively breastfeed, and facing their feeding realities may cause a degree of grief, sadness and disappointment.
