Low Production in the Early Weeks
There are three main reasons why breasts may not make enough milk.
- Infrequent or ineffective removal of milk.
- Hormone or hormone receptor issues.
- Anatomical problems including insufficient tissue and breast surgery
Infrequent or Ineffective removal
It is recommended that a baby breastfeed within the first half hour to hour after birth and then on demand (usually every two to three hours), including the middle of the night. Oftentimes, especially in the hospital setting, this does not happen.
There are also cases where the baby breastfeeds as frequently as stated above, but the removal is not effective.
- Sleepy babies,
- Babies with a weak suck
- Babies delivered by forceps or vacuum and
- Babies with anatomical issues such as tongue tie
Hormone and Hormone Receptor Issues
Certain hormonal problems may lead to lower milk production. They include:
- Polycystic Ovarian Syndrome
- Insulin Resistance
- Thyroid Dysfunction
- Increased Testosterone Levels
- Pituitary tumors,
- Pituitary Insufficiency
- Growth Hormone Deficiency
- Late Onset Congenital Adrenal Hyperplasia
- Severe blood loss
- Abrupt blood pressure changes during or after labor
Anatomical Problems of the Breast
- Insufficient Glandular Tissue / Hypoplasia: The breasts did not mature completely during puberty.
- Ductal Outlet Obstruction: Alveolar cells may make enough milk but the milk cannot exit. These women become engorged and milk cannot be removed easily by baby, pump or hand expression.
- Breast Reduction Surgery:Milk making tissue may be reduced. Ducts may be severed during surgery so these women may become engorged in parts of the breast. Scar tissue may form and cause ductal obstruction.
- Breast Augmentation (Implants): The implant surgery itself should not cause problems with breastfeeding. However, it may be that the breast had insufficient tissue (see breast shape/hypoplasia) which led to the decision for augmentation surgery.
- Lumpectomy or Biopsy (rarely cause low production)
There are a number of medications that may lower milk production:
- Sedating antihistamines like diphenhydramine
- Pseudephedrine and related products given for nasal congestion
- Estrogen containing oral contraceptives
- Estrogen vaginal cream