Will I Make Enough Breast Milk?

Let's start a conversation about why so many parents and soon to be parents today, question their ability to make enough breast milk

to feed and sustain their babies. As a lactation consultant and nurse, I understand there are certain medical conditions, specific medications, surgical alterations and social or personal situations that may directly affect development of a mother's full milk supply. For some time, lactation consultants have been taught that only 5% of women are unable to produce a full milk supply. I personally have some doubt that 5% is even accurate. Where is this "data"? For strictly conversational purposes though, let's just accept that this 5% failure rate is accurate. That then presumes that 95% of women ARE capable of producing a full milk supply. So why then do so many parents and soon to be parents today not trust that their bodies will make enough milk to feed their babies?

Perceived Insufficient Milk Syndrome

As a lactation consultant, this subject fascinates me. This doubt of making enough breast milk amongst parents is SO prevalent, well beyond 5%, that the medical community has given it a name and acronym: Perceived Insufficient Milk Syndrome, or PIMS for short.

A Day In The Life Of A Hospital Lactation Consultant

As an in-patient nurse lactation consultant (IBCLC), every day started by making my report sheet of all the patients in Labor & Delivery, Postpartum, and NICU. After morning Safety Huddle with all the Charge Nurses, Pediatrician, Neonatologist, Obstetrician, and Managers, I started my lactation rounds, first checking in on struggling breastfeeding and pumping moms, then on to all the newly delivered moms on the postpartum unit. Room by room, after introductions and pleasantries, my lactation consult would commence,

"So how would you like to feed your baby so I can best support your feeding choice?"

Feeding Choice

I'd say roughly 35% of my new moms at delivery, had their feeding choice confidently dialed in. The overwhelming response of the other 65% to my question, every shift?

"If I make enough breast milk, I'd like to breastfeed"

My job as a lactation consultant is not only to help parents and babies with their clinical skills of breast milk removal, but to educate parents about the biology of lactation, without even a hint of judgement. If I'm doing my job well, I'm meeting parents where they are, in that moment in time, assessing what their needs are and empowering them with the information/education they need to make their informed feeding choice successful. Over their hospital stay, I encouraged optimal practice of their chosen feeding plan (more on combination feeding coming below), thereby instilling parental confidence and promoting infant feeding success. My hope by discharge, was to be given a thumbs up by moms, as they were wheeled out of the unit, saying, "I've got this".

Why Moms Doubt They Can Make Enough Milk

• "Nothing's coming out. I leaked breast milk like crazy while I was pregnant, now nothing!

• "I can't feel any milk in my boobs and my baby is constantly acting STARVED!"

• "I didn't make enough milk with my last baby, so I have to feed formula"

• "I was told to feed formula until my milk came in so my baby wouldn't starve"

• "My last baby never latched, so I had to pump and I couldn't get any milk"

• "My baby never latched, so I had to feed formula"

• "My baby was in the NICU and when we went home, she wouldn't latch"

• "My baby was in the NICU and she never breastfed"

• "My baby was in the NICU and he prefers the bottle now"

• "My baby was in the NICU. They had already fed him formula, so it was too late"

• "My baby is in the NICU and he eats more every feeding than I can pump"

• "I breastfed during the day and formula fed at night to get more sleep. After 2 months, my baby wouldn't breastfeed anymore."

• "My baby formula fed at daycare and breastfed at night because I had to go back to work. My milk dried up after 2-3 months"

• "My baby hates my boobs so I have to formula feed"

• "What do I need to eat to make more milk?"

• "Which Gatorade should I drink to make more milk, again? I learned on TikTok there is a special color"

• "When I try to latch my baby, she just sits there staring at it. She drinks just fine out of the bottle"

• "My sister didn't make enough milk for her baby, so I'm going to do formula and try breastfeeding"

• "If this whole breastfeeding thing doesn't work out, I'm good with formula"

• "I learned on TikTok that not everyone can make milk"

These are just a few quotes from my last 5 years working as an in-patient lactation consultant. Each and every one of them is honest, valid, and worthy of respect. There are no stupid comments or questions when it comes to breast milk. There are a few common threads these quotes share: misinformation, social media, limited role models, inadequate lactation support, breast pumps, and education. The largest reason, by a long shot, that moms doubt their bodies making enough breast milk is due to never having been taught the nuances of how their body makes milk and how to sustain lactation as long they desire. It wasn't until I became an International Board Certified Lactation Consultant, that I was taught the THOROUGH biology of lactation and the balancing act necessary with outside/unknown variables to sustain lactation. Like most women in the United States, I was taught I had two breasts, they can feed your babies, and it's a supply and demand equation...milk out = milk in, rinse and repeat. I was lucky I didn't have any problems or hardships while nursing my babies or pumping/bottle feeding, other than a wicked case of mastitis 2 weeks postpartum. Seriously, I was LUCKY.

Pro-Tip:

Unless a medical professional tells you otherwise, assume you will make a FULL milk supply!

Free Mini Lactation Consult For The First 2 Weeks Postpartum

Whether your feeding choice is to exclusively breastfeed or combination feed with formula and breast milk, for the potential of a FULL milk supply, the recommendation is going to be the same after delivery for the first 2 weeks:

Feed your baby exclusively at the breast, on demand (whenever your baby is looking for a breast) a minimum of 8 times in a 24 hour period, being sure to not let them sleep more than 3-4 hours in between feedings. The more skin to skin time moms and babies spend together, the more opportunities for latch practice, milk removal, and increased milk supply stimulation. Ideally, stimulation of the breasts should be within one hour of delivery, no more than 3, for optimal milk supply development.

Even though moms may not feel any breast milk in their breasts, they have had their full first milk supply (colostrum) since their 7th month of pregnancy. At delivery, each breast contains approximately 5 ml of colostrum. By design, a term baby's stomach is approximately the same size (a cherry). With a deep latch and a succession of big sucks, their stomachs are full with just one breast! The more they suckle, switching back and forth between breasts, the more proficient they become at milk removal (and filling their tummies); thus, signaling moms' hormones to continue increasing milk production daily towards a full milk supply. Babies' innate reflex to suck frequently, assures their survival. Parents honoring their babies' feeding cues and offering their breasts every time asked, assures the potential of full milk production. Full milk supply is typically achieved by 2 weeks. If, for any reason, you are struggling with breastfeeding, please immediately make an appointment with a lactation consultant!! We literally have this job because breastfeeding is CHALLENGING!

Pacifiers. Why Wait 2 Weeks?

Rooting Baby With Pacifier = No Milk Transfer = Missed Signal For Full Milk Supply

After 2 Weeks, Then What?

Time for your baby's 2 week pediatric check-up! Here's your chance to verify that all your hard work and sleep deprivation landed you a FULL milk supply if you exclusively breast fed, on demand, since delivery! The pediatrician will be asking many detailed questions about your baby: how many pees and poops and diapers daily, how many breast feedings in 24 hours (or if exclusively pumping, how many pumps daily and when, volume pumped, and number of bottles fed), do you feel your breasts filling and emptying, is your baby satisfied after eating, etc. Next, your baby is placed on the scale. If your baby is back to his/her birth weight at the 2 week appointment, there is your confirmation that you DID produce a full milk supply! It's very validating for parents to have their pediatrician confirm all is well since they couldn't see how much their babies were eating! If only breasts were transparent or came with a tank gauge like cars do!

For Combination Feeding Parents

Approximately 50% of my patients proudly combination fed by choice for a multitude of reasons, all of which I greatly respected. I did however, recommend to them all, from a biological stand point, to exclusively breastfeed for the first 2 weeks and THEN commence their combination plan; thus, starting their combination feeding plan from a milk supply position of strength. Choosing combination feeding, esp. from delivery, means understanding and accepting the unavoidable down-regulation of one's milk supply, due to less frequent breast emptying. It's not that you couldn't make a full milk supply, it's that you signaled to your body that you didn't need a full milk supply. That's a HUGE difference!

I've shared many tips over the past 5 years so parents could combination feed breast milk as long as they desired. Many parents express interest in reaching the one year goal of combination feeding. That is a huge challenge for so many reasons. For context, I had only 6 combination feeding parents over the last 5 years successfully meet their one year goal of feeding breast milk. I asked all 6 parents what their secret sauce was so I could pay their wisdom forward. They all said EXACTLY the same thing:

"I breastfed most of the time, but offered probably 3-5 bottles of formula, a week"

Let's Get The Word Out

I've been asked many times, if there were just one thing you could give your moms to help them meet their breast milk goals, what would it be? My unapologetic answer, confidence. Let's get the word out there that moms CAN trust their bodies to make enough milk to feed their babies if they choose. Education is POWER! Let's make PIMS a thing of the past. Try the two week challenge after delivery. Then tell your friends and family how it turned out.

I have a hunch...