High-Risk Newborns and Low Milk Production

For breastfeeding mothers with high-risk newborns, low milk production can be a concern. And it isn’t one easy answer—the causes can be numerous.

A Delay in Milk Production and Other Hurdles

A delay in the time when milk “comes in” sometimes occurs after the birth of a high-risk baby. Also, it is not unusual to experience a drop in the amount being pumped after several weeks. A drop may be gradual or it may occur suddenly.

Do not wait to get help if milk production is ever a concern. Ask a international board certified lactation consultant (IBCLC), your baby’s nurse, physician, or a breastfeeding support leader to help you figure out what might be affecting milk production if:

• You are not producing at least 16 ounces (about 470 ml) of milk daily by seven to 10 days postpartum.

• You begin obtaining less and less milk each day for three or four consecutive days.

• The daily total dips below 12 or 13 ounces (350 to 400 ml) for more than two or three consecutive days.

Infrequent or insufficient breast pumping—milk removal—is the most common reason for a delay in the time when the milk “comes in,” for insufficient milk production, or for any drop in milk production. A review of the number and length of pumping sessions should always be first thing you do if you are ever concerned about milk production.

It is easy to fall into the trap of letting more and more time pass between pumping sessions when recovering from birth and visiting the baby in the NICU. Also, a mother may initially obtain more milk quickly when several hours pass between pumping sessions. However, without frequent and effective milk removal, the breasts soon get the message to slow milk production. Within a day or two, a mother who pumps less and less often will start producing less milk.

Check Your Breast Pump

If your breast pumping routine does not seem to be the problem, it may be the breast pump you are using. Be sure to use a hospital-grade, electric pump. For most women, manual, battery-operated, or smaller electric breast pumps cannot establish and maintain milk production. Of course, even the best breast pump is still a machine, and machines can break down. Call the rental station if you suspect a problem and ask if they, or the manufacturer's representative, can check the suction with a special pressure gauge. If in doubt, ask to exchange the pump you are using for another one.

When You Have a Health Condition

Occasionally, a mother has a health condition that may delay the large increase in milk production usually seen between three to five days postpartum. These mothers may not begin to get large amounts of milk until seven to 14 days after birth. If this happens to you, do not feel discouraged. Keep pumping.

It can be difficult to keep pumping at least eight times in 24 hours—for more than 100 total minutes—when getting only drops of milk with each session. But it’s very important to keep expressing milk frequently. This kind of delay does not mean you’ll have trouble producing enough milk once the milk does “come in.” Usually, you’ll have plenty of milk as long as you’ve been pumping often enough.

Some conditions, or treatments, that experts think may possibly contribute to a delay for milk to “come in” include the following:

• Stress

• Cesarean delivery

• Postpartum hemorrhage

• Retained placenta fragments

• Infection or illness with fever

• Diabetes—juvenile, adult-onset, or gestational

• Thyroid conditions

• Strict or prolonged bed rest during pregnancy

Other factors can also lead to insufficient or low milk production. These include the following:

• Smoking

• Some medications and herbal preparations

• Hormonal forms of birth control, especially any containing estrogen. However, some mothers report a drop in milk production after taking a progestin-only contraceptive during the first four to eight weeks postpartum. Talk with your doctor for more information.

When All Else Fails

If insufficient milk production still seems to be a problem, yet you have been sticking with the recommended pumping routine and the pump is in good working order, consider the following:

• Increase milk expression to nine to 12 pumping sessions, or to 120 to 160 total minutes of pumping in 24 hours, for several days.

• Begin or increase the amount of skin-to-skin contact you have with your baby during visits to the NICU.

• Ask your physician or an IBCLC to review your health history with you to learn if there may be a health condition, treatment, or medication interfering with your milk production.

• Ask your obstetrician or an IBCLC about medications or herbal preparations found to have a positive effect on milk production.

• Think positive. Although insufficient milk production usually can be reversed, any milk you produce, even drops, is valuable for your baby. Try to remember that the milk collection bottle is half full rather than feel discouraged that it is half empty.