Where did the milk go?


Your baby is growing well, you’ve established a good milk supply and even have a bit of a stash in the freezer. You have gone back to work or school and your milk has been keeping up with what baby needs. Suddenly, or maybe not so suddenly, it seems to be dropping. You are pumping less during the day; baby is eating more (or at least day care is asking for more). You are getting worried. What’s happened? Possibilities:
• Perception of low milk: has your output really changed? You may not feel as full-then-empty-then-full as during the first few months of breastfeeding; you are probably leaking less. Your body has gotten more efficient at producing milk. There may be just as much milk, it just isn’t as obvious. Go back to logging if you aren’t certain.
• What a breastfed baby needs may be less than day care is asking for: many caregivers interpret the first signs of fussiness as time for a feed. At home you are more likely to check other things first: a diaper change, a change of scenery. In addition, babies often drink from a bottle very quickly and will continue sucking if they are given more, even if they aren’t really hungry. The total intake of a breastfeed baby between about one and five or six months doesn’t change much: 25-32 ounces per 24 hours. Divide that by the number of times your baby feeds per day, and you will see it’s probably about 3-4 ounces per feed. Make some suggestions to the caregiver about slowing down your baby’s feeds perhaps or spacing them farther apart.
• Has your baby dropped a feeding or is he sleeping longer at night? If he is only nursing 7 times in 24 hours, but he used to do an 8th feed say at midnight, you will not be getting the same level of emptying and stimulation you had when he was feeding more often. 

It’s true there are changes in milk production over time:

• One theory is that during the first 6, or 12 or even 20 weeks of nursing you have an oversupply of milk: pumps and perhaps baby doesn’t remove all of the milk and the process of calibrating your production to what your baby really needs actually takes that long. With this perspective you could say your milk supply is not down-sizing, it is right-sizing.
Hormones play a role in milk supply. As the weeks go on, you may ovulate, start your periods or start hormonal birth control pills. Even the mini-pill can have an effect on milk supply for some women.
Your health can impact your milk supply. It’s common to hear concerns about milk supply and then find out a mom has had a cold or the flu. You may have gotten dehydrated when you had family in town; you got caught up in their activities and forgot to drink as usual, Perhaps you even missed a feed without being able to pump.

What to do:

• Go back to basics: take care of yourself. You may feel great (after months of pregnancy and sleep deprivation), but don’t take on the world yet.
• Watch your baby’s lead: if she’s eating like she is in a growth spurt, try pumping more at work and allowing baby unlimited access to the breast when you are with her for a while to match her pace.
• Try power pumping or pump after feeds at home to step up the messages to your body to increase the amount of milk you make. (Sit down for an hour to read or watch TV: pump for 10 minutes, stop for 10 minutes, pump for 10minutes, etc. through the hour. Don't worry about how much you get: you are putting in the order for more milk in days that follow.
• Make sure you haven’t gotten ho hum about the pumping; set the mood to relax while pumping with smells, sounds or a picture of your baby. Wait for a second letdown rather than rushing through. You may need to add an extra pumping session in the evening before you go to bed.
• Learn manual expression. Women doing long term pumping for very low birthweight babies at Standford University’s School of Medicine have found they can express ounces of additional milk by manual expression, even after they have pumped the appropriate amount of time with their hospital grade pump. 
Cosleep with your baby. Research shows mothers and babies who sleep together have twice as many breastfeeding sessions, some even when neither mother or baby are fully awake.  or take the baby into bed with you to get some extra breastfeeding in at night, even if the two of you barely wake up. (Be sure you are sleeping safe: check these guidelines.)
The bottom line is: don't panic. You have some things you can try. Watch your baby closely and follow her lead.

Bonyata, Kelly, “Increasing Milk Supply”, Kellymom, http://www.kellymom.com/bf/supply/low-supply.html

West, D., Marsco, L Making More Milk. (McGraw Hill, 2009)

 “Maximizing milk production with Hands-on pumping’” Stanford School of Medicine, http://newborns.stanford.edu/Breastfeeding/MaxProduction.html 

McKennaJJ,MoskoSS,RichardCA.”Bedsharing promotes breastfeeding.” Pediatrics 1997; 100: 214–219