Breast Milk...How Much is Enough?

I don't seem to produce enough milk. Should I supplement breastfeeding with formula?

Perceived insufficient milk supply is a frequently experienced problem for breastfeeding women and is one of the most common reasons reported for complete cessation or decreased exclusivity of breastfeeding1-4. It is characterised by a mother’s belief that she is not producing enough breastmilk to meet the needs of her infant2. Reasons that women assume there are problems with their milk supply range from their baby appearing unsettled and crying, or demanding more frequent feeding, to reduced breast size and firmness5. None of these factors give a clear indication of inadequate milk production, and are more likely to signal that the baby is uncomfortable or in an accelerated growth phase, while changes in breast fullness are associated with healthy milk production3,5. Sufficient milk production is more accurately determined by observing that the baby breastfeeds well and often, wets at least five nappies and passes a minimum of three soft stools per day1,3,5. A well-fed baby should be gaining weight and appear alert and happy at times throughout the day1,3,5.

Breastmilk supply fluctuates with variations in infant feeding patterns and demand1,2. When a baby consumes more milk from the breast, more breastmilk will be made1. Mothers who feel they are not producing adequate volumes of milk are encouraged to try breastfeeding their baby more often and ensure frequent skin-to-skin contact1. It may take a week or more of increased feeding to notice a subsequent increase in milk supply1. Supplementing breastfeeding with formula satiates the baby’s hunger and therefore reduces the volume of breastmilk which will be consumed, negatively impacting milk supply6. If breastmilk supply is truly insufficient, the method of supplement delivery is an important consideration. Where breastmilk is supplemented using bottle feeding, it is important to be aware that artificial teats require less involved suckling mechanics, which may result in nipple confusion and breast refusal7. Artificial teats should be avoided where possible, instead opt for lactation aids, which keep the baby in contact with the breast and simulate natural feeding mechanics2,7.

Current Australian guidelines recommend infants be breastfed exclusively to six months of age when solid foods can be introduced alongside continued breastfeeding to 12 months of age and beyond1,8. Breastmilk is superior to formula as it is nutritionally complete and highly bioavailable, and contains hormones and immunological agents to aid healthy development and immunity1,8. Breastmilk is cheap, convenient, fresh and safe1. Evidence shows that breastfed babies are less at risk of suffering digestive, respiratory and ear infections, type 1 diabetes and leaukaemia8. Women who breastfeed recover more quickly from childbirth and are less at risk of suffering maternal depression, or breast and ovarian cancers in the future8. Mothers who are concerned about their milk supply are encouraged to seek expert advice and support by contacting their doctor or postnatal support network, or utilising online resources, such as the Australian Breastfeeding Association1.

  1. Australian Breastfeeding Association. ABA Website [internet]. South Melbourne: ABA, [date unknown] [cited 2017 Mar 22]. Available from: https://www.breastfeeding.asn.au
  2. Gatti L. Maternal perceptions of insufficient milk supply in breastfeeding. J Nurs Scholarsh [internet]. 2008 Sep [cited 2017 Mar 22];40(4):355-63. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1547-5069.2008.00234.x/
  3. Whitten D. A precious opportunity: supporting women with concerns about their breastmilk supply. Aus J Herb Med [internet]. 2013 [cited 2017 Mar 22];25(3):112-26. Available from: http://search.informit.com.au/documentSummary;dn=605350526251277;res=IELHEA
  4. Noonan M. Breastfeeding: is my baby getting enough milk? Brit J Midwif [internet]. 2011 Feb [cited 2017 Mar 22];19(2):82-9. Available from: http://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2011.19.2.82
  5. Amir LH. Breastfeeding: managing ‘supply’ difficulties. Aus Fam Physic [internet]. 2006 Sep [cited 2017 Mar 22];35(9):686-9. Available from: arrow.latrobe.edu.au:8080/vital/access/manager/Repository/latrobe:16809
  6. Kent JC, Gardner H, Geddes DT. Breastmilk production in the first 4 weeks after birth of term infants. Nutr [internet]. 2016 Nov 25 [cited 2017 Mar 22];8(12):756-62. Available from: http://www.mdpi.com/2072-6643/8/12/756
  7. Moral A, Bolibar I, Seguranyes G, Ustrell JM, Sebastia G, Martinez-Barba C, Rios J. Mechanics of sucking: comparison between bottle feeding and breastfeeding. BMC Pediatr [internet]. 2010 Feb 11 [cited 2017 Mar 22];10(6):6-14. Available from: http://www.biomedcentral.com/1471-2431/10/6
  8. The Department of Health. DH Website [internet]. Canberra: DH, 2017 [cited 2017 Mar 22]. Available from: http://www.health.gov.au