My archives might be a little outdated especially the older blogs. My links above are all new and current.

I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

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Monday, May 26, 2008

Low Milk Supply in Pregnancy

Welcome to the Motherwear's 16th Carnival of Breastfeeding! This month's theme is pregnancy and breastfeeding. Be sure to check out the great posts from other bloggers at the bottom of this post.

This post, previously published 4.5.08, has been Selected to Participate in Motherwear's Carnival of Breastfeeding and has been bumped to the top of the blog. The theme is Pregnancy and Breastfeeding!


My first impression on reviewing my schedule in the morning when I saw I had an expecting mom, 3 months along and her 9 month old coming in for low milk supply was that I probably couldn't do anything to help her supply. I am not recommending herbs and pills to boost supply in pregnancy because they don't work then.

But like everything, you need to sit down, get your facts, and watch the mother and the baby, their interaction and nursing.

So, I have mom sit in my rocking chair with the foot stool and I make sure her 9 month old is relaxed and then she can relax and talk. The baby latched and stayed latch the entire time we talked. The baby reached for mom's long hair with her free hand and massaged and fingered moms hair as she nursed. She made soft little "happy" sounds the entire time. Looks pretty good to me so far. She was normal weight, happy, alertness, and otherwise thriving. Doesn't look like low milk supply to me.

This is where the problem came in. The PEDIATRICIAN told mom to start formula. Why? Because that's what pediatricians typically say when they don't understand breastfeeding. Mom interprets this as something is wrong with her milk supply. Who wouldn't?

My Plan to maximize the duration of breastfeeding:
1. Encourage the skin-to-skin, co-sleeping, co-bathing, the lifestyle stuff that will keep mom and baby together.
2. Let her know that Reglan, Domperidone, herbs are not used in pregnancy. Fenugreek is not recommended in pregnancy at all.
3. Emphasized mom's vitamin, nutrition and water intake.
4. Emphasize the 9 month olds nutrition. At 9 months old, what she doesn't get at the breast, she can get in whole food! (why formula?)
5. LLL has a great book for Mother's who are breastfeeding through a pregnancy. It's called "Tandem Nursing and Beyond." It's subtitle explains why it would be a good book for this mom, "Breastfeeding through a Pregnancy." This is a perfect book if you are contemplating continued nursing while concieving or being pregnant. This is a mother at the right stage for this book. I have it in my lending library.
6. Consider her birth provider. We do have several local midwives that would support her continued nursing.
7. Reconsider her choice of pediatrician. HELLO! Family physician's can provide wellness care. ;)

All-in-all nothing was wrong with her milk supply.

We have some great posts from other bloggers on the topic of breastfeeding and pregnancy. Check them out! (List will be updated throughout the day).

Natural Moms Talk Radio - Carrie shares practical information on breastfeeding while pregnant.
Permission to Mother - Dr. Denise writes about a milk supply mystery.
Crunchy Domestic Goddess - Amy writes about her experience with nursing during pregnancy.
Breastfeeding Mums - Sinead shares advice on preparing for breastfeeding.
Motherwear - A Breastfeeding Friendly Birth Plan.
Breastfeeding 123 - 10 tips to prepare for breastfeeding while pregnant
Milk Donor Mama - I speak from Experience


pearly1979 said...

I met a mom in a similar position. She was actually the princess house consultant that did my party a couple of months ago. She had just found out that day that she was unexpectedly pregnant and had a 7 month old. Her OB told her that day when she called in to make her first appointment to stop nursing immediately. Boy was a I glad she was at my house that night so my breastfeeding friends and I could tell her how WRONG that was. She isn't some one I know well so I don't know how things are going for her, but I hope we made enough of an impression (without being too overzealous) that she sought some info for herself and has been able to continue. She was pretty upset about the idea of having to wean so I am optomistic for her. The misinformation some times is just shocking.

Permission to Mother said...

I know first hand how discouraging it can be told to stop breastfeeding by your OB.
(page 27 PTM)

I lost faith in this OB with her obviously wrong advice this time and other times. When she was on call when I went into labor with Scott, it was one more thing that contributed to me wanting to stay home as long as possible to labor. Nor did I have any desire to call and give her heads up I was pushing and on my way to the hospital.

A midwife from another group caught him (page 30).

And then this OB showed up to sew me up (page 40) and treated me like a complicated birth...

Danibee said...

Not to sound like a walking (or typing) advertisment for your practice, but this is the VERY reason why I have just recently left my Peditrician and started with Dr. Punger for my 3 month old's primary care. I would, in many visits, ask specific questions of my Pediatrician regarding breastfeeding and only hear in return "Breast is best!" I had to challenge my traditional thinking recently when my peditrician recommended that I give my daughter Pedialite during a recent bout of the flu. This recommendation was made over the phone, with no examination of my daughter and no inquiry to see if we were breastfeeding or not. Uh... I think "breast is best" over Pedialite (in this case).

Formula For Orphans said...

Interesting post!

It just makes sense, doesn't it? In my mind, a nursing mother & breastfed baby should see a Family Practitioner who specializes in breastfeeding medicine. We are very fortunate to have PTM in our backyard.

Permission to Mother said...

Danibee (and Sarah and Lauren),
I appreciate your walking and typing advertisment for my practice. Except for LLL and old issues of Mother to Mother, I generally don't "advertise." I do that to support the project. I prefer all my "advertising" to be in the form of education, like writing and teaching. It tells me they got lucky and I have a LOT of work to do.

I'd be to scared to "advertise" in a paper that goes to everyone. I'd be scared at what might come in. I love referrals because it tells me a lot about the new mom and baby (or grandma, etc...) just by knowing who sent them.

When someone (usually not the case with a breastfeeding mother) tells me they picked me off the insurance list or they live two houses down and I am so close, it lets me know they did NO research in choosing a provider.

Paula said...

Those were good advice! I "meet" new moms so often on my website that come for advice on the problems with feeding thier baby (constipation, not eating enough etc, etc). Very often the moms have stopped breastfeeding their babies due to the advice of their doctor. I think it is so sad! It seems to be a common "truth" that milk supply is a problem and the only way to solve it is to start with formula.

I'll bookmark you advice for future reference to my visitors at

Angela said...

I enjoyed this discussion. My child's pediatrician told me to wean when I got pregnant with my second. Fortunately I knew better (and told her about the information in the tandem nursing book) and continued to nurse successfully throughout the pregnancy, and tandem nurse after the birth.

The next time I got pregnant my second nursling was not so interested in nursing and my supply was not where it was the first time. My daughter ended up weaning during the second trimester, and we've both been fine with that!

womantowomancbe said...

My older son was 10 months old when I got pregnant with my younger son. When I was about 3-4 months along, he gave up nursing in 1 day. Literally. One day, I nursed him normally (probably before and after bedtime and naptime, plus another couple of nursings in between), and the next day, he totally refused the breast. I tried for a week to get him to pick it back up, but he steadfastly refused -- crying if I even held him in a nursing position. I guess the taste of the milk changed. But I would have nursed him longer, if he would have.

Layla said...

I wish there were doctors like you around here!

If I get pregnant anytime soon, I plan to Tandem Nurse, because neither my daughter nor I are ready to quit just yet! (She's thirteen months.)

GREAT blog--I can't wait to read your book!


Daniella said...

Thank you so much for posting this. So far this is by far the most useful post I've found. Thanks again!

Happymomma said...

This is very easy for everyone here to say, but I was exclusivly nursing my daughter who I became pregnant while she was 3 months! I was so upset to see that my supply is clearly diminishing at this point, and I saw that I was producing a lot less milk. In Hilary flowers book about pregnancy and nursing she speaks about the fact that 70%, which is the majority of women, expirience a decrease in milk. The milk even changes content. I was so so upset that I had to start to suplement, but at this point (daughter is not even 6 months yet) my diminished milk supply will not be giving her enough food as she is not eating other foods yet and milk is supposed to be the main source. The pregnancy hormones usually slow down lactation and if you are of the 70% you hve to take care of yourself but there is nothing to do to fight hormones in ur body, if they are causing the milk to decrease.

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