What Is Perceived Insufficient Milk Supply?

Midwife supporting a breastfeeding mother with her newborn baby

 

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What Is Perceived Insufficient Milk Supply?

Perceived insufficient milk supply (PIMS) is when a person who breastfeeds believes that they are not making enough breast milk to adequately feed their baby. Sometimes, the mother does, in fact, have a low supply of breast milk but oftentimes their supply is just fine or simply needs a boost.

This is a problem because worrying if your baby is hungry, your breasts are not producing enough milk, and/or whether you aren't "good" at breastfeeding often leads to early discontinuation of breastfeeding.

Overview

One of the most frequently cited reasons for supplementing with formula and/or weaning earlier than planned is PIMS, which is also called perceived low breast milk supply or perception of insufficient milk supply and also may be shortened to perceived insufficient milk (PIM). In fact, over a third of women who wean early report perceived insufficient breast milk supply as their primary motivation.

Researchers note that many women use infant hunger cues to determine if their child is getting enough breast milk and/or if they are producing adequate amounts. However, researchers note that, for many reasons, parent interpretations of infant satiety may not always be completely reliable.

Additionally, people who have PIMS usually assess their milk production as inadequate independently, without feedback from their doctor or a lactation consultant. This means they may assume they have a low supply and lose confidence in breastfeeding without ever having their actual supply evaluated.

These breastfeeding moms often prematurely begin supplementing with formula out of concern that their child is hungry, usually before getting lactation help, which may then cause an actual reduction in supply.

Perceived insufficient milk supply (whether or not the breast milk supply is low) can create a self-affirming loop, as the more a breastfeeding person shifts toward feeding their baby formula instead of nursing, the lower their breast milk supply and breastfeeding confidence may go.

How Breast Milk Is Made

To combat PIMS, it's important to understand how breast milk production works. The system operates on supply and demand so that your body makes as much milk as your baby or babies need. Essentially, the more your baby nurses (or you pump), the more breast milk your breasts will produce. Sometimes, this system may get disrupted (more on this below), resulting in a lower than optimal supply, but usually will rebound with more frequent nursing.

In most cases, if your supply is indeed low, breastfeeding (and/or pumping) more is the ideal, first-line remedy—and is usually quite effective.

Visiting your doctor is also important to rule out and/or treat any underlying, contributing issues and to ensure your mammary glands (which make the breast milk) are functioning properly. Other interventions, such as working with a lactation consultant, adjustments to your breastfeeding technique, or taking lactation-promoting herbs, may also be helpful.

How to Know How Much Milk You're Producing

One reason so many breastfeeding women worry about their breast milk production is that it's hard to know exactly how much you are making.

This is because when a baby breastfeeds, the milk goes directly into their mouth, so it's hard to gauge if they're getting enough. However, there are multiple effective ways to monitor (and feel confident about) how much breast milk you are producing and feeding your baby. There are many methods to increase your supply if needed as well.

Count the Diapers

A key way to know if your baby is getting enough milk is to keep track of their wet and soiled diapers. Five to six wet diapers a day is a strong indication a baby is getting enough milk after the fifth day of life. Between days one and five, the amount of pees and poops should match the day of life.

Note that diaper output will vary from baby to baby but you should expect to change a diaper every few hours, particularly after breastfeeding sessions. Your child's pediatrician can let you know more specifically how many diaper changes you can expect for your baby.

Tune In to Infant Cues

Understanding your baby's infant cues can also help you evaluate your milk supply. Importantly, don't expect these indicators to always be 100% clear—and you're not a "bad mom" if you aren't always clued into this newborn-parent language.

Babies provide many signals to their caregivers, indicating a range of needs (such as hunger, tiredness, discomfort, or overstimulation) and emotions (like loneliness, fear, or joy), but these can be easily misinterpreted, especially in the first weeks of life. For instance, while a baby may cry after feeding if they are still hungry, they also might cry for other reasons, such as due to gas, a soiled diaper, colic, or needing to sleep.

Be aware that if you're already concerned about your milk supply, you may be more inclined to worry that they are signaling hunger rather than something else. In fact, studies show that many women with PIMS use their perception of their baby's post-feeding behavior as proof of low milk supply. The problem is, as noted above, these readings of infant's cues aren't always accurate.

Hunger cues tend to include pursing or smacking the lips, opening and closing the mouth, moving the head side to side, as well as fussiness. Signs that your baby is full after breastfeeding include falling asleep, periods of alertness or contentedness, and producing a soiled diaper.

Remember that in the first few weeks of parenthood, you're still be getting used to the nuances of breastfeeding and your baby's cues. You're also likely quite tired and may be worried about doing everything "right" for your baby, which naturally can breed fear about whether or not your baby is getting enough to eat.

After a feeding, if you think your baby could still be hungry, try addressing their other needs, such as holding them, changing their diaper, rocking them, checking if they could be too hot or too cold, and/or reducing the stimulation (such as lights and sounds) in the room. If your baby still seems unsatisfied, offer them the breast again, either the other breast or more on the same side.

Note too that breastfed babies need to eat often (between eight and 12 times per day for newborns). So, while it may seem like you just fed your baby, rather than there being a problem with milk supply, they may just need to nurse again. Also, some babies use nursing for comfort, similar to how pacifiers are used.

Monitor Infant Growth

Your baby will have a series of well-baby visits in the first year of life where their growth and development will be measured and monitored by their pediatrician. Growth rates will vary among babies but typically, your infant should gain around six ounces weekly and grow a half-inch to one inch monthly. If your baby is growing as expected, you can feel more confident that you are producing (and feeding them) adequate amounts of milk.

Also, be aware that babies go through multiple growth spurts, during which they may seem extra hungry and want to nurse more than usual. This is a normal and expected part of infant development and not an indication that anything is off with your breast milk supply.

If have questions about their growth and/or feeding, ask their doctor. They can let you know if there is anything to be concerned about and can help you solve any feeding issues and/or connect you with breastfeeding resources.

Notice How Your Breasts Feel

If you know what to look for, your breasts can let you know if they are successfully producing milk. Essentially, your breasts should be filling and draining regularly. If you have an adequate breast milk supply, your breasts should feel full (bigger, hard, or firm) before a feeding, and softer (less full) after the feeding.

Some people, but not all, will feel the letdown sensation prior to feedings, notice that their breasts leak a bit before or between feedings, and will notice that the flow of milk seems to be stronger or faster at the beginning of feedings. But don't worry if you don't notice these clues. Not every lactating person experiences these things.

Watch Your Baby Feed

Watch your baby as they nurse. Audible swallows after day five is also a good indicator the baby is transferring milk. Are they latching on with a strong latch over the areola? Can you see some milk filling their mouth? Do they start out feeding more aggressively and then begin to slow and grow sleepy? These are all signs that a baby is feeding well and getting enough milk.

Use a Pump

Another way to check your breast milk output is to pump and see how much you accumulate. While the efficacy of pumping varies, by pumping into a bottle, you can measure how much milk is emptied from the breast. Breast milk consumption rates vary. In general, though, most exclusively breastfed babies take between 25 to 35 ounces of breast milk per 24 hours between 1 to 6 months of life.

Keep in mind that while this can be a good indication that the breasts are indeed making milk, it is not an accurate indication of how much milk a baby is able to transfer. Babies tend to do a better job at extracting milk than a pump.

Get Lactation Support

Another great way to know if you have sufficient breast milk production is to meet with your doctor and/or a lactation consultant. They can tell you for sure if your baby is getting the food they need and if your breastfeeding practice is working.

One way they may evaluate your breast milk output is to weigh your baby before and after breastfeeding. They can also help you finetune any issues that may be impeding your breastfeeding success and connect you with support groups.

Call the Doctor

If you are ever concerned about your breast milk supply, have breastfeeding questions or concerns, or wonder if your baby is feeding or growing well, consult your doctor and/or their pediatrician to address any issues that may be occurring.

Impact

While it's certainly an option to wean and use formula instead if breastfeeding isn't working for you, many people who breastfeed may quit based on misguided assumptions or worries about their ability to nourish their child. In fact, while approximately 84% of moms start out breastfeeding their babies, at three months under half are breastfeeding exclusively and by six months the rate drops to only about 25%.

This disparity matters because the American Academy of Pediatrics (AAP), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) all recommend exclusive breastfeeding until six months of age, with continued breastfeeding for the rest of the first year (or longer) while first foods are introduced.

Still, many parents choose to use formula instead of breastfeeding, either from the start or in the first few weeks or months after their baby is born. Reasons for this include convenience, fear that breastfeeding will hurt or be awkward, going back to work, difficulties with breastfeeding, preference, and other issues.

Note that while breastfeeding has well-documented benefits, formula is also an acceptable option for those who choose to bottle-fed their babies. Only you know what feeding method works best for you and your baby.

Promoting exclusive breastfeeding is considered a public health imperative and is recommended by medical experts over formula for many reasons, including that it is free, easy (once you get the hang of it) and always available, requires no equipment, is nutritionally-tailored to your child, provides immune protection, may offer cognitive and lifesaving benefits (for example, by reducing the risk of SIDS), and prevents a host of health issues such as type 2 diabetes and obesity.

As PIMS is a big contributing factor in reducing breastfeeding rates, it's important to look into what causes perceived or actual insufficient milk supply and how to address those issues.

Many women with PIMS stop breastfeeding simply because they think breastfeeding isn't or can't work for them. However, if there is an issue with supply, it can usually be addressed effectively by adjusting breastfeeding techniques and/or addressing an underlying medical issue.

Since many women quit or reduce breastfeeding due to PIMS, it's also very important to seek out lactation support and find out for sure if your breast milk production is working properly or not.

Once breastfeeding women know if their supply is sufficient or not, they can gain breastfeeding confidence by either being reassured that they are making enough milk and/or get help boosting a lagging supply, enabling them to continue breastfeeding for as long as they desire.

Causes and Solutions

While breastfeeding often becomes a breeze after the first few months, it's not always easy or "natural" at the start—and it's common for doubts to start creeping in.

Recognize that in the early weeks of feeding a newborn, both the mom and baby are adjusting this new skill, which often takes some practice and a few tweaks to get the hang of. In fact, for many new parents, there is a steep learning curve and a variety of issues can crop up until the breastfeeding practice is established.

Technical

Perceived insufficient milk supply often occurs in the first weeks of nursing, right as mom and baby are learning together how to breastfeed. Often a newborn is handed to the mother right after birth (which may have involved many tying hours of labor) and they're expected to just start breastfeeding.

Sometimes, lactation support is given, but often they're not provided much guidance—or are uncomfortable about asking for help and/or don't know who to ask.

Common technical issues often arise with learning effective positions (or holds) and latch, both of which when done less optimally can quickly impede feedings. Plus, small newborns (especially preemies) sometimes have trouble getting enough of the areola in their mouths for an optimal latch, particularly for women with larger nipples or breasts. Sore nipples or engorged breasts due to ineffective nursing practices can also discourage breastfeeding confidence and frequency.

If not resolved, technical breastfeeding issues can result in frustration for both mom and baby and ultimately a lower milk supply if the baby isn't sucking properly or often enough to promote as much milk production as is needed.

However, small tweaks in breastfeeding techniques can often make a world of difference. Lactation consultants, your doctors, and labor and delivery nurses can troubleshoot any problems you are having, as noted above.

Physiological

If it's determined that you do have lower than adequate breast milk production and technical issues aren't to blame, there may be a physiological cause. Some physical or medical issues that can impact breast milk supply include the following:

  • Diabetes
  • Hypothyroidism
  • Insufficient glandular tissue
  • Obesity
  • Polycystic ovarian syndrome (PCOS)
  • Previous breast surgery, such as breast reduction
  • Retained placenta

Premature birth, particularly of babies that need to spend time in NICU, can also complicate breast milk supply issues. Your preemie may not be able to breastfeed (or as often as needed) at the beginning, which may reduce your supply. Pumping is often suggested during this phase to keep up your supply and provide a store of saved breast milk for your baby.

Evaluation by your doctor can help you get a proper diagnosis and treatments, which can often improve your ability to breastfeed. Sometimes, a physiological issue may prevent effective breastfeeding and formula will be needed either exclusively or to supplement breastfeeding.

Psychological

Many new moms who wish to breastfeed their infants wonder if they have a low breast milk supply. However, in many cases, their supply is just fine or simply needs some fine-tuning.

Unfortunately, PIMS can often start a cycle of unnecessarily supplementing with formula—and stressing out or feeling guilty about not adequately feeding your baby—which then may cause an actual decrease in supply, creating a reaffirming loop, as described above.

Know that many women find the first few weeks of breastfeeding to be challenging, emotionally, physically, and practically.

On top of that, new mothers are typically exhausted after just completing months of pregnancy, the rigors of labor and delivery, transitioning to the 24/7 demands of caring for their newborn, and transitioning from life as a single or partnered person into a family with one or more children. All of these factors can combine to take a serious hit on your breastfeeding confidence.

Aim to be kind to yourself and patient as you adjust to breastfeeding. Remember that it's very normal for new moms to feel uncertain and/or frustrated with breastfeeding at first and generally, overwhelmed, inadequate, and simply very, very tired.

Baby blues and postpartum depression are also common and can further undercut a breastfeeding person's trust in their body's ability to produce breastmilk and feed their child.

Despite what our culture may tell moms, breastfeeding is not entirely intuitive and it is harder than you may expect to get breastfeeding successfully established. However, while many women think their supply is inadequate, breastfeeding is often going better than you think.

Pervasive advertising by the companies that make formula may further undermine some people's breastfeeding confidence as well. While these products do contain the basic nutritional requirements that your baby needs, your breast milk is the superior food.

While some products tout their "brain-boosting" and immuno-protective ingredients, know that this does not mean the products provide greater benefits over breast milk.

Demographics

There is a significant disparity in breastfeeding rates based on a variety of demographic factors, including race, age, education, culture, and income. PIMS comes into play with these factors because of a range of ingrained societal inequities.

Studies show that breastfeeding prevalence and longevity are highest among those with higher socioeconomic backgrounds compared with those in more underprivileged communities, particularly families who are Black and/or living in poverty.

The interplay of demographics with perceived insufficient milk supply is crucial because those who are the most likely to stop (or never start) breastfeeding—people in underserved communities—are the least likely to have access to lactation education and support and/or reliable postnatal care.

This means that if people in marginalized communities are worried about their milk production, they may not get the help they need to either boost their supply or get reassurance that their baby is getting the nourishment they need.

So, inequity in services and support may prompt these parents to unnecessarily switch to formula and/or stop breastfeeding sooner than planned.

Tips

New parenthood is rife with joy, wonder, exhaustion, and many worries. You may worry that your baby won't sleep or worry they're sleeping too long. You might worry they are crying too much or not enough, the same goes for soiled and wet diapers, growth, meeting milestones, and feeding. You may also worry that you have no idea what you're doing—this is all normal.

You're suddenly responsible for a whole new life that depends on you making food for them in order to grow—give yourself grace and trust that your body will rise to the occasion.

As a breastfeeding mother, who has to master a whole new skill set of feeding their baby breast milk—a job that they alone can accomplish—it's easy to understand why doubts about whether or not enough milk is being made can occur.

That fact that most of this process happens subconsciously and/or without you being able to "see" it, can also make breastfeeding feel even more out of your control, which may also feed concern over truly making enough milk.

As noted above, the keys to countering PIMS and feeling more agency and confidence in the process are to get breastfeeding support, find out for sure if your supply is indeed low, and continue breastfeeding (and breastfeeding more often). Additional remedies to boost supply and breastfeeding confidence include the following:

  • Be patient with yourself and with breastfeeding—it takes effort and time to establish a successful breastfeeding practice
  • Breastfeed on both breasts at each feeding, which prompts more output
  • Contact a breastfeeding support group
  • Don't drink alcohol or smoke
  • Drink lactation-boosting teas
  • Drink more water
  • Eat a healthy, breast milk-friendly diet, including foods such as fenugreek, chickpeas, ginger, almonds, and sesame seeds
  • Experiment with different breastfeeding positions, such as reclined, side-lying, upright, and football holds
  • Find out for sure if you are making enough milk and then focus on overcoming any obstacles to successfully feeding your child (even if that means using formula instead)
  • Get enough sleep
  • Let go of guilt, worry, or shame about your breastfeeding choices, ability, and how much milk you are producing.
  • Meet with a lactation consultant
  • Practice self-care to reduce stress and take care of your physical and emotional health
  • Pump in between feedings
  • Try nursing supplements
  • Supplement with formula, if needed

Note that every strategy may not work for everyone, so aim to try a variety of interventions until you find what works best for you.

Trust your body—and your instincts. If you think something is wrong, get help, but also have confidence that your body most likely can produce the milk your baby needs.

A Word From Verywell

PIMS is a pervasive worry among people who breastfed, particularly in the first weeks and months after birth. This concern is often unwittingly reinforced by loved ones who may bring over breast milk-boosting foods or products (leading you to worry about your supply), ubiquitous articles on low breast milk supply, and the self-doubt that can sneak in at 3 a.m. with a fussy baby in your arms.

As noted above, maternal uncertainly about having enough milk supply is often due to a lack of lactation support and education about establishing an effective breastfeeding practice.

However, by knowing more about how breast milk production works and how to solve any issues that arise—along with a little support from doctors, lactation consultants, and breastfeeding friends or family, most women can overcome PIMS and produce more than enough breast milk for their baby.

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Article Sources
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