Module 1: Clinical management of low milk supply

Introduction to Low Milk Supply Management

• Discussing the prevalent issue of low milk supply in lactation consulting.

• Educational purpose of the webinar with no conflicts of interest.

Key Statistics

• In Canada, over 90% of mothers initiate breastfeeding.

• 42.5% stop before one month due to perceived low milk supply.

• Actual low milk production (hypogalactia) occurs in only 5% of cases.

Understanding Low Milk Supply

• Hypogalactia: Insufficient milk supply to maintain exclusive breastfeeding.

  • Only 5% due to anatomical or medical issues.

  • 95% related to poor feeding management or perception of low supply.

Causes of Low Milk Supply

• Poor support and feeding situations leading to confusion about milk supply.

• Medical Conditions affecting milk production:

  • PCOS, retention of placental debris, and primary hyperplasia.

  • Side effects from drugs, alcohol, or medical treatments.

• Feeding Management Issues:

  • Ineffective latching, separation of mother and baby, etc.

Importance of Investigation and Diagnosis

• Low milk supply must be investigated rather than normalized.

• Identify whether early supplementation is truly necessary.

• Assessment of weight gain in newborns is crucial.

Types of Low Milk Supply

• Early Supplementation: Can lead to a perceived low supply.

• Late Onset Low Milk Supply: Occurs when babies who were previously well-fed start showing fussiness or reduced weight gain around 6-12 weeks.

  • Important to assess milk output (wet/dirty diapers, weight gain).

Investigating Low Milk Supply

• Comprehensive assessment involving:

  • Feeding technique, breast conditions, and oral health of the baby.

  • Analyze mother's medical history and lifestyle factors.

• Team Approach may be needed for effective management.

Strategies for Management

• History taking and clinical assessment are foundational.

• Feeding Assessment:

  • Analyze the baby's latch and drinking patterns.

• Breast Exam:

  • Check for engorgement, cracks, and any signs of clogging.

Lactation Care Plan Development

• Create a structured plan for management including:

  • Education for the parents on strategies to increase supply.

  • Follow-up timeline to monitor progress and adjustments.

Identifying Effective Positions and Techniques

• Optimize latch and breastfeeding position based on baby’s needs.

• The importance of consistent stimulation and feeding on demand.

• Use lactation aid for supplementation as necessary, while retaining breastfeeding.

Evaluation of Strategies

• Regular reassessment to determine need for more complex interventions (body work, oral motor therapy).

• Manage expectations and provide clear timelines to parents to avoid overwhelm.

Referral and Team-Based Management

• Collaboration with healthcare providers (doctors, SLPs, etc.) for specialized care.

• Mental health and community support evaluation for the mother.

Use of Galactagogues and Supplements

• Discuss various galactagogues and their efficacy, based on practice scope.

• Options ranging from dietary recommendations to prescribed medications.

Conclusion and Follow-Up

• Importance of follow-up assessments to track improvements.

• Encourage parents to communicate ongoing concerns and successes.

• Ensure to provide a concise lactation care plan and support resources.