I found this interesting little scoring chart for self assessment and when to seek help. I mentally scored our first few weeks and came up with a score of 21. Low end of normal, me mostly getting points from my inherent nipple shape, and not having rock hard boobs, but having scores of 1 and 2 in multiple areas. I had 5 1’s and 5 or more 2’s. I think we can safely say that milk consumption by my child was an issue. But there’s not so much information on delineating milk transfer issues from milk supply issues. It seems there’s a lot of focus on either supply or latch and positioning. But looking at that list above I can mentally tick off causes for the troublesome symptoms listed, probable latch/oral abnormality issue, potential milk supply issue and so on down the list.
I was chatting with a woman months ago and she mentioned some really classic tongue tie symptoms: clamped nipple, serious damage and pain, baby losing weight despite her experiencing engorgement, baby who would only latch if propped up just the right way, and baby slipping off the breast. I said, tongue tie, get it checked, and go to a dentist if your LC doesn’t agree, here is a list of ones in your area. Here’s some pictures. She ignored me (as people do, after all, who am I?) because her lactation consultant focussed instead on propping the baby up just so, having the right amount of pillows, sitting just so in a special chair. So she was able to feed the baby with someone there to make sure everything was just so. Not so much when she didn’t have help. It still hurt, but it was tolerable. For a while. Then she started pumping to give herself a break. Then she had to do the whole song and dance over getting her baby to take the breast again. Finally, after several months of this she finally got a tongue tie diagnosis. During this time she was concerned about her supply. Her baby wasn’t gaining quite right. I kind of wanted to bang my head against the wall and say it’s not your supply! Or at least it wasn’t… Ah well. It seems somewhat common to ignore the potential oral issue in favour of finding a positioning, or latch technique, fix.
Supply issues are a common worry. Here are some common features that low supply and milk transfer can share:
- Long feeding times (in excess of 40 minutes with short breaks and few substantial sleep periods)
- Poor infant weight gain, or loss
- Poor infant output
- poor infant test weight
- apparent lack of milk in the breast (poor engorgement, not full feeling)
- Lack of appropriate sucking or swallowing motions (mine was a big flutter sucker)
What features are unique to low supply?
See, that’s the thing. I can’t think of any that do not benefit from first ruling out milk transfer issues. Low supply is certainly real, as well as more common than it’s made out to be, but a lot of the probable symptoms benefit from a wait and see approach (apparent tubular breasts or IGT), or can be caused by ineffective milk transfer. There isn’t a whole lot you can do before birth to assess probable low milk. Breast shape and placement are good markers, but breast changes from days 2-5 post-partum and physical examination of the infant for sucking ability are better indicators. Hence the wait-and-see.
So what features are more commonly associated with milk transfer issues?
- Latching issues. Anything from slipping off the breast, to pain, to tissue damage.
- infections or blocked ducts
- nipple shape-coming out of the infant’s mouth compressed or inherently flat or inverted
- When your breasts do not grow, become painful or otherwise change during pregnancy.
- Flat or inverted nipples, large breasts
- When you have PCOS, thyroid disorders or other autoimmune disease.
- If you had a short luteal phase (8-10 days or less), excess spotting before or after menstrual periods. This is a sign of low progesterone.
- Any kind of breast surgery
- Previous breastfeeding issues
- Diabetic, gestational or otherwise
- Other mother medical issues, or expected baby medical issues