Most mothers experience, at some point during their pregnancy or lactation, a fear that they will not be able to produce milk or produce too little. In many cultures there are even rituals (mother’s rest, feeding, medicines, infusions) in order to guarantee successful breastfeeding.
Despite the frequency of these fears, the usual thing is that the mother is perfectly capable of breastfeeding her babies . What’s more, in the case of having twins, you would also be able to breastfeed both; or in the case of tandem breastfeeding, in which the newborn and an older sibling are breastfed.
However, there are some situations in which mothers are not able to produce enough milk to exclusively breastfeed their baby, which is known as hypogalactia .
Hypogalactia is the inability of a mother to produce enough breast milk to exclusively meet the nutritional needs of her baby.
True or primary hypogalactia and secondary hypogalactia
We can find different classifications of hypogalactia; I like to talk about primary or true hypogalactia and secondary hypogalactia . In both cases there is a low milk production but the origin is different.
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In primary hypogalactia , the mother is not able to produce milk, for different reasons that we will see below. Fortunately this is very rare .
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Secondary hypogalactia , on the other hand, is much more common and, fortunately, can be reversed. Here we find babies who are not capable of a good expression of breast milk (babies with a frenulum, poor latch on …), the breast being half full and thus reducing the stimulus to produce more.
We also find here with poorly focused breastfeeding, with rigid schedules instead of on demand, skipping a feeding or in which there is prolonged separation from the mother. In this case it can be corrected when we fix the initial problem. We can also increase (or in addition) the production of breast milk through manual expression or with breast pumps or by performing powerful expression.
Women with breast hypoplasia and breastfeeding
We have long demystified the belief that small breasts were not good for breastfeeding: size does not matter in breastfeeding.
However, there is a special condition: breast hypoplasia . In this case, the breasts are small because they have a small amount of mammary gland (unlike breasts that are normally formed but small because they have little fat tissue).
It can be due to an abnormal development, already during the embryonic stage or to an insufficient hormonal stimulus or an inadequate response of the breast to these stimuli. Upon reaching puberty, the breasts begin to develop.
Through hormonal stimuli the breast tissue begins to grow and also the fatty tissue that shapes the breast. During pregnancy it finishes developing and preparing for the stage of lactation. Hypoplastic breasts are not synonymous with small breasts, but rather have certain characteristics:
- have a characteristic tubular or cone shape
- they are usually very far apart
- the areola and nipple are very large compared to the breast
- there may be a significant asymmetry between them
If you want to breastfeed and have hypoplastic breasts, the first thing to do is get informed and have specialized help. Although breastfeeding in these cases can be difficult, I have seen mothers who have achieved exclusive breastfeeding , and many others who have been very happy mixed breastfeeding. So it is worth a try.
Women with breast surgery and breastfeeding
Breast interventions can cause problems in breastfeeding.
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Breast augmentation . In these cases there is usually no problem if the approach is inframammary (respecting the areola). The prostheses themselves do not contraindicate breastfeeding. Sometimes we find mothers who underwent surgery because their breasts were hypoplastic, with little mammary glandular tissue, and in this case we will encounter the difficulties discussed in the previous section.
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Breast reduction . Very often mothers who have undergone breast reduction have difficulty breastfeeding. The surgical approach is usually done through the areola, cutting ducts and nerves. Thus, on the one hand, the nerves cannot transfer the stimulus to produce milk when the baby sucks; on the other, the milk cannot come out (although some ducts are able to look again for an outlet, this is usually not enough). In these cases, it is advisable to know the limitations, seek specialized help and closely monitor the baby.
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After conservative surgery and radiotherapy for breast cancer, breastfeeding is possible with a healthy breast and sometimes also with the affected one.
Hormonal disturbances
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Untreated thyroid hormone disturbances , especially hypothyroidism, could lead to low milk production. Therefore, it is important to follow the pregnancy and postpartum controls. The medication is compatible with breastfeeding. In addition, iodine is essential during pregnancy and lactation; During breastfeeding, iodine needs increase to 250-30 micrograms per day, so it is recommended that the mother take supplements.
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Polycystic ovary syndrome (PCOS) , which is suffered by up to 15% of women, could lead to a delay in lactogenesis (milk production). However, having PCOS is not synonymous with low milk production. Many women have no difficulty breastfeeding and up to a small percentage of cases have overproduction (hypogalactia).
Medication and production of breast milk
There are certain medications that can interfere with milk production such as selective serotonin reuptake inhibitors (a type of antidepressant) or dopamine agonists (such as bromocriptine).
Prolactin inhibitors (such as carbegoline) are given to women who do not wish to breastfeed after delivery to inhibit lactation. Oral contraceptives that contain estrogens also affect milk production and are therefore especially discouraged during the first six months after delivery.
There are other oral contraceptives that have less effect on milk production. To check the compatibility of medicines with breastfeeding, I recommend the e-lactancia website.
Feeding and production of breast milk
The belief that certain foods increase milk production and others decrease it has no scientific basis. In our environment, the lack of food is not a cause of hypogalactia . Only severe malnutrition can affect the amount of milk.
However, women who have suffered eating disorders in adolescence, causing this lack of menstruation for months or years, could see their milk production affected by not having had a full breast development (since with each menstruation the breast undergoes changes).
On the other hand, women with obesity, especially if they associate insulin resistance, may have a delay in lactogenesis, in the same way that it would happen in those with diabetes. In the latter cases, hypogalactia is usually temporary.
Other possible causes of hypogalactia
We would include in this group placental retention (which prevents the rise of milk from being triggered and we will only extract colostrum) or Sheehan’s syndrome (a severe hemorrhage that can affect the pituitary gland, the brain organ that controls the hormones involved in the production of milk).
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