Tips for Supporting Patients and Clients

People with low supply are used to having outsiders place value on their milk; some want them to stop because of the physical or emotional toll and perceived benefit, and others urge or pressure them to keep pushing to exclusively breastfeed, even when it may not be possible, or is not desired by the lactating parent due to the extreme obstacles they would need to overcome. Any amount of milk is valuable, and only the person who is making that milk can decide what it means to them, their baby, and their mental health. We owe it to low supply families to present the same opportunities to work on supply that we would give to anyone, whether that means educating them about galactagogues or supporting their desire to maximize even a very small supply. At the same time, they should not be expected to do more than everyone else just because their bodies require more work to make a moderate amount of milk, and we should respect and empower them if they choose to limit breastfeeding and pumping or to stop entirely.

Here are some other ways we like to approach primary low supply with patients:

–Help them move away from all-or-nothing thinking. Every bit of human milk they choose to give their baby for any period of time is important.

–Provide support for grief when breastfeeding does not go as planned. We recommend Amy Brown’s book, Why Breastfeeding Grief and Trauma Matter. Or have them come to our support group or a breastfeeding grief group from PSI International. Whether they have ended their breastfeeding journey, are exclusively pumping (while not exclusively giving their own milk), or are direct breastfeeding with supplementation, parents deserve to be part of a community where they can process the feelings that come with the shock of not being able to breast/chestfeed as they had hoped. Often, a typical lactation support group is not the place for this. But these spaces do exist (check out our list of resources too).

–An SNS or at-breast supplementer is a legitimate long-term tool for the low supply community. While this isn’t for everyone, some people with low supply choose to feed this way for months or years. Breastfeeding is obviously about a lot more than just milk, and there is a segment of the low supply population for whom at-breast supplementation creates a much desired and otherwise elusive path to experiencing that very specific kind of connection. We owe it to patients to present this option while also understanding that many will not want to use it, and that others have experienced trauma from feeling like they had to use an SNS in past attempts to increase supply.

–The superpower of known cases of primary low milk supply is that we don’t necessarily have that pressure to follow all the best practices to make a full supply, because we very likely can’t. Every individual can decide if it’s worth it to them to take certain actions that will have a moderate effect on supply, in absolute terms. For example, someone may choose to get longer stretches of sleep because they decide that rest is more important than a few ounces (or more, or much less) of additional milk per day. On the other hand, they also get to decide what is worth the extra effort to them, and it may be a lot more than those capable of making a full supply would ever have to do.

-A positive perspective can go a long way. If we want our clients and patients to understand that there is value in any amount of milk they can produce, we should start by reframing how we talk and think about low milk supply, even in professional circles. So let’s avoid saying that someone’s supply is “almost nothing” or that they’re nursing “just for comfort” and focus instead on the hard work from the family and benefit to the baby.

–While it’s important to promote self-efficacy and empowerment, we have an ethical responsibility to the low supply community. Prenatal education should include a discussion about primary low milk supply, ideally with signs that someone should seek a prenatal lactation consultation. If we can identify moms at risk of low supply before the baby is born, we have a chance of mitigating some of the trauma that can accompany unexpected low supply. It will also allow for families to make a plan to maximize milk production and for providers to be especially watchful for signs of undernourishment in the first days. Patients have the right to know this information about their health, and to be informed about it when intervention can have the greatest impact. See page 31 of Caoimhe Whelan’s book, Practical Breastfeeding: An Illustrated Guide for Parents, for an elegant example.

–UCSF’s Sarah Quigley, MA, IBCLC, tells patients that they are in a judgment-free zone and that she is there to support them however they choose to feed their babies. These words are never more needed than in a consultation with a low supply parent.

Thank you for taking the time to read this!