Breastfeeding Positions For Low Milk Supply

Introduction

The benefits of breastfeeding are clearly defined in scientific literature, with many studies highlighting its benefit in reducing infant mortality and morbidity. Infants who are breastfed in their first year have a clear reduction in infectious diseases such as respiratory tract infections. However, data shows that many women are unable to meet the required duration and amount and that this is becoming increasingly common. One of the main reasons that mothers cease breastfeeding is that the milk supply is thought to be insufficient.¹

Here we will look at insufficient supply, perceived insufficient supply, who is at risk of perceived insufficient supply, and positions for low milk supply. Some of the positions that can be tried include:

• Cradle hold
• Lying on your side
• Laid-back nursing
• The rugby hold

Definition of low milk supply

Low milk supply is defined as when the mother is not producing enough milk to reach their baby’s development and growth needs. It is common for mothers to worry that they are not producing enough milk, yet the majority of mothers do have enough milk.

If a mother’s milk supply is low, this is usually temporary and can be improved with support. You can talk to a GP if you are concerned that you are not producing enough milk. 

Causes of low milk supply

• The baby is not attaching well to the breast, meaning they are not feeding as they should. The mother may experience nipple pain 
• The baby may not be feeding as frequently as it requires. A baby should feed around 8 to 12 times in 24 hours
• Formula milk is being used alongside breastfeeding 
• You are taking a contraceptive pill with oestrogen
• Medication can potentially reduce milk supply
• The baby is not feeding effectively 
• Occasionally, there can be medical conditions causing a reduction in milk supply, or even no supply at all. This is thought to impact less than 5% of mothers

Why women may think that their milk supply is low

• The baby is feeding very frequently. It takes some time for babies to get settled, especially in the early days
• Breasts feel soft. Breasts may not feel as full as they are adjusting to the baby’s needs. As long as the baby continues to feed, the breasts will continue to produce a sufficient amount of milk
• The baby only feeds for a short period of time

Perceived insufficient milk (PIM) supply is a common observance reported globally, and is the most common problem reported by breastfeeding women. PIM often leads to breastfeeding being stopped and formula use. There are tools in development to help identify which women are at risk of developing problems with breastfeeding. It is thought that most women are using the baby’s satiety signals as an evaluation of milk supply, but there is rarely a problem with milk supply. There is still more research needed into perceived milk supply and actual milk supply.¹ 

How to know if a baby is receiving enough milk

• In the baby’s first week of life, they should wake up for feeds on their own
• They should be settled between feeds
• They should be getting through 6 to 8 soaked nappies in 24 hours
• They should be pooing once per 24 hours

How to increase milk supply

• To increase milk supply, the breast should be stimulated and emptied frequently
• Use skin-to-skin contact when feeding the baby
• Feed every 2 to 3 hours
• Ensure a good attachment when feeding
• Switch between breasts and offer each breast twice 
• For more stimulation, express after feeding 
• Massage breasts to help with flow
• If the baby needs more milk, give expressed breast milk as a first option before formula milk
• Some medications can be prescribed to help increase milk supply

Proper breastfeeding positions

When in a proper breastfeeding position, the baby will be able to suck swallow and breathe comfortably. The baby will be happier if you respond to their early feeding cues. If they are already crying, they should be calmed before feeding. To calm them, you can hold them against you, walk them around and talk to them. 

The first breastfeeding position you can try is the cradle hold, the most commonly used position. For this hold, you can sit on a bed or in a chair. Then, lay your baby across your lap, towards you. The baby’s head should rest on your forearm so that the mouth is in line with the nipple. Your arm should support the baby. Supporting the baby’s head, neck and back allows them to tilt their head backwards slightly. It is key to allow room for the baby to tilt their head backwards. 

You could also try lying on your side with the baby. This may be a preferable position if you have had a cesarean or are feeding during the night. You can get comfy lying on your side and then lay your baby facing you. Make sure the baby’s ear, shoulder and hip line up so that they aren’t twisted. You can use some pillows or blankets for support. The arm you are lying on can go under your head or support the baby.

Laid-back nursing involves the mother reclining on a sofa or bed, with the baby on her front. The mother can use pillows and cushions to prop herself up so that she is not lying completely flat. The baby’s stomach should be resting on the mother’s stomach. When the baby is supported, it can be guided to the nipple. This position allows the mother to relax and the baby to easily attach to the nipple. This is a particularly good position to try if you’re having some difficulties with breastfeeding. Feeding in a laid-back position can decrease breastfeeding problems such as sore and cracked nipples, as it uses biological nurturing. 

A study has shown that the laid-back position improved nipple pain and nipple trauma, and that the correct latching position was better than in a control group. It is thought that this position is beneficial in improving lactation-related nipple problems.²

The rugby hold can be good for mothers who have had a cesarean as there isn’t any pressure on the stomach. The baby is positioned at the mother’s side and she places her arm under the baby. The baby’s hips should be close to her hips. The baby’s head should be supported with the palm of the hand and they can be guided to the nipple. 

Breastfeeding position tips

• Make sure you are comfortable before you start
• Tuck the baby close to your body
• Bring the baby to the breast or let them attach themself, rather than leaning towards the baby
• Make sure the ear, shoulder and hip are lined up so that the baby’s body is not twisted
• It’s best to get the baby attached to the breast and then bring in cushions and pillows

Breastfeeding and diet

Mothers do not need to eat a specific diet whilst breastfeeding, but maintaining a healthy diet can help with breast milk supply. 

The mother’s diet should include:

• At least five portions of fruit or vegetables per day, ideally more 
• Good sources of starch such as wholemeal bread and wholemeal pasta
• Fibre coming from fruits, lentils, beans and cereals 
• Protein from chicken, eggs, fish and soya
• Dairy such as milk, cheese and yoghurt 
• Plenty of fluids, ideally water 

Everyone should consider a vitamin D supplement during the winter months, and for breastfeeding women, this can be discussed with a GP. 

Healthy snacks for breastfeeding mothers can include:

• fresh fruit
• sandwiches with grated cheese
• salad and cold meat
• hummus with bread or vegetable sticks
• baked beans on toast and fortified cereal

Summary

Overall, perceived low milk supply is common amongst women who are breastfeeding. However, often there is a sufficient milk supply and the mother has been tuned in to the baby’s satiety signals. Sometimes the baby can not latch well, which can be improved by settling the baby before feeding. Causes of low milk supply include the baby not latching well, the mother taking oral contraceptives with oestrogen, medication and the baby not feeding well.

Various different positions to feed the baby can be used. These include the cradle hold, laid-back position, rugby hold and lying on your side. The laid-back position seems to improve nipple pain and may have advantages in improving lactation-related nipple problems. The mother should maintain a healthy diet when breastfeeding and the breasts can be stimulated to maintain milk supply.