I have a slow breast milk flow and it is not increasing – why?

With premature childbirth, your body has not yet fully completed the cycle of pregnancy. Breasts are not ready either to start producing milk as at term. If because of the stress and anxiety in the first days, you have not begun to express soon enough after delivery and often enough, the delay in the increase of breast milk is not surprising. The most common reason for the delayed and difficult increase in the breast milk supply is exactly this – a late start (3-4 days after delivery) and an insufficient frequency (3-4 times a day instead of 9-10 times). Fortunately, this problem can easily be overcome if dealt with during the first week.

According to research, for only a quarter of the mothers whose babies are born earlier breast milk starts to flow about the same time as when the baby is born at term (48-72 hours after delivery). For most women it takes about a week to observe a steady increase in the breast milk supply.

If, with an early start and a good organisation of pumping, at the end of the first week you are able to express only drops or 10-15 ml of breast milk, it is important to contact a nursing consultant immediately and try to identify the reasons.

  • Is the reason related to the pump? An unsuitable pump (e.g. a syringe-type pump or one with a bubble for squeezing) may be the reason why you are not able to drain the breasts well. Pump connectors have different sizes as nipples differ in size and diameter. If the connector is too small or too large for your nipples, pumping may not be possible. Changing the connector (or the pump if the one you are using cannot be fitted with the proper size) can quickly resolve the issue. The improper use of the pump can also lead to difficulties. Carefully read the instructions in order to be aware of the different buttons controlling your pump. Begin to pump at lower vacuum power and when you can feel the milk start descending or see the first streams, increase the power to the maximum possible level that is comfortable for you (on the border between OK and signs of discomfort).

  • Is the reason related to your breasts? If you have had breast corrections (implants, reduction, lifting) or other types of breast surgery, this may have interrupted the ducts and be the reason why your breasts cannot produce much. Have you ever worried about the appearance of your breasts? A “strange” shape and/or a serious difference in the size of both breasts can suggest a poor development of the glandular tissue. Try not to make a diagnosis yourself but contact a consultant to discuss what exactly is going on and if the appearance of your breasts is a sign of possible problems.

  • Is the reason related to the hormones? If you suffer from a hormone disorder (such as, not exhausting all the possibilities, thyroid problems, diabetes, hyperprolactinemia, etc.), this can have a significant impact on the descent of milk and the increase of its quantity. Fertility issues caused by hormonal and immune problems are also a risk factor for you. The retention of placental parts in the uterus after delivery also confuses hormones and often creates problems with breastfeeding, as progesterone levels do not fall as they should. This prevents the normal increase of prolactin and therefore breast milk does not increase as expected either.

  • Is the reason related to medication? Corticosteroids, which are done with a threatening preterm delivery, are extremely important in helping the baby’s lungs mature so that the baby has less breathing problems after birth. Unfortunately, however, in some cases (e.g. when done 7-10 days prior to delivery) they affect breastfeeding hormones and for a certain period may prevent the increase of breast milk supply. If for controlling hyperprolactinemia during the pregnancy you have taken Bromocriptine or Dostinex for a long time (these two are also used for suppressing breast milk production!), this can also prevent breast milk from increasing in proper terms. Sometimes pills for suppressing breast milk production are prescribed in rather preterm delivery even without your knowledge with the idea to spare you the labour to express for months. It is therefore very important to ask every time what medicine you are given and why. There is no reason to stop breast milk production only because your baby was born earlier – the maintenance of breast milk is possible. And the provision of breast milk will really help your baby immensely!

The doctors and your nursing consultant will help you overcome all the problems you may encounter in increasing and maintaining your breast milk supply. Do not despair even if nothing goes according to plan. Normally, you have weeks to work hard on eliminating problems. Nursing consultants have the knowledge and skills to identify the obstacles and to support you on the way to overcoming them. Your doctors can prescribe medication and help control the conditions that interfere with breastfeeding. Together you will succeed!

Welcome to  "All About Premature Babies" website.
This is a project of "Our premature babies" Foundation based in Bulgaria. The book is a result of a team’s hardwork that includes doctors, psychologists, breastfeeding consultants and premature babies parents. The common information about premature babies which you can find here will help you understand better the situation you've been facing.
Please keep in mind that some of the information related to the neonatal intensive care units is prevalent only in Bulgaria.

We hope that this website and the book are going to help you to be more informed, calm and confident. We wish you and your baby best of luck and health.

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