As a Certified Breastfeeding Counselor, you will run into families experiencing a variety of hurdles while breastfeeding. One rare hurdle parents might face is chronic low supply. Having chronic low supply is not a common breastfeeding challenge. However, it can be a very difficult, frustrating, and heartbreaking experience.

One hurdle for lactation experts supporting parents is determining if a situation is true chronic low supply or there’s simply a challenge with breastfeeding management. A challenge with breastfeeding management might look like not feeding frequently enough, a missed shallow latch so milk is not transferring effectively, etc.

True chronic low supply means all “best practice” breastfeeding management is implemented but there still is not a milk supply sufficient to meet 100% of baby’s needs. As a CBC, you would not be diagnosing a parent with chronic low supply. However, in providing support, education, and resources to parents, it is important to be familiar with it.

What is Chronic Low Supply?

The Low Milk Supply Foundation defines this as:

“Chronic lactation insufficiency (CLI) or chronic low milk supply (CLMS): The production of less milk than is required to exclusively feed an infant for the duration of the breastfeeding relationship, despite following best practices and the adequate management of infant-side complications.

These best practices include support from lactation professionals including latch and positioning, frequent breastfeeding and/or pumping, and no separation of the lactating parent from the infant. Infant-side complications include issues with the infant’s oral anatomy such as ties or cleft palate, prematurity, and any other issues that could affect oral motor skills and/or effective milk removal.”

As a lactation expert, if you notice a parent is doing most, or all, of these best practice recommendations, even working with an IBCLC, and they are still reaching out to you for ideas, it is helpful to suggest they inquire about chronic low supply.

An IBCLC is typically warranted when an ongoing supply issue is involved. As a CBC, you can provide education, support, and help families as they implement the plans recommended to them by their IBCLC, pediatrician, etc.

How is Chronic Low Supply Managed?

How one manages their low supply varies for many reasons. One, low supply might mean being able to produce 70% of a baby’s needs, or it might mean producing very little, perhaps only enough for one or two feeds per day.

For those at the higher end of low milk supply, they might consider trying prescription medication (e.g. domperidone) combined with frequent stimulation and just a couple supplemented bottles per day.

For parents with a significant low supply, they might balance a bit of comfort nursing, mostly bottles, a supplemental nursing system (SNS), or decide the amount of effort required to remove milk far exceeds the amount removed.

Having chronic low supply can be extremely difficult. As a CBC, your role is to point them to resources, such as the foundation linked above and an IBCLC. You can provide information about questions they can talk to their providers about such as medication options, tests (e.g. thyroid panel).

However, most importantly, you want to provide them with emotional support and encouragement. Remind them that however much milk they provide for their baby for however long was beneficial to their baby. Supplementing with formula or donor milk does not negate the benefits their baby receives or received from their milk.