Baby

The Little-Known Reason Some Women Have Low Milk Supply

by Wendy Wisner

Photograph by Twenty20

As a lactation consultant who has worked with hundreds of new moms, I will tell you that in most cases, the biological aspects of breastfeeding work quite well. Most healthy moms of healthy babies are able to produce enough milk and almost all babies are born with strong instincts to nurse. Of course, breastfeeding is a learning process for everyone involved; it can be exhausting and sometimes hard as hell. But in most cases, the biological and physiological aspects of it aren’t the main problem.

That said, there are definitely some conditions for both moms and babies that can make breastfeeding complicated or nearly impossible. Some of these conditions are easy to spot, others are trickier to diagnose. In my experience, there’s one condition in particular that is almost always missed, but it’s more common than people realize. It’s called retained placenta, and it can have severe impacts on a mother’s ability to produce milk for her baby.

Here’s the low-down: Retained placenta is when a piece, or even a fragment, of a mom’s placenta isn’t fully delivered after birth. It is often diagnosed at birth, but not always. Symptoms include fever, foul-smelling vaginal discharge, pain and bleeding. Other times, symptoms are more subtle and easily missed.

Besides the medical problems it can present for the mom herself (retained placenta is often associated to postpartum hemorrhaging, which can be very serious), it also halts the process of initial milk production. The problem is, most people don’t know this, and a new mom’s case of low milk supply stays an absolute mystery until the condition is properly diagnosed and treated.

Basically, if a piece of the placenta remains inside the mother, her body still thinks it’s pregnant. The placenta continues to produce progesterone, which inhibits milk production. The hormonal cycle of milk production—signaled by the delivery of the placenta—just doesn’t happen.

So, how much should you be worried about this? I caught up with Dr. Sylvia Romm, a pediatrician, certified lactation counselor and current medical director of American Well. Dr. Romm says that while retained placenta only affects 2 percent of birthing women (which still amounts to millions of women), it is a real issue that can knock out a woman’s ability to produce enough breastmilk for her baby.

Some moms do not get properly diagnosed after birth and their lack of milk remains unsolved, which can really throw a wrench in their breastfeeding plans.

“Having retained placenta means that, from a hormonal standpoint, your body hasn’t gotten the full signal that you’ve given birth,” says Dr. Romm. “So, just like your milk production is suppressed when you’re pregnant, your milk production can be suppressed with retained placenta.”

There is some good news, though, according to Dr. Romm. Once your doctor removes the placenta pieces from your uterus, milk production should commence pretty much right away. “Many women find that when the placenta is finally fully removed, they are able to produce milk normally,” she explains.

The problem is that until you get the diagnosis, you will likely have very little milk for your baby. Most moms with retained placenta produce colostrum in those few days right after birth, but they never have their milk “come in,” which means that until they have the placenta pieces or fragments removed, they will not have enough breastmilk to feed their baby.

In work as a lactation consultant, some of the moms I’ve seen who have retained placenta know this from the onset and are able to rectify the problem pretty immediately, going on to have a normal supply of milk. But some moms do not get properly diagnosed after birth and their lack of milk remains unsolved, which can really throw a wrench in their breastfeeding plans.

Dr. Romm says that if you suspect retained placenta is the cause of your low milk supply, bring up this possibility with your doctor. “If you and your lactation consultant are unable to determine the cause of your low milk supply, speak to you obstetrician about the potential for retained placenta,” says Dr. Romm. “Having your health care providers work together will help you find a solution more quickly.”

For a mom who wants to breastfeed, the experience of something like low milk supply can be truly earth-shattering. But there's almost always a solution out there. That's why it's a good idea to surround yourself with supportive people, reach out for help when needed and arm yourself with information about how breastfeeding works (and what to do if something goes wrong).

You’ve got this. You deserve a chance to have the breastfeeding experience you want and deserve.

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