Up to 10 to 15% of breastfeeding moms can have low milk supply due to underlying causes.

When I say underlying causes, I, I mean anything in the maternal body, such as anatomy, issues with anatomy, hormones, or metabolic health.

This is low supply caused by biology.

It's not because you're doing something wrong

Motherhood is all-consuming Having babies, nursing, feeling the fear of loving someone that much Then there's this baby on your chest, and boom, your entire life has changed

It's a privilege of being your child's safest space and watching your heart walk around outside of your body

The truth is, I can be having the best time being a mom one minute, and then the next, I'm questioning all my life choices

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside, and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this, and we're leaning into that truth here.

With a mix of real life and what the textbook says, expert insights, and practical applications, each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the Lo and Behold podcast.

You guys, I am so excited to put today's conversation, today's guest in front of you because we are having a conversation about low milk supply, and it is a conversation that is not had enough, even though this is a concern, a worry, and a legitimate part of many, many breastfeeding relationships.

I have Kyah with me here today.

She is Low Supply Mom on the social media platforms, online, all of those spaces.

After her first child was born, Kyah was totally blindsided by low milk supply, particularly primary low milk supply, and you're gonna hear more about what that means and why it was such a blindside.

After exclusively pumping and then weaning early with that first baby, she set out to learn everything that she could about low milk supply from other specialists and the research and other lactation scientists.

Since that point, she's gone on to become an International Board Certified Lactation Consultant herself.

That's that IBCLC term that you might hear, like online or on social media platforms.

She's also gone on to have two more children.

With both of those children, she has been able to maximize her milk supply those babies and has had a breastfeeding relationship with both of them for three-plus years.

So Kyah would tell you that she wants to help you discover your own success in breastfeeding, not because she knows how out of reach sometimes that success can feel, but more so because she knows how impactful it can be when you find the version of success that is right for the two of you.

So glad to have you here with me today.

Why don't you go ahead and introduce yourself, kind of share whatever you wanna share about yourself, and then we'll get into our conversation.

Yeah.

Thank you so much for having me.

My name's Kyah Lacy, and I am online as Low Supply Mom.

And I kind of got into that work just through my own experience, but my primary focus is helping families feed their babies with low milk supply, or more creative ways when we have, issues with lactation or bottle feeding, breast refusal.

And so yeah, I'm all about low milk supply, and I'm really excited to be here and chat with you about it.

Yeah.

I love this conversation, and, like to be frank from the start, I never had low supply issues, though I've had supply issues, you know, the ebb and flow of breastfeeding ways and isn't going on right now, at different times.

And so I'm trying to remember, like, why I found you or what made me look for someone like you online.

But that is... I mean, I've connected with you first on Instagram, and I just feel like your resources on your Instagram account were so good for someone coming at it- Just not having, I don't wanna say I had no understanding of it, but you're just so good at explaining what it is, how it can happen, why it might happen, what to do about it.

I just think that this is a, a quiet issue, and you showed me very quickly, like, this is happening to a lot more of us than is acknowledged or recognized or even that, like- Yeah ... research has recognized yet.

And it didn't feel fearful.

It just was like, "Hey, y'all, we have to be talking about this. Like, this is a real thing."

And I know you dealt with it personally as well, so my guess is that's part of the story of ending up in this space.

But I just think you do a really good job of educating and just that kind of classic give these people the information so they can use it if they need to use it, right?

Instead of kind of- Yeah

withholding it because we don't wanna worry you or something like that.

So specifically, I'll say the wrong thing.

But give us some numbers of, like, how common low supply is, what this actually looks like, what we can be thinking about when we're pregnant and considering, eh, this, you know, this could be a part of my story, and what should I be thinking about it?

Yeah, for sure.

And, you know, it's really interesting when we have this discussion of low supply because the numbers and the data are actually kind of difficult to, lay out just because so often low milk supply research is, defined as perceived, right?

So we'll hear about perceived low milk supply, which, I feel like, you know, in just, like, the real world when we're not, like, going through research gate, when we hear perceived low milk supply, we think, oh, that's someone who thinks they have low milk supply, but they don't.

But so often, even in low milk supply research, because it's self-reported low supply, it's not confirmed as either perceived or not.

And so, there's a bulk of studies that, you know, with low supply we, we kind of, we can't really ascertain too much from because it's perceived.

But, thankfully in the last decade, there's been a lot more research that has looked at, you know, the test weighing of, infant intake, and really gotten into the nitty-gritty.

And so we know now that, about up to 10 to 15% of, breastfeeding moms can have low milk supply due to underlying causes.

And when I say underlying causes, I, I mean anything in the maternal body, such as anatomy, issues with anatomy, hormones or metabolic health.

And so those three, anatomy, hormones, metabolic health, which those last two kind of tie in, but, I feel like it's easier to branch them out as three.

Those can cause low milk supply in 10 to 15% of people, and that can be chronic, which means long, long term.

And then there's- Primary low supply, which is, that type that has to do with that underlying maternal cause, and then there's secondary low supply, and so we hear a lot about secondary low supply.

Secondary low supply, we don't have the data for.

We know that up to half of mothers worldwide report low milk supply.

We can't confirm, or dismiss whether it is a statistic that high.

I would say that, you know, we know that a lot of people don't have a good understanding, especially nowadays, I feel like it's gotten worse with social media- Mm-hmm

Of what a, quote-unquote, adequate supply would be, right?

And so, you know, I think it's fair to, to assume that within that 50%, there's definitely a number of parents that, are probably making a, a really adequate amount of milk, but because they're on TikTok seeing, like, 10-ounce pours of pumps- Pours

they're, they're probably- Sounds like a bar, 10-ounce pours ... getting a little confused.

Yeah, exactly.

Yeah, yeah.

10-ounce pours there.

So but it's, you know, one of the reasons why I think it's so important to talk about low supply is because we often will be confused as to whether we have it or not, and I feel like the dominant response is going to be like, "You don't have low milk supply.

Low supply is really rare.

You just need to nurse.

You just need to pump more." And when that's the default, we miss out on educating and supporting a lot of people that do, do genuinely have low milk supply and are struggling.

And so, , that's just kind of, for now, it's 10 to 15% maternal cause.

Secondary, we don't know, but we do know that it's higher, and that's, those secondary issues, unlike the maternal causes,

I'm also very long-winded, so- ... it's just all my answers.

Giddy up.

Buckle up.

Get ready,

guys.

Uh, the secondary-

I kind of am too, so that's

great.

Okay, great.

The secondary causes are caused by anything impacting, milk transfer or milk draining efficiency, and, by that, I mean, you know, if baby has issues draining milk from the breast, if, you know, we're told not to feed our baby more than every four hours, and we're spacing feeds out, if we're sleeping long stretches overnight and not emptying the breast.

Anything that's getting in the way of efficiently getting that milk out can cause secondary low milk supply, and, This is the type of low supply versus primary.

Secondary is the type of low supply that's most malleable, right?

So we can increase secondary low milk supply.

But it's also, you know, it's nuanced.

And so, yeah, primary, secondary, 10 to 15%, and who knows?

But more than that, so-

Okay

... Kai: it's,

it's definitely not rare.

So that 10 to 15%, that number, and I, I feel like I, I remember looking at something, you know, you mentioned like ResearchGate or whatever.

This is years and years and years ago, and I swear I remember looking at something and it said, you know, we estimate about 3 to 5% of women have low milk supply.

And I remember thinking like, that's the number for a really long time.

And I don't know if it was you or someone else who s- shared this more, this 10 to 15% number.

And I know there's more papers and things to back this up and support this now too, but I just remember seeing more of that 3 to 5%.

And so I think naturally a lot of us are gonna go, "Okay, probably not me," right?

That's gonna be a pretty small number.

And so I think, like you said, it instantly makes us assume it won't be us and/or we're just... So we just don't have any information if we do run into it, right?

Well, and

you know what's funny about- And so it's like this huge The, what's funny about that number is that, so Diana Cassar-Ull, she's the author of a book.

She's an IBCLC, and she wrote this book called Finding Sufficiency about insufficient glandular tissue and low milk supply.

And she looked into that number, and that number- That three to five or the 10 to 15 ... that three to five.

Right, 'cause it's everywhere.

The three to five.

Yeah, and what she found was there was a discussion in, like, the '20s or '30...

It might have been as, as late as, like, the '40s or '50s.

But it was a, it's been a bit of time, and it was really, it was just this male doctor- Like almost 100 years ... who threw out that number.

Yeah.

This male doctor threw out that number, and then that number was just regurgitated, and it wasn't ever confirmed.

Kind of a rude word, but it's okay.

Yeah.

She's, she's a wonderful woman.

That she was able to, present that number.

And since then there's been more-

The 10 to 15.

Exactly.

Yeah.

Yeah.

Exactly.

Which i- yeah- So ... which is so wild, 'cause I mean, that's a really big difference.

And from what I'm understanding, correct me if I'm wrong, you're saying 10 to 15 or so have, like, a primary cause low milk supply issue?

Correct.

Right?

Yeah.

And then we have these- Yeah ... secondary ones as well, and I mean, maybe you can clarify this a little bit better, too.

I know you were throwing out different causes.

Maybe give everyone a list really quick.

Because I want... What, what I want you guys all to hear again, and reiterate this, is that there's primary causes of low milk supply, and I'm gonna let you just list them all again in a second, and then the secondary causes of low milk supply.

So just go through those.

Give us the list really quick more or less of each of those, and I want everyone to hear those so you can understand that maybe you have none of the primary causes, 'cause a lot of times we know or we will, we will know with a subsequent baby, but these secondary ones can happen to any of us, right?

'Cause some of them are related- Yeah ... to baby, or some of them are related to what happened, like, in birth or something like that.

And so lay those out for us really quick.

Again, the primary causes and the secondary causes of low milk supply.

Yeah, absolutely.

And so, and it's so hard 'cause I feel like when I have these conversations, I'm like, "Okay, I'm gonna just, like, throw as much information at you as possible," and, like, if you get 25%, you're gonna know so much more about low supply than- You

will, though Um-

I mean,

you will 'cause you do know-

more than you did 10 minutes ago, so that's

great.

Yeah, it's exciting.

But, it definitely, you know, if this feels a little heavy, it makes sense 'cause it is, it's so nuanced, and we, we definitely don't get that message, and it's so important.

But, that aside.

So primary low supply, again, we wanna think back to the maternal causes that have to do with anatomy, metabolism, and hormones, right?

So the most common things that can cause primary low supply are, really anything that can impact your hormones, right?

So thyroid dysfunction, if you have insulin resistance, which we kind of... This is metabolic syndrome as well.

If you have history of infertility, as luteal phase defect, which is low progesterone, can impact, supply.

If you have, pituitary dysfunction, as it can impact your prolactin, which is so important.

so when I give the list, I'm gonna say the top three are always gonna be insulin resistance, thyroid dysfunction, PCOS, because PCOS, has an umbrella, which was just renamed.

I think it's PMOS now.

Did you hear about this?

I don't

know, I don't know if I know that.

I'm gonna Google when we're done.

It's

breaking news, actually.

I guess so.

How'd

I miss that?

Yeah, within the last, 24 hours, which someone said it's, it's now- Oh, that's

funny

... Kai: piss me off syndrome, which I feel is accurate for many people.

That works.

Yeah, but it's, anything that...

So PCOS, under the umbrella of PCOS, someone can experience, thyroid dysfunction, insulin resistance, high androgens, which is why we see, like, the hirsutism and, and hair growth, and issues with fertility, right?

And so, beyond that, there's many.

I don't have my list in front of me.

I probably should.

Do you want me to pull it up?

No, that's okay.

I just want, I want them to kinda hear some of these bigger ones, knowing that there's more And then hear that other side of the list too.

Okay.

So hear those like now

as well.

Okay, yeah, for sure.

Yeah, and so, um, you know, with thyroid dysfunction, insulin resistance, PCOS symptoms, all of these that can impact hormones, they can cause primary low milk supply because they can be impacting how your hormones are functioning now, how your cells are communicating now during lactation, but they can also impact your anatomy.

And so all of these are kind of strung together, right?

And so for instance, if someone has insulin resistance during lactation, Insulin plays this really crucial role on how your brain and your breast communicate.

And if you have insulin resistance, you may have a slower refill rate, so your milk supply is low because it's slow.

Mm-hmm.

Mm-hmm.

And so within 24 hours, you get a smaller output, right?

But if you have insulin resistance and those symptoms occurred around puberty and adolescence or during pregnancy, this can also impact how your breast developed and your glandular tissue growth, and can cause insufficient glandular tissue or a smaller amount of that lactation tissue, which now we have an anatomy influence as well, right?

Right.

And so, it's, you know, with primary low supply, we wanna look at hormones, we wanna look at, underlying health.

But even we found that micronutrient deficiencies and, anemia and high blood pressure, really anything that can impact your hormones can impact lactation, right?

Right.

On the secondary side- Secondary low supply, I have seen it caused by many, many, many things.

I'll say that the top three, if we had to list those, we'll say, when an infant has issues, with oral dysfunction.

So this could be something like a tongue tie, a high palate, weak suck reflex, discoordinated kind of tongue function.

And so baby struggles at the breast, right?

And the biggest flags for these are, you know, if somebody has pain when they're latching or nipples are misshapen, when baby comes off the breast.

You feel breast fullness, but then breasts aren't softening too much during the feed, low weight gain with the baby.

So oral dysfunction is a big one.

The second is, is actually, an incompatible pump or flange.

Flange sizes are huge, because if we have a flange size that is oftentimes gonna be too large, we're not gonna be able to efficiently get that milk out of the breast, and that's gonna lower supply.

And then, the third would really be spacing.

So everybody's gonna have their own unique amount of glandular tissue coming into postpartum, right?

When we're on social media and we're seeing people that are like, "Here's a 20-ounce pumping session," those people are predisposed to oversupply.

They have a huge volume of glandular tissue, right?

We all have-- It's a big spectrum, right?

So when someone is coming into postpartum and, they're more of like an average glandular tissue size, necessary to drain the breast pretty frequently, like every like, you know, two, three hours in the day, you know, a few hours at night, maybe one four-hour stretch early part of the night.

Otherwise, our glandular tissue just cannot support sustaining the same speed of production to keep up an adequate milk supply.

And so this kind of brings me to, you know, with secondary and primary low milk supply, primary is very nuanced.

There's so many different causes, and each of those causes can impact lactation in very specific ways.

With secondary low milk supply, it's actually really interesting because there's so many different causes In a kind of like, you know, on a surface level, but on a cellular level, there's one cause of secondary low milk supply, and this is inactive prolactin receptors.

And so to get a little science-y, 'cause this is like the

I love talking about this so much.

I don't know why this isn't in all the feeding education.

I

know.

I love that PDF that you built years ago that shows the receptors and, like, what's going on.

I love the science stuff, too.

Yeah.

You know, talking about that PDF and- Yeah ... because I just think it's valuable to understand, oh, ultimately, at the root of all of these possibilities, this is what's going on, which is-

Yeah

what you can expect.

Yeah.

Well, yeah.

I mean, so with, you know, with the secondary low milk supply, at its core, all of it is caused by inactive prolactin receptors.

And so what happens is, and this is always kind of hard when someone doesn't have a visual, so like close your eyes wherever you are, and you can kind of imagine.

But if you, you know, think of the breast and, inside the breast we have, like, you'll see all those illustrations of, like, these, like, blossoming trees or, like, you know, blooming flowers, and that represents your glandular tissue, your alveolar tissue.

These are all alve- it's called alveoli.

They're these teeny-tiny cells.

It's like the ones that are in your lungs, right?

So you breathe in, they expand, then they contract.

So this glandular tissue, if you were to pluck one of those off the tree and put it in front of you, let's enlarge it 7 billion times so we can see it.

It's like the size of a basketball now.

So inside this circle, inside it's got all these dots, right?

And all of these dots are prolactin receptors.

These are all your milk-making cells.

So they line the inside of the cell.

And lactation is like, it's so much more than supply and demand.

I know.

So it's- I know, it really is.

When, when you get the stimulation, your brain is going to send signals to those prolactin receptors, right?

And when they get the signals, they'll say, "Okay, it's time to go to work. Let's start making milk." And so all these little dots start churning out in their milk factories, and they push the milk into the cell, and then when you're ready to nurse or pump, it comes out, right?

With secondary low milk supply, some of these little dots that are lining our little circle here have turned off, and that's because of the most annoying thing in breastfeeding called the feedback inhibitor of lactation.

So, or FIL for short, F-I-L.

So, the feedback inhibitor of lactation, I like to describe as your body's mechanism to make sure your breasts don't explode because- Mm-hmm.

It really

is.

Yeah.

No, it is.

Mm-hmm.

It's like if you were continuously making milk all the time, like- Right ... your alveoli would just burst.

Those milk-making cells would burst, right?

And so the job of FIL is that it's this protein in the milk itself, and as, you know, those cells are filling with milk, this protein gets higher and higher and higher.

And as it's getting higher, it's a stop sign for prolactin.

So it's like this reversible blockade, right?

So, you know, when we're... especially in those early days, when we're, feeding babies and we're having like, everyone will have that kind of engorgement.

The reason it goes down is because of this FIL, right?

It's also what causes secondary low milk supply because when FIL is, getting higher and higher as you're making more milk, your prolactin's gonna get a little angry.

You drain the milk out, and then we keep going.

But if we have repeated episodes of that FIL being high, it doesn't just tell prolactin to like cool their jets.

It tells prolactin to stop coming to certain cells.

So we don't just get slower milk supply, we actually get some of our milk-making factories turn off, right?

And so that secondary low milk supply, it can happen with tongue ties.

It can happen with NICU stays.

It can happen with bad flange sizes.

It can happen with, you know, not emptying the breasts overnight.

At a cellular level, it means some of your receptors are not churning out milk.

Some of your factories have turned off.

And so increasing milk supply with secondary low supply means targeting those receptors.

How do we target those receptors?

By increasing prolactin, because that's what they respond to.

How do we increase prolactin?

The easiest way is with nipple stimulation and breast draining.

In some countries, we use domperidone.

In the US, there's Reglan, which I am not crazy about at all because of the side effects.

But anything that's going to increase prolactin, when we increase it to a point, it's going to inspire those factory workers to come back and open shop again, and that's how we increase supply.

But This is also, you know, it, it's wonderful that we have a great understanding of this.

It's also frustrating for the primary low suppliers because all low milk supply approach really does center secondary low supply.

And so when you're looking at someone who has, you know, insufficient glandular tissue or a thyroid dysfunction or low prolactin, if we tell them, "Okay, well, we just need to increase your pumping or nursing, and that's gonna increase your prolactin, your, your milk supply's gonna get higher," their issue is not these inactive prolactin receptors.

Their issue is not that we don't have factory workers making milk.

Their issue is that they have a specific underlying health condition that's impacting a specific role within that cell communication with lactation.

Or, you know, the anatomy is just like, with IGT, like, all your receptors can be on, and it's just like, woo, we're going wild.

But, like, we just don't have enough of those factories to make the amount of milk to exclusively breastfeed.

You know what I mean?

Yes.

So good.

That's so much.

Okay, quick pause for a second.

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All right, let's get you back to your episode

So primary causes, often related to, like, the maternal body.

I... This is really general, and I know you're gonna... There's the nuance that we talked about.

The secondary causes, I sometimes I'll say it's, like, often related to the baby.

Like, maybe they're draining you inefficiently, maybe they have a tie.

Like, it's not their fault.

But again, it's this idea of, like, it could be an unknown that, that after birth we're like, "Oh, you're not great at draining me.

Oh, this is my...

Like, I'm not positioning you well, so then you are not efficient at the breast because we need to figure that out." But it's kind of something that we often learn later.

Yeah.

Quick question.

I forget.

When, there's retained placenta, that's a secondary issue, right?

If there were to be retained- I mean- 'Cause it's kind of this hormonal- Technically-

thing as well.

So do, do... where do they put that when that happens and it causes supply and stuff?

So technically,

we put that under primary- We do.

Okay ... because when you have retained placenta, that's going to impact your prolactin, so hormones, right?

Right.

Right.

So really for primary and secondary, I say primary is, underlying maternal causes, and secondary is, anything to do with milk draining and efficiency of, of- Right

stimulation.

Right.

So in research- Placenta would

be the other one.

Yeah.

Yeah.

So in research, I mean, this is one of the things that's super annoying, is no one, none of these scientists or lactation, nobody talks to each other, right?

And so we have 500 different names for all these things.

Primary low supply and secondary low supply are kind of, like, I think, the easiest ways to understand it.

I do too.

But we have... Yeah, I mean, if you talk to, someone who has a medicine background, they may, categorize these as pre-glandular, glandular, and post-glandular.

So that would be, IGT would be the glandular, and then pre-glandular would be the hormones.

Post-glandular would be secondary.

And then we also have, intrinsic and extrinsic low supply.

And then we have, you know, it's just, it's just... Guys, let's all just get on board.

I would love that so much.

But that's the thing.

And I promise you, I make people annoyed, I'm sure.

It's all the same thing.

Yeah.

Yeah.

But I'm just like- Well, I- ... I say primary and secondary because I think it's the easiest way to understand it.

I think that's the easiest way to understand it too, so that's the way that I've always oriented it in my brain.

And I think it's easiest for our moms too when they think, "Okay, like, here's some things I actually already know about my body. Like, I know the... And then here's some things that might come up, and I can be aware of those."

I just think that that, like, delineation's really clear and really easy.

The other thing that I mentioned to you when we started too is I think it's valuable for people to understand that sometimes you can have, like, a primary issue and a secondary issue.

Or maybe there's kind of, like, two different secondary issues- Yeah

going on at the same time.

And so you've already kind of mentioned this, but this idea of a lot of support for you if you're finding that low supply is occurring for whatever reason, is focused on those secondary issues.

So, like, my thought process is there's, like, the best support is just gonna be really good at figuring out what is causing that low supply.

Mm-hmm.

And is it potentially, like, multifactorial instead of just this- Yeah ... like, "You need to pump more." And then if you're asking her about that supply and demand conversation.

So actually, you kind of mentioned this as well.

Why does that, "Oh, it's just supply and demand," why do you feel like that's not super valuable in the low milk supply conversation, that kind of general concept?

I mean, I don't... Like, you know what?

To be honest, I don't know that it's super-

Valuable in any conversation?

Well, let's say- It's just kind of shallow, right?

We have the lucky ones.

You know what?

There are the lucky ones- Yeah ... that, like, yeah, baby comes out.

Maybe it's a little uncomfortable in the beginning.

We're learning each other's bodies, and then like, "Oh, wonderful. Okay, well, it's just supply and demand now. Like, I bring you here, you're happy." And then we just are in this, like, you know, kind of, push and pull of, like, when you feed, you feed, and that's just, it's gonna demand that.

And so yes, in that way, you know, for the average dyad who doesn't have any sort of, speed bumps in the road whatsoever, which I find to be kind of rare, then yes, it can be, it can be as simple as supply and demand.

And I've had, you know, a bunch of friends who have had that experience.

But I think that sometimes we shrink things down, into, like, these very simplistic terms that honestly, like- I would love if it was, you know, lactation is supply and demand, dot, dot, dot.

You know, because there's, there's all these kind of asterisks that need to go with it.

And with, secondary low supply, you know, you could even be approaching it like, "Oh, it's just supply and demand. I just need to, like, pump more, and then I'm gonna make more milk." But you have, like, 13 millimeter nipples and you're using a 21 millimeter flange, like that's actually not gonna get that milk out efficiently, and it's not gonna increase your supply.

So even though you're like, you're demanding more, supply is not gonna grow, right?

And I think that it's also, you know, it's, it's worth noting that low supply is not always cured, and that's one thing that always is so frustrating to me in conversation because I feel like it's this, you know, we're just-- I'm just finally getting people to be like, "Okay, yeah, it exists.

It's real." And the approach to it now is, "Okay, how do we fix it?

How do we make it go away?" We can definitely do things to support low supply depending on secondary, primary, right?

But the reality is, for a lot of people, we're going to have chronic or long-term low supply of some sort, right?

Even with secondary low supply.

So research tells us that with secondary low supply, you have 100% likelihood of relactating.

So what's interesting is, is increasing supply is actually technically relactating, turning on those receptors again, 'cause it's the same thing, right?

So you have 100% chance of increasing supply, but, not everyone increases it to the extent where you can exclusively breastfeed.

And so this means that, especially if baby is over six weeks old, if mother is over 25, and depending on the duration that, you know, supply has been lower, that can impact the likelihood of getting back up to that, exclusively breastfeeding rate.

If you fall within those categories, you have like an 80% chance of doing it, right?

But there's also people that have secondary low supply where, you know, maybe baby's like two and a half months old, three months old, and, you know, they're pulling out all the stops, and it's just, ugh, they just can't get over the hump.

And I, I wanna honor that too, 'cause that's a difficult experience, and I think it's one that we dismiss 'cause we say it's just supply and demand.

You know, and it's not.

And so like you said too, it, it, it's interesting because you can have primary and secondary low supply.

I feel like a lot of times we wanna say like, "What is the cause?" The one cause.

And I can tell you in, in working with people, it's usually not one, right?

It's usually, you know, there's, there's things that we can do As far as the secondary side, to increase efficiency and breast draining, but then we also might have, you know, underlying stuff going on here.

And so supporting both of those simultaneously and having an open mind with that, right?

And then also being, you know, mindful of those expectations and seeing, okay, what is happening as we're trying to increase supply.

So with secondary low supply, I will say there are timelines attached.

It usually takes about 15 days to increase supply to,

It's, that's like the, the most impactful timeframe when you're trying to increase supply with, with secondary low supply.

It can take up to 30 days.

If you suspect that you might have secondary low supply, I always tell people, like, "Okay, f- first I wanna get you with someone who understands low supply so they can help identify those factors for you.

Is it, does it have to do with pumping?

Does it have to do with, how frequently feeds are happening?" And we kind of tick those off the list, and then we come up with a plan for, like, let's get you a trial, timeline to try to target that secondary low supply.

So once you have the right flange sizes, you understand, like, the frequency that you need to be feeding, you have all those patterns in place, right?

We've optimized the latch.

Baby's doing well.

There's no oral function issues.

Then we say, "Okay, we're gonna put these in play for seven days." So I hear way too often about people that have been triple feeding for five weeks, seven weeks, two months, just, like, it just, it makes me so- It's

unsustainable.

It's crazy.

It-

So- It- It j- it blows my mind.

Yeah.

Because we know when we put these, these trial measures in place, if you are consistently and efficiently frequently draining the breast, we should see milk supply increase within seven days.

Generally, we'll see the first impacts in three to five days.

If you get to seven days and you don't see any increase, then it's worth looking at primary factors.

After seven days, some increase should be evident, and then it should continue, and then every few days we kind of look, like, okay, when are we hitting the ceiling here?

It's around two weeks for a lot of people, can be up to 30 days.

So, a long-winded answer there about secondary low supply.

But yeah- ... I mean, this thing of, like, "Let's fix it.

We can all fix it.

It's all curable" is, is, is a hard one- Yeah ... because, like, for so many of us, it's like, "Ugh, now I just feel awful." Well,

I just think it's so important to understand it's more than supply and demand for all of us, right?

Because even going back to what you talked about, that feedback inhibitor of lactation and when our breasts are really full, that that actually then tells our body to stop making milk.

Like, there's these basic things that I think that- We either don't understand or fall under this supply and demand umbrella, and it's like, oh, there's so much more here.

And so-

Yeah

... Lo: like, like you mentioned, oh, well, if your flange size isn't right and you're pumping more, maybe you're s- getting super full.

But if you're not emptying it well, then that's actually gonna not support the supply conversation at all, right?

Yeah.

Your actually body, at some point, these little factories are gonna turn off, even though you're like, "I'm pumping every hour." It's like, well, if it's not coming out well, it's actually gonna hurt.

It's, it's gonna, it's... You're stimulating your body, but the milk's not coming out.

Yeah.

I just think there's all these little... There is so much nuance underneath, like, the supply and demand conversation, whether or not we're talking about low supply.

And so I just think that that's an important part of this conversation, like, has to be acknowledged, whether that be this idea of, hey, if you have primary low supply, that supply and demand conversation is actually kind of annoying, just in general, right?

Yeah.

Because you can't just pump more for glandular tissue that doesn't exist or whatever.

Like, it's not gonna-

Yeah

... Lo: it's not gonna work, right?

And then for secondary supply, still understanding the nuance underneath, right, of like, are you emptying well?

Like, are we doing this efficiently?

'Cause again, none of it is gonna help increase supply if all of that stuff isn't working well, too.

Yeah.

So I just know.

I know you're so like, "Oh, that was a long-winded answer," but I just think it is so valuable for us to understand what's going on here.

Or, "Wait, I'm doing X, Y, Z, the right things, and it's still not working." Like, there's typically another layer or a question to be asked, and then you think, "Okay, I'm super overwhelmed right now," 'cause everything these two just said, I don't...

Like, I'm not a CLC.

I don't know what they're talking about.

Well, that's where I would think a, a good professional can be really valuable or a resource to say.

You don't have to know everything about the feedback inhibitor of lactation.

I hope you guys all understand a little more from just listening to this, but, like, that's what a lactation consultant should be able to help you understand is some of those smaller things or be able to support you.

Like, it is not your job.

I just don't think it's everyone's job to understand the proteins and how those little cells work- Yeah ... and all of that, right?

Like, that's someone- Yeah ... else's passion or their entire life.

But I love for you to be aware of it, if that makes sense, so that then if you were to encounter problems, it's just like, "Okay, I remember, like, there's a few systems going on here that could be impacting what's going on right now," and not just like, "Well, you need to latch your baby more, and that's the problem."

Like-

Yeah

... Lo: rarely is that- Well- ... the only answer.

Yeah, and I will say, like, especially for secondary low milk supply, like, I'm not gonna torture you and we're in consultations and be like, "Let's talk about the science here." Right, right.

Because oftentimes it's like, "Okay, we're gonna try some things, and, you know, if this doesn't work, let's talk a little bit more about this."

But I will say for- Someone who has primary low milk supply, it's interesting because I, I do hear a lot that, that going into the nitty-gritty is very, very impactful for them because we've spent oftentimes many weeks, if not months, not understanding why our bodies, quote unquote, "don't work," right?

So because, you know, it, it's, it's just so difficult when you're like, "I am doing all the things right.

Like, I am pumping, I am nursing all the time.

Like, I just don't know, like, what is happening." And oftentimes you're just going to be hearing, about, you know, "Just keep trying.

Just keep going." Right. And so for those people, I do find, like, it can be very relieving, it can be very cathartic, it can be, like, really difficult, but also affirming when we're like, "Hey, let's talk about what's happening within your body that doesn't have anything to do with your effort.

It doesn't have anything to do with you wanting this.

It doesn't have anything to do with you doing something wrong or right.

Like, this is low supply caused by biology.

It's not because you're doing something wrong." And that's just something that I find, to be really impactful for a lot of people with primary low supply because it's just like we've spent so long being like, "I guess I just suck at this," you know?

That's

so good.

Episode 48 with Emily, is, like, verbatim what you just said.

So she reached out and said, "Can I come on your podcast? You know, I'll tell the birth story, but I wanna talk about having low supply." And it turns out she ha- has IGT, right?

And it was, like, the way that you just described that idea, perhaps sometimes for that primary low supply person to be able to, to pinpoint a cause, to understand what's going on, to know that it's not about lack of effort or lack of learning or understanding.

Like, it was all ... That's, like, all of the things that she shares inside of that episode when she's talking about it is like, "This just wasn't out there for me, and so I spent all this time like, 'What am I doing wrong?

What am I doing wrong?'" And really, the conversation was like, "Oh, no." Like, there's something for her in your body that's not available to you, right?

You're not doing anything wrong.

This is nothing to do with your effort.

So it's kind of cool to hear you say that, like, you are a great IBCLC because that's exactly what this woman, if she'd been sitting in front of you, like, would've needed to hear is, is this science and this reasoning that it's not related to lack of effort on her part.

Yeah.

So, so good.

Well, yeah,

and

I mean, I'll tell you what, like, honestly, my work, like, I like to joke, like, it was just my trauma response because when I had my first baby, I didn't know that I had IGT.

I didn't know that Exclusive breastfeeding was not going to be in the cards for us.

And so I had a really, really bad experience breastfeeding my first child.

And, you know, I think that, like, a lot of what I do is rooted in, I want to give parents what I didn't have because I can-- I, I know how negative the impacts were on me, and I have seen how positive the impacts can be when we help people early, when we get them the right information, when we're able to support them, right?

And so, yeah, I mean, for me, like with IGT, I always will like throw it out anytime I'm talking.

Like, I always want people to be aware that, that signs of IGT include no breast growth in pregnancy or very, very minimal, and no breast growth, postpartum.

You know, with that sensation of a lot of us are told, you know, early, like maybe babies l- having to supplement in, the hospital or supply issues are happening very early, and we just have this sensation of like, my milk's not, quote-unquote, "coming in."

Like, people are saying like, "Okay, the colostrum's gonna transition to mature milk, and then your breasts are gonna get big, and you're gonna feel this engorgement." When you have IGT, that just never happened, right?

And so that's one of those things that I like to affirm because a lot of times I'll say that, and people will be like, "That happened to me."

You know?

And so, breast growth in pregnancy, breast growth postpartum, those are flags that you wanna, you wanna look at and, kind of see, you know, is this something to do with anatomy?

It can also be hormones too, but those are, are two big signs to be aware of.

It's kind of a good segue because the last question I really wanted to ask you is I- in theory, we could have just, like, scared a lot of people thinking, "Okay, there's 10,000 different reasons I might have low supply," right?

And you're pregnant right now with this baby.

So how would you say that people kind of prep and prepare?

Like, in my mind, I'm like y'all just got so much more knowledge about the possibilities, and now you still step into this, and, you know, you try to breastfeed, and you have support, and, and you see what happens.

But how do you tell people to prepare?

And I would say, let's say, give me two answers.

For first baby, where maybe you're not aware of prior supply issues that are going to, reoccur based on what you learn.

So first baby prep, and then second baby prep if you did have a history of low supply, and what that kind of looks like.

What should those expectations- Yeah ... be or big-picture advice for we're gonna acknowledge this stuff, but you're not gonna end up terrified and worried about it every night while you, while you wait for this baby to be born.

Well, for sure.

And I think that honestly, like, I don't want this to be a scary conversation at all.

I want this to be something that feels very empowering, and I think that, um, a lot of us in the, you know, postpartum or lactation world are, like, scared to talk about low supply 'cause we're like, "Oh, no, it's self-fulfilling." Like, "We're gonna scare people into thinking they have it." But really what I find is, like, when you talk about low supply, people that do have it are like, "Oh my God, this is happening."

Mm-hmm.

"Like, I can get support." Mm-hmm.

Or people learn more about it, and they're like, "Oh, I actually don't have it," and like, "Great, I feel good now," right?

And so, you know, with people that are expecting and preparing, I would say that, you know, hopefully, hopefully this conversation has relayed that lactation is so nuanced, and it does very, very, very much deserve support.

And it's something that, like, a prenatal lactation consult is so valuable and, is accessible to a lot of people.

If in, if you're here in the States, insurance will cover lactation visits for most people.

There are some insurances that are a little more annoying.

But ... And even telehealth consults, right?

And so preparing in pregnancy is a great way, but also knowing that, you know, this can happen up to 10 to 15% of dyads.

Secondary low supply, if you are well, you know, supported and you have the right information from very early on, it's not something that anyone's predisposed to, right?

With secondary low supply, a lot of times we will, you know, say for, like, second-time moms, they'll be like, "Yeah, all these things happened."

And then they're, they get super prepared in pregnancy, and they learn about all these things, or maybe they have a lactation con- consult in pregnancy.

And secondary low supply, like, there's no risk factor for Right?

So just preparing I think is, is best, but also knowing, like, information, like, you're not gonna catch low supply from it, right?

And so it's just, it's just a good thing to, to have on your radar, creating that safety net for postpartum and saying like, "Okay, if I have these concerns, if I'm seeing things like no breast growth in pregnancy, my breasts aren't changing postpartum, if baby's losing weight, if stool is, you know, stool and urine diapers are low, if, you know, these things happen, low supply is on my radar, and I'm gonna get support for that quickly, and I know who to go to."

Right?

Yeah.

It's like that- So- ... cheesy knowledge is power, right?

But there's a reason we say that.

Like, having the knowledge then supports you and empowers you when, when you're actually in it, right?

Be that breastfeeding, birth, or whatever we're talking about.

Yeah.

And then I would say, you know, if, if somebody's had low supply previously, i- it can be really difficult when you're, considering your next baby and, and some of us are like, "I, I'm never doing this again.

This is terrible.

I hate it." And, you know, I will always honor somebody who's just like, "Mm-mm, nope, we're tapped out.

We're gone." I'm like, "Great, let's talk about bottle feeding, you know?

Let's talk... What do you wanna do?" But I, I also wanna encourage you, especially if you, y- you may have had a primary cause, there are such amazing, empowering, beautiful ways to feed your baby with your body even if you can't provide all of their nutrient requirements.

And that's one thing that, I find to be so healing for a, a lot of people.

I, I found it healing for myself.

I find it healing for a lot of clients I work with, is that, for those, a prenatal consult is, is really impactful, but, you know, there are ways to continue to nurse, to feed at the breast, to extend breastfeeding.

I mean, I, I have a... I breastfed my second baby till she was three.

I'm breastfeeding my toddler now.

He's almost three, and I never thought that would've been possible with insufficient glandular tissue and having to supplement more than half of his needs through the first year.

But there are, you know, ways to maximize the supply that your, your body's capable of.

There's a way to balance your mental health with milk production so you're not just like a lactation machine, and there are ways to feel like you have a lot of autonomy and influence in what you're providing your baby.

And I think that that's one thing to know, is that, like, you don't have to chase ounces forever.

You really can, find sufficiency in what you do provide, 'cause it's so valuable, and so long as, you know, you're experiencing joy within that, and bonding with your baby, and feeling that benefit, then I'm just like, "Let's do it, you know? That's great."

Yeah, yeah.

I love that.

Okay, I've mentioned some things that I love from you.

Your Instagram account, obviously, but share with us, you know, different ways that you can help people, whether that be right now or if they run into an issue later.

What do you got for us?

Yeah, so I have my Instagram.

And so on Low Supply Mom, I share a lot of just kind of general information about primary low supply and secondary low supply.

And on my website, which is lowsupplymom.com, I offer, a few different services.

I have... Right now, I have a prenatal course.

I have consultations, which can be, performed over telehealth, which is really amazing, and, I also offer a weekly support group, so that's new.

I'm doing that, as of this month, actually.

Oh,

nice.

Okay.

And yeah, and then I have a, a blog there as well, but yeah, just- Okay ... Low Supply world over here.

Yeah, yeah.

Low Supply Mom on, like, all the places and all the spaces though, right?

Yeah, yeah.

Website, blog, all the things.

Mm-hmm.

Okay, cool.

Last question I always ask everyone, what is something in your life that is just bringing you a ton of joy right now?

Oh, man.

You know, honestly, I think it's just, like, seeing my kids... Okay, I'll show you this.

No one on podcast- ... can see it.

My daughter just, like, drew this for me.

But seeing my, my kids are, like, coming into this transitionary period where my two-and-a-half-year-old is now becoming, like, no longer a baby.

I've been in denial about it, but it's happening.

And I feel like I've just come through the grieving process of that, and I'm now kind of arriving on that other side where I'm actually really excited about my little people now becoming, like, these little humans that are so sweet and funny and exciting.

And so, yeah, so that's exciting for me that, like, my grief- my grieving baby, you know, finishing that is, like, now transitioning to, like, hey, we're all just, like, a wonderful sweet family, and I get to, like, grow up and see you guys grow, and it's been great.

It's been good.

Yeah.

We're in similar stages, so that resonates with me, for sure.

Those of you just listening, she just shared one of those cute pictures where your kids draw the family with, like, the longer legs and the funny size proportions.

It's just the sweetest.

I love it.

I have s- I would say two kids still in that stage of drawing family portraits like that, and they're just so cute.

I love them- Yeah ... so much.

So- They're ridiculous.

It's like it... Well, a six-year-old draws it, and you're like, "This is so endearing," but if it was, like, a 38-year-old man, you'd be like, "This is terrifying."

Right.

Right.

Right?

I know.

And so it's,

it's...

I love it It's like you don't want them to stop, but you do because that's, you know, skill and growth and all that, but it's so cute.

I mean- I know ... you have to frame at least one of them or put it above somewhere 'cause they're, they're such a specific picture of that season of their life.

Like, there is a- Yeah ... specific number of years where children draw themselves and their moms and their dads and their siblings and their aunts and uncles and, and they look like that, and it's just so cute.

Okay, Kaya, thank you so much.

I know this was, like, a lot of science, a lot of kind of, information, I would say, for everyone, but man, like we said when we started, I just think this is so important.

It is not talked about enough, and the more people who just are aware of it when they go into their births, like, the better we're all gonna be, so thank you.

Yeah.

Thank you so much for having me.

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