Factors Contributing to Inadequate Supply (Nursing)

00:01 So there are some factors that contribute to this inadequate milk production.

00:06 So if the birthing person has had some sort of breast surgery, and not talking about a biopsy, but maybe breast augmentation or something like that, then they may actually not produce enough milk in order to adequately feed the baby.

00:21 They may also have sore nipples from poor latch, you saw we talked about all of those different positions for feeding.

00:27 So maybe we want to adjust that.

00:29 Or if perhaps the baby has a poor latch, we want to do what we can to help treat the nipple to actually make it more comfortable for them.

00:37 Because sore nipples affect latch.

00:39 A poor latch doesn't allow prolactin, we don't get enough prolactin, we don't get enough milk.

00:46 Other factors that may contribute to an inadequate milk supply would be maybe a congenital anomaly or a pituitary insufficiency.

00:55 Why would a pituitary insufficiency be important? Exactly, because the pituitary gland is where we get the release of prolactin that makes milk.

01:07 Hypothyroid disease also can cause an inadequate milk supply.

01:12 Other factors such as stress of the birthing person or obesity, or any sort of glandular development abnormality, any of those things can also lead to an inadequate milk supply.

01:23 So it's important for the nurse to really look at that past medical history when the patient comes in for labor.

01:31 We also want to think about other types of diseases like hypertension, and diabetes, those can also impact our milk supply.

01:39 Things like medications.

01:41 So using oral contraceptives that contain estrogen, exactly, would absolutely contribute to an inadequate milk supply.

01:51 Hopefully, some of this is coming back from our previous lectures.

01:54 If they're retained placental products, then that can lead to an inadequate milk supply, because it's the release of all the progesterone and the placenta that triggers the body.

02:04 And it lets it know it's time to start making mature milk.

02:08 If we still have products of conception that are still within the uterine cavity, that message is not sent.

02:14 And the milk supplied never gets up to where it needs to be.

02:18 When we delay breastfeeding.

02:20 So remember, the first 30 minutes are critical in establishing good breastfeeding.

02:25 If we delay it, that can actually contribute to an inadequate supply later or a poor latch.

02:31 If the baby's not able to really establish good suckling, then we don't have the release of prolactin, we don't have good milk production and so on.

02:40 So any baby that has a poor suck or swallow or any lip or tongue difference, so think about a cleft lip or cleft palate or a frenulum underneath the tongue that's attached, that keeps the baby from actually being able to move the tongue, any of those things can actually contribute to an inadequate milk supply.

02:59 So sometimes when the milk is not coming in, we nurses have to do a little bit of investigating to figure out what the root cause might actually be.

03:08 So how do we know there's enough milk? I mean, there's not a graduated cylinder somewhere on the inside, where we can measure and say, "Oh, I think you have about 4 ounces of breast milk." We can't do that.

03:19 So how can we figure it out otherwise? Well, after the milk comes in, when we're talking about day 4, because colostrum by volume is really not very much.

03:29 So we're speaking about day 3 or 4, we would expect to see about or at least 6 wet diapers a day.

03:38 We would also expect to see about 2 stools diapers a day.

03:41 So there may be a few more and that's okay.

03:44 But if we have fewer than that, then we want to really check in and make sure there's enough milk being produced.

03:50 Also, when we think about how the birthing person is breastfeeding, and what's going on with the nipple.

03:55 If we seen signs of trauma, so if there's blisters or bleeding, or cracked nipples, or damaged nipples in any way, we know that there's a poor latch.

04:05 If we have a poor latch, we may not be getting adequate stimulation to the pituitary, which decreases our milk supply.

04:13 Also, if we don't have milk that comes in, you might notice that the baby is saying, "I'm hungry, like this not enough in this happy meal for me to make me happy." So the baby is just gonna eat and eat and eat and eat.

04:27 And it's not because they're greedy, it's because they're not getting enough.

04:30 So that might be a sign that we can pay attention to.

04:34 Also, if the baby is not gaining weight.

04:36 We expect the baby to gain about half an ounce per day.

04:40 So if we find after we are weighing the baby over a few days, if they're not gaining weight, or they're coming in for their checkup, and their weight is not increasing, then that may be a sign that they're not getting enough milk.

04:52 And finally, if the baby has not regained their birth weight by day 10, that's definitely a red flag.

04:58 So if we have a situation where we have have a failure to thrive or failure to grow, one of the things we're going to first pay attention to is, is there enough milk being produced and is the baby getting what they need?