The Month 3 Supply Drop
Reading time | 7 minutes
Last year in the United States, 83.4% of all babies started off breastfeeding. By three months, however, only 46.9% of babies were still exclusively breastfeeding (CDC report card).
Now it's true that any human milk a baby receives is beneficial and that people should continue to human milk-feed in any capacity they can manage. The efforts of parents who are putting in the work to provide human milk in any quantity are not diminished just because at a certain time they may choose to or need to combination feed.
But as we push towards getting more babies human milk for longer, there is a simultaneous effort to get more babies directly feeding at the breast/chest for as long as possible.
The 3-month mark seems to be an important milestone in human milk feeding directly at the breast/chest, as it tends to be a point in time where many parents have concerns about their supply and about how infant feeding is going in general. These doubts about supply usually lead to supplementation or the cessation of breastfeeding, contributing to the declining rates come 3 months.
The anxieties regarding supply usually fall into two categories: 1) worries over supply regulation and the breast changes that may accompany it 2) concerns about a sudden decrease in milk supply.
In today's' post I'll address both concerns in hopes of providing reassurance and information to further the mission of increasing direct breastfeeding rates.
To better understand the regulation process and explain the possible dips in supply around 3 months, it's important to know the different stages of lactation.
During pregnancy, usually around the 16th-week mark, your body starts creating milk (Lactogenesis I). By the time your baby arrives, be it 24 weeks or 42 weeks, colostrum is available. Colostral milk tends to be low in volume due to the hormonal influences of your placenta but will always be present because it's made due to the hormones of pregnancy.
Colostrum production is under hormonal production.
After your baby's birth and the delivery of your placenta, your body receives the signal that it needs to start the transition of colostrum to mature milk. Around day 3 or so, in response to the shift in placental hormones, your body starts to increase the volume of milk it makes, at the same time it begins to change the composition of colostrum. Parents often report their breasts feeling full, heavy, and warm to the touch (engorgement) for a few days during this time.
This process will happen regardless of if baby directly breastfeeds or if you're expressing. We use the phrase Lactogenesis II to describe this process.
Lactogenesis II or "milk coming in" is under hormonal control.
Typically by day 9, after your transition to mature milk has already begun, your milk production switches to autocrine control. This means that milk production will continue on a "demand and supply" basis, making frequent, effective milk removal vital to the continuance of lactation.
Continued milk production is under autocrine control (demand & supply)
Supply Regulation
Despite the change from hormonal control of lactation to demand and supply, your breasts will continue to make more milk than your baby needs.
Your breasts may get full very easily or may regularly feel heavy and you may leak between feeding/expression sessions.
If you're expressing in addition to nursing during this time period, getting "extra" milk may come easily. And if you're solely expressing, you may get used to seeing a relatively large output every pump session.
This period of "calibration" typically lasts until 4-6 weeks postpartum but may last 12 weeks or longer if you're dealing with a real case of oversupply. It's during this time (the first 4-6 weeks) that your body is getting a good idea of how much milk it needs to make and will gradually regulate its production to match.
After your supply has regulated, your breasts may no longer feel full and heavy, you may stop leaking between feeds, and you may notice a decrease in output during expression sessions. This can be very alarming to parents and is a common point in time when people first question their supply.
Things to remember about supply regulation:
Usually occurs between 4-6 weeks, but may occur later
Is a normal process and not a sign of low supply
Breast changes are normal and not a sign of supply issues
May occur concurrently with a growth spurt (6-8 weeks)
Not a reason to supplement. Supplementation will interrupt the demand and supply cycle and begin to down-regulate your supply.
Feeding changes at 3 months
Just as your breasts are going through amazing changes during the first 3 months postpartum, so is your baby's oral development.
During the first three months, your baby is being guided by reflexes to accomplish feedings. Around month 3-4, your baby switches to using oral motor skills to eat. Additionally, around month 3, your baby's oral anatomy starts to change. Your baby's chin, which may have been recessed, may start to come forward and the distance between the oral, pharyngeal and laryngeal structures may increase.
These changes may influence your baby's ability to manage the breast and feed effectively.
Why the drop in supply at 3 months?
In many cases, the perceived decrease in supply is related to supply regulation discussed above. Many parents incorrectly assume that because their breasts are softer, they no longer leak, and/or they are not able to express as much, their supply has dropped. In these situations, there is no decrease in supply and things are going perfectly. Wet and dirty diaper output, along with weight gain should be the guiding factors in assessing supply.
If your baby is having 6-8 wet diapers a day and frequent bowel movements (ideally daily), then odds are your supply is fine.
There are some cases where there is a legit decrease in supply. 8-12 weeks is a time where parents may notice changes in their baby's feeding pattern, diaper output, and weight gain which are attributed to decreased supply.
The decrease in supply may seem sudden but with a bit of investigation, it may become clear as to the underlying cause of the decrease.
Common reasons for a decrease in supply at 3-4 months
A baby with oral restriction (such as tongue tie) has a hard time draining the breast following a decrease in letdown force due to supply regulation
A baby with oral restriction or other feeding dysfunction has difficulties draining the breast due to difficulties with relying on oral motor skills to eat
Supplementation due to perceived low supply following supply regulation
Decreased number of feeding/expression sessions, especially at night
The start of hormonal contraception
Pregnancy
Naturally, these aren't the only reasons out there for a decrease in supply. If you feel that you may be suffering from low supply, I encourage you to seek the help of a lactation professional as soon as possible. The quicker we can identifying what is causing the decrease in supply, the sooner we can help you with a plan that resolves it.
Here's some reading to get you started!
Want to start investigating the cause of your low supply? Here's an easy- to- use checklist that will help you quickly identify possible influencing factors
Need help to increase your supply fast? Check out this blog post, which provides you with things you do starting today to quickly increase your supply.
Knowing what is normal and expected during the course of lactation is extremely helpful to long term breastfeeding success. Many parents stop breastfeeding because they have concerns with their supply that aren’t actually real issues.
On the flip side of that, I know many parents feel guilt or embarrassment at the idea of reaching out for help when issues arise. I want to end the post with a little reassurance:
Lactation professionals get into the field because they WANT to help families reach their human milk feeding goals. We enjoy providing support, encourage, and information to those who need it.
When my daughter was born, I sought the help of the on staff IBCLC despite my training and knowledge in lactation. It’s a funny little reminder but one that I find reassuring when I hear it. International Board Certified Lactation Consultants (IBCLC) needs IBCLCs too. There’s no way we can know how to self manage every possible issue that may arise and I remember being so sleep deprived and stressed with baby care, there was no way I could manage my own challenges and be a mom at the same time.
Lactation professionals want to help. So if you need help, let us help you! :)
As always, I would love to hear your feedback below!