Almost all mothers worry whether their milk supply is adequate, especially when they begin breastfeeding.

Normally, new mothers worry about their milk supply, especially in the early stages of breastfeeding when their babies cry or want to breast feed frequently. Even before their babies arrive, mothers may hear alarming reports about challenges of breastfeeding.

Friends and relatives share their own experiences in a bid to prepare expectant mothers for the worst. Some even advise the new mothers to take certain drinks

and foods so that they will not experience low breast milk supply after giving birth.

Charlotte Umulisa says as soon as she gave birth she immediately started to breastfeed her newborn as advised by the nurses.

"Three days after my baby was born, while she suckled I noticed that she was not swallowing. I put her to the other breast and there was no change. She started to cry and even refused to suckle anymore,” she narrates.

Umulisa says there’s no worse feeling than the devastation of not being able to breastfeed.

"I was so worried and confused. I cried uncontrollably thinking my bay would die from hunger or get some serious problem,” she says.

Umulisa sought advice from adults in her neighbourhood who told her to relax and increase her intake of fluids, particularly using sorghum flour to prepare her porridge.

"I followed the advice and the next morning milk flowed normally. However, whenever I get a mood change the problem occurs again,” she says.

While some people may think that all mothers are capable of producing ample breast milk to feed their babies, Umulisa’s experience reveals the opposite. And, indeed, she is not the only mother with this problem.

Health experts say there are many things that can lead to inefficient breast milk supply.

What causes low breast milk supply?

Anastasie Mukakayumba , a nutritionist at Sante Plus in Kigali, says stress, previous breast surgeries, diabetes, hypertension, insufficient mammary tissue and thyroid or other hormonal disorders, are some of the more common causes. Any of these issues may contribute to low breast milk supply because making milk relies on the hormonal signals being sent to the breasts according to nutritionists.

"Sometimes, low breast milk supply may also be associated with practical inefficiency. The baby may have sucking difficulties or anatomical issues (mostly premature infants) and not be able to stimulate and drain the breast effectively. It can also be because the new mother is holding the baby in the wrong way while breastfeeding (which can be adjusted with the help of the nurses or relatives by showing her how to hold it properly,” says Mukakayumba.

On the other hand, Dieudonné Bukaba, a nutritionist at Avega Clinic, Kigali, says infrequent nursing may also result in low breast milk production. In many cases, the baby simply needs to be nursed more often and most babies must feed frequently in order to take in enough milk, he says.

"Many babies who are not gaining weight well simply need more time at the breast and some babies need encouragement in order to feed more often. A mother may help this process by offering the breast every 1-2 hours and paying close attention to signs that the baby is hungry or satisfied. When the breast is drained, the body responds by making more milk”, Bukaba explains.

Bukaba adds that almost every mother should be able to boost their milk supply, especially if they notice the problem early. In some cases, though, a low breast milk supply can put a baby at risk for malnutrition, so it’s important to get it checked out.

How to fix the problem

Mukakayumba says it is important for mothers to explore all of the possible maternal or infant causes of low breast milk production in order to help restore full and exclusive breastfeeding for the first 6 months.

She says where the problem is not linked to malpractice of the mother the best solution is to seek medical help.

"A lactation consultant might recommend herbs to help boost your supply, or prescribe medication. In some cases, treatment of your health problem will help you to boost breast milk production, although supplementation may be needed,” she says.

How to tell you have enough milk

Felicien Ntakirutimana, who has been a nurse for over 12 years, says a mother can tell that she has enough milk simply by the heaviness of her breasts, leaking and by hearing frequent swallowing when the baby is nursing.

"Your newborn should breastfeed at least eight times in 24 hours. By four days of age, a breastfed baby’s stools should turn yellow and seedy; it should have at least four stools a day; and that pattern should continue for at least four weeks. Also, it should urinate at least six times a day and the urine should be clear, not dark yellow. The baby’s weight gain is also another key indicator of a well breastfed baby,” he explains.

Sometimes, babies do not gain weight at the minimal expected rate for health and development and need temporary additional nutrition, he says.

Bukaba suggests that when a mother supplements with formula, she should be encouraged to pump her breast milk in order to maintain (or increase) her milk production.