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What if I don't make enough milk?- Insufficient Glandular Tissue
- thesmartdoula
- Aug 2
- 8 min read
Its World Breastfeeding Week 2025 and this years theme is 'Prioritise Breastfeeding' - Create Support Systems!
To celebrate a Virtual Doula Mum Lucy has kindly shared her two breastfeeding journeys to demonstrate how the right support system can make the difference between successfully breastfeeding or not.
We first meet Lucy for her first feeding journey...
'I was convinced I wasn't producing any milk'
My breastfeeding journey with my son started with great difficulty and, through undiagnosed issues (Insufficient Glandular Tissue) as well as a lack of support, ended after just 4 weeks.
After he was born I really struggled with feeding and by day 3 my nipples were blistered and bleeding.
My milk hadn’t come in and I was convinced I wasn’t producing any milk and I must be starving my baby who seemed to be constantly feeding and never satisfied after a feed.
There was no support with breastfeeding from the midwives and due to a bank holiday weekend I wasn’t able to access the volunteer BF supporters until a few days later. When I did speak to them I was advised to take fenugreek and to express between feeds.
Feeding continued to be incredibly painful. I was disheartened that I was only ever able to express a couple of mls despite all my efforts.
At 4 weeks I developed a particularly bad case of mastitis and made the decision to stop feeding. Breastfeeding had never stopped being painful and I was convinced I wasn’t producing any milk anyway.
I felt so much shame and guilt about the way breast feeding had gone and I always remember a health visitor’s comment when I was explaining to her why I had felt I needed to stop.
She said ‘Everybody can breastfeed but it’s fine if you choose to stop’. It didn’t feel like a choice at the time.
Low milk supply
Lucy's first journey was one that is probably familiar to a lot of people, breastfeeding difficulties, lack of support and grief that the journey is over before it had even begun.
Looking at her story there are clear signs that feeding wasn't successful for Lucy or for her baby, these are:
Painful bleeding nipples
All though some pain at the start of the latch can be normal especially when you start out, extreme pain and nipple damage such as blisters or bleeding are a huge red flag that baby's latch isn't correct and therefore they are causing damage and not removing milk sufficiently.
Baby never satisfied after a feed and frequent feeding
All though frequent feeding is normal to an extent, and the first weeks breastfeeding a baby are littered with cluster feeds and growth spurts, this can also be a red flag when viewed with the other signs.
A baby that is on the boob constantly and never seems satisfied (see milk drunk!) could indicate they aren't getting enough milk - either because there isn't enough being created or they aren't removing it sufficiently - or both!
Mastitis
Another red flag for a ineffective latch or ineffective milk removal.
Nappy output
Not mentioned here but another important but not fail safe indicator of milk supply / effective feeding is nappy out put and poo colour!
What cause low milk supply
During puberty your breast are already getting ready to feed your babies, the breast tissue starts to develop!
During pregnancy the prolactin hormone causes the development of mammary tissue and the milk making cells, but other hormones restrict the production of milk, some people will produce a small amount of colostrum during pregnancy.
Once baby is born the other hormones drop and oxytocin rises, at first you produce colostrum a nutrient dense very concentrated version of milk, but as the baby suckles on the nipple and removes the colostrum this creates more prolactin which leads to your milk to transition into the form that is most recognisable as milk!
Your breasts work on a supply and demand basis, the more milk removed, the more created, effectively allowing your baby to put in its order for just the right amount of milk.
Most peoples milk transitions on day 3-5, they will notice a significant increase in milk volume and a colour change from yellow to white.
Your breasts may feel heavy or full, and you may see / hear baby swallowing more than before.
Your baby's poo will change from dark green to lighter green then yellow / mustard.
Early removal of milk is important to establish overall milk supply. Research on lactation after premature birth has shown that starting to express milk within an hour of birth, compared with starting at six hours, is associated with more milk six weeks later.
There is a theory that as milk builds up in the breast, a protein in the milk, known as the “Feedback Inhibitor of Lactation” (FIL), begins to slow down milk production, which is why its important that milk is removed effectively to prevent the overall supply from dropping.
All of the above means that if your baby isn't latching effectively and feeding effectively removing sufficient milk, your milk supply drops.
You can learn more about milk production here: https://laleche.org.uk/how-milk-production-works/
Sometimes there are other things at play as well but we will get into that later! Lets follow Lucy into her second pregnancy!
Preparing for breastfeeding during pregnancy
So fast forward to my second pregnancy 7 years later.
I learned from a good friend that inductions and epidurals as well as bleeding can all affect milk supply in the early days (they don’t tell you that when recommending these interventions!).
So I realised that getting the right birth would be as important as what I did afterwards.
I was determined to have a better go at breast feeding so we invested in a birth course, a virtual doula, listened to hundreds of podcasts and sought the support of a lactation consultant.
I remember listening to a podcast on Insufficient Glandular Tissue and feeling a real lightbulb moment. I just knew that is what I have. It felt quite validating when the lactation consultant confirmed the diagnosis, but I also felt sad to know I would probably never be able to exclusively breast feed.
However, I now had a feeding plan and felt great that I had much more knowledge and support to give it a better go this time.
Can your birth impact breastfeeding?
Lucy's good friend was right, it is evidence based that interventions during birth can affect breastfeeding success!
This population based study identified that 'Common intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth'
Looking deeper into this one of the things that seems to have an impact is the use of artificial oxytocin one review of current research showed that: Fifty percent of the results (17 of 34 measures) demonstrated an association between exogenous oxytocin and less optimal breastfeeding outcomes, while 8 of 34 measures (23%) reported no association. The remaining 9 measures (26%) had mixed findings.
Bleeding is associated with less positive breastfeeding outcomes as well, a 2010 study showed: Following a significant PPH, women with greater blood loss are less likely to initiate and sustain full breastfeeding and this may be related, in part, to delays in initial contact with their baby as a consequence of the PPH.
What is Insufficient Glandular Tissue (IGT) ?
During her second pregnancy Lucy was diagnosed with IGT....but what is this?
IGT is caused by the glandular breast tissue not developing as it should, either in utero, in puberty or during pregnancy.
There is a typical physical presentation that may indicate you may have IGT, this is:
A wide space between breasts on the chest wall.
Tubular breast shape and bulbous areolae.
Lack of breast growth in pregnancy.
Not everyone with IGT have these signs, and they can be differing in how pronounced they are.
It is often diagnosed when you are having breastfeeding issues, as with IGT you will produce colostrum but the volume of the milk you produce when it starts to transition will be affected. It is unlikely you will produce a full milk supply.
With IGT ensuring that the milk making cells you do have are switched on asap by your baby having a sufficient latch or by pumping is important, as well as recognising that you may have to supplement your baby with either donated breast milk or formula alongside breastfeeding.
Lets see what Lucy did!
Breastfeeding with low milk supply
'It was a tough couple of months feeding 10 or 12 times a day and pumping in between every feed, but we eventually settled into a routine and could stop expressing when my milk supply was optimised. Through guidance from the lactation consultant we were able to adjust the amount of top up that was needed according to Edie’s weight and we continue to have her weighed regularly.
We use a supplementary nursing system (or SNS) to give the top up. The SNS is a method of providing a top up through a small tube inserted into the corner of baby’s mouth whilst she feeds at the breast. Having baby take the top up at the breast rather than from a bottle helps stimulate milk production.
Edie is now 7 months and I’m happy to say we are still breast feeding with the SNS. It’s such a shame there wasn’t support available when I needed it with my son, but it has been a healing experience to have a positive breast feeding journey with my daughter.'
Supplementing breastfeeding
Lucy chose to use a supplementary nursing system to ensure her baby got sufficient milk, this meant that she didn't have to top up her baby's feeds by using a bottle after a breastfeed, As she mentions it also means the feeding baby stimulates milk production in the breast.
Other mums may choose to bottle feed alongside breastfeeding, in this case paced feeding is very important!
She worked alongside a lactation consultant to help her determine how much milk was required in the top ups.
Other ways to increase milk supply.
Lucy was told to take fenugreek in her first breastfeeding journey, although this has traditionally been used to increase milk supply it has been shown to decrease milk supply in some women.
In her second pregnancy Lucy researched Domperidone and along with a lactation consultant decided that she would like to take it once her baby was born to help increase her milk supply, she found it hard to get a prescription for this as it is an off label use, and eventually had to go to a private doctor who specialised in breastfeeding to get the prescription.
You can find out more about Domperidone here:
Support
This is what Lucy has to say about the support she received to enable her to breastfeed.
Although the professionals I saw with my daughter were lovely and very supportive, most had very little, if any, knowledge of IGT and most had never heard of an SNS. One was even quite suspicious and concerned and asked me where I got it from!
To get the support I needed to have a successful breast feeding story this time I had to do my own research and seek private support.
I know that this is not an option available to everyone and I hope that in the future this kind of support is available through the NHS.
Overall, being able to breast feed second time around has been amazing for me and my daughter and it was only possible through seeking a greater amount of support than would ordinarily be available.
Breastfeeding is amazing and should be available to everyone who chooses to do it.
Where to get support:
Who am I?
I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.
With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.
I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.
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