Perceived milk insufficiency: A systematic review and synthesis of the literature

Background: Concerns about inadequate milk production are among the most commonly cited reasons for early weaning by breastfeeding women. While many studies identify perceived milk insufficiency (PMI) as a common problem, and some address why women lack confidence in their milk production, PMI itself has not been adequately analyzed as a discrete entity. The purpose of the current study is to synthesize the literature on PMI and arrive at a definition that is both theoretically sound and clinically practical.

Methods: Database searches were performed in Highwire, PsycINFO, MEDLINE, Pubmed, and the Cochrane Library using search terms “perceived”, “insufficient”, “insufficiency” and “milk” combined with breastfeeding/breast-feeding/breast feeding. Peer-reviewed references from relevant studies were also searched. Included studies were published in English from 1991-2012.

Results: Approximately fifteen (15) studies will be included in the review. Initial analysis suggests that the perception of inadequate milk production is more behaviorally-related than physiological, and occurs when infant suckling demands exceed the amount of time and effort that women feel able to invest in breastfeeding.

Conclusions: 1) Better anticipatory guidance during pregnancy could potentially reduce the incidence of PMI 2) low self-efficacy and insufficient time/social support play significant roles in its development 3) PMI can best be addressed through counseling individualized to women's concerns about the demands of breastfeeding and their milk production.