Perceived insufficient milk supply in early postpartum: clinical differentiation, counselling challenges, and implications for maternal health practice

Perceived insufficient milk supply in early postpartum: clinical differentiation, counselling challenges, and implications for maternal health practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Perceived insufficient milk supply in early postpartum: clinical differentiation, counselling challenges, and implications for maternal health practice Mekala Moorthy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9602258/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Perceived insufficient milk supply (PIMS) is a common concern in the early postnatal period and is one of the leading reasons for early breastfeeding supplementation and discontinuation. In many instances, this perception arises even when milk production is adequate and is often linked to misunderstanding of normal newborn behaviour. Objective: To describe how perceived and actual insufficient milk supply can be differentiated clinically in the early postpartum period and to explore the implications for maternal health practice. Methods: A clinical case from the early postnatal period was examined. Maternal concerns, infant clinical indicators, breastfeeding assessment findings, and the response to counselling were reviewed alongside existing evidence. Results: Maternal concern was primarily triggered by frequent feeding and infant crying. However, clinical assessment showed reassuring findings, including effective latch, audible swallowing, normal urine output, and weight loss within expected physiological limits. Following counselling and reassurance, maternal confidence improved, and exclusive breastfeeding was maintained. Subsequent weight gain confirmed adequate milk intake. Conclusion: In early postpartum care, perceived insufficient milk supply often reflects misinterpretation rather than true lactation failure. Careful clinical assessment combined with timely counselling can prevent unnecessary supplementation and support continued breastfeeding. Maternal & Fetal Medicine Breastfeeding perceived insufficient milk supply lactation counselling postnatal care maternal health WHAT IS ALREADY KNOWN Perceived insufficient milk supply is a leading reason for early breastfeeding discontinuation [3] Maternal perception often does not correlate with actual milk production [5] Early formula supplementation negatively affects exclusive breastfeeding rates [6] WHAT IS NEW Demonstrates how simple clinical indicators can help distinguish perceived from actual low milk supply Highlights the importance of incorporating structured breastfeeding assessment into routine care Emphasises counselling as a key intervention in early postpartum management INTRODUCTION Breastfeeding is widely recognised as the optimal method of infant feeding, offering important nutritional, immunological, and developmental benefits [ 1 ]. Although many mothers initiate breastfeeding, continuation during the early postnatal period remains a challenge. One of the most commonly reported reasons for early supplementation or discontinuation is perceived insufficient milk supply (PIMS) [ 3 ]. PIMS refers to a situation in which a mother believes that her breast milk is not adequate for her infant, despite normal physiological milk production [ 5 ]. This perception is often influenced by misunderstanding of normal newborn behaviour. Frequent feeding, cluster feeding, and crying are typical in the early days after birth and play an important role in establishing lactation. However, when mothers are not adequately prepared for these behaviours, they may interpret them as signs of inadequate milk supply [ 6 ]. From a clinical standpoint, differentiating perceived insufficiency from true lactation failure is essential. Objective indicators such as urine output, weight patterns, and feeding effectiveness provide reliable evidence of adequate intake in most cases [ 4 ]. Nevertheless, maternal anxiety, lack of confidence, and external influences—particularly from family members—can strongly shape perception and decision-making. While these clinical indicators are well established in the literature, their consistent use in routine bedside assessment is not always observed. This case illustrates how a structured clinical approach, combined with appropriate counselling, can help distinguish perceived from actual insufficiency and support positive breastfeeding outcomes. CASE PRESENTATION A 24-year-old primiparous woman delivered a healthy term infant at 39 weeks of gestation by normal vaginal delivery. On postnatal day 2, she expressed concern that her baby was not receiving sufficient breast milk. The infant’s birth weight was 2.9 kg, and the weight on day 2 was 2.7 kg, corresponding to a 6.8% weight loss, which is within expected physiological limits [ 4 ]. The mother reported that the baby was feeding frequently, approximately every 1–2 hours, and crying often. She interpreted these behaviours as indications of inadequate milk supply. On clinical examination, the infant appeared active, alert, and well hydrated. Urine output was 6–8 times per day, and the stool pattern was appropriate for age. Direct observation of breastfeeding showed effective latch, coordinated suckling, and audible swallowing. The mother had no medical conditions known to affect lactation. However, she expressed low confidence in breastfeeding, and concerns from family members appeared to reinforce her doubts. Taken together, the clinical findings were reassuring. Normal weight loss, adequate urine output, and effective milk transfer suggested that milk intake was sufficient. Based on these findings, the situation was identified as perceived insufficient milk supply rather than true lactation failure. The mother was counselled regarding normal newborn feeding behaviour and reassured using objective clinical indicators. Guidance on positioning and attachment was reinforced. At follow-up on postnatal day 5, the infant’s weight had increased to 2.81 kg. The mother reported improved confidence and continued exclusive breastfeeding. Table 1 Clinical Summary of the Case Characteristic Finding Maternal age 24 years Gestational age 39 weeks Mode of delivery Normal vaginal delivery Postnatal day Day 2 Birth weight 2.9 kg Day 2 weight 2.7 kg Day 5 weight 2.81 kg Urine output 6–8/day Feeding pattern Frequent (1–2 hourly) Key concern Perceived low milk supply Outcome Exclusive breastfeeding continued DISCUSSION Perceived insufficient milk supply is a frequent concern in early postpartum care and continues to be a major contributor to unnecessary supplementation [ 3 , 5 ]. This case highlights how maternal perception, in the absence of supporting clinical evidence, can lead to misinterpretation of otherwise normal feeding patterns. In the early neonatal period, behaviours such as frequent feeding and crying are expected and play an important role in establishing and maintaining lactation. However, without adequate preparation or explanation, these behaviours are often perceived as indicators of inadequate milk intake [ 6 ]. This disconnect between normal physiology and maternal understanding remains a key challenge in clinical practice. In contrast, the clinical findings in this case were clearly reassuring. Effective latch, audible swallowing, appropriate urine output, and expected weight changes provided consistent evidence of adequate milk transfer [ 4 ]. These objective indicators should form the basis of clinical assessment and decision-making. Psychosocial influences were also evident. The mother’s low confidence, along with concerns expressed by family members, contributed to her perception of insufficient milk supply. In many settings, such external influences can significantly affect maternal beliefs and feeding practices. Addressing these concerns requires a supportive and empathetic approach, rather than simple reassurance. The positive outcome in this case following counselling reflects the importance of timely and targeted support. Counselling not only provided information but also helped build maternal confidence and trust in the breastfeeding process. This is consistent with evidence demonstrating that structured support can improve breastfeeding outcomes and reduce unnecessary interventions [ 9 ]. From a clinical perspective, this case underscores the need for a structured approach to breastfeeding assessment in routine postnatal care. Incorporating direct observation and using simple clinical indicators can help healthcare providers differentiate between perceived and actual problems more effectively. Equally important is the provision of anticipatory guidance, which can prepare mothers for normal newborn behaviour and reduce anxiety. Clinical Relevance This case represents a common situation encountered in early postpartum care. A structured assessment approach, combined with appropriate counselling, can improve clinical decision-making, prevent unnecessary supplementation, and support successful breastfeeding. IMPLICATIONS FOR CLINICAL PRACTICE Prioritise objective clinical indicators when assessing breastfeeding adequacy Include routine observation of breastfeeding in postnatal care Provide anticipatory guidance on normal newborn feeding patterns Use counselling strategies that enhance maternal confidence Recognise and address psychosocial and family influences Avoid unnecessary supplementation unless clinically indicated LIMITATIONS This report is based on a single clinical case and may not be generalisable to all populations. Follow-up was limited to the early postnatal period, and long-term breastfeeding outcomes were not assessed. However, the clinical principles described are relevant to routine practice. CONCLUSION Perceived insufficient milk supply is a common concern in the early postpartum period but is often not associated with true lactation failure. This case demonstrates that maternal perception alone should not guide clinical management. Instead, assessment should rely on objective indicators such as feeding effectiveness, urine output, and weight patterns. When these findings are reassuring, counselling plays a central role in management. Providing clear explanations and supporting maternal confidence can help prevent unnecessary supplementation and promote continued breastfeeding. Early recognition and appropriate management of PIMS are therefore essential in improving postnatal care outcomes. Declarations Ethical approval and consent to participate: Not applicable. Consent for publication: Informed consent was obtained from the patient for publication of this case. Conflict of interest: The author declares no conflict of interest. Funding: No funding was received for this study. References World Health Organization (2021) Infant and young child feeding. WHO, Geneva UNICEF (2020) Improving breastfeeding, complementary foods and feeding practices. UNICEF, New York Huang Y, Ouyang YQ, Redding SR (2021) Perceived insufficient milk supply: a systematic review and meta-analysis. Matern Child Nutr 17(1):e13066 Kent JC, Gardner H, Geddes DT (2016) Breastmilk production in the first weeks postpartum. J Hum Lact 32(3):489–499 Gatti L (2008) Maternal perceptions of insufficient milk supply in breastfeeding. J Nurs Scholarsh 40(4):355–363 Brown CRL, Dodds L, Legge A, Bryanton J, Semenic S (2014) Factors influencing why mothers stop breastfeeding. Can J Public Health 105(3):e179–e185 Rowles G, Keenan J, Wright NJ et al (2025) The impact of breastfeeding difficulties on maternal mental health: a qualitative study. Sci Rep 15:13572 Academy of Breastfeeding Medicine (2017) ABM clinical protocol #3. Breastfeed Med 12(3):188–198 McFadden A, Gavine A, Renfrew MJ et al (2022) Support for breastfeeding mothers. Cochrane Database Syst Rev 10:CD001141 Demirci JR, Bogen DL, Holland C, Tarr JA, Rubio D (2022) Breastfeeding discussions at prenatal visits. J Hum Lact 38(2):255–264 Pérez-Escamilla R, Segura-Pérez S, Lott M (2023) Feeding guidelines for infants. Int Breastfeed J 18:12 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9602258","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":633708902,"identity":"49ac4e5f-27c5-486c-a109-8370e1081f4f","order_by":0,"name":"Mekala Moorthy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACAyCSeABiSTAwPv5TAWQwMzcQ1pIA0cJswHMGpIWReC1sErxtIBYBLeYSyRtvJLZtk5OP7jE2kJxXG83fDtTyo2IbTi2WM9KKLRLbbhsb3jlj+MBw2/HcGYcZGxh7ztzG7bAbOWYSQC2JG2fkGBskbjuW2wDUwszYRlhLPVCLmcTBOcdy5xOrJUFeIsdMsrGhJncDIS2WPc+KLRLO3TbcIJFWbMxw7EDuRqCWg/j8Ys4ODLEPZbfl5Wckb3zMUFOXO+/84YMPflTg1gIGjGxAFx4AMw+DyQP41YPAHwYG+QYwq46w4lEwCkbBKBhxAABCMWH8rmYFCAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0003-3796-2086","institution":"KMCH College of Nursing","correspondingAuthor":true,"prefix":"","firstName":"Mekala","middleName":"","lastName":"Moorthy","suffix":""}],"badges":[],"createdAt":"2026-05-03 19:41:35","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9602258/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9602258/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108463739,"identity":"9d10e270-67c3-4e01-a79a-edd15c45c62e","added_by":"auto","created_at":"2026-05-05 02:41:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":137659,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9602258/v1/9c9a8243-a74e-4eb6-9a36-6ab1758db1cb.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cblockquote\u003e\u003cstrong\u003ePerceived insufficient milk supply in early postpartum: clinical differentiation, counselling challenges, and implications for maternal health practice\u003c/strong\u003e\u003c/blockquote\u003e","fulltext":[{"header":"WHAT IS ALREADY KNOWN","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003ePerceived insufficient milk supply is a leading reason for early breastfeeding discontinuation [3]\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMaternal perception often does not correlate with actual milk production [5]\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEarly formula supplementation negatively affects exclusive breastfeeding rates [6]\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWHAT IS NEW\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDemonstrates how simple clinical indicators can help distinguish perceived from actual low milk supply\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHighlights the importance of incorporating structured breastfeeding assessment into routine care\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEmphasises counselling as a key intervention in early postpartum management\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eBreastfeeding is widely recognised as the optimal method of infant feeding, offering important nutritional, immunological, and developmental benefits [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although many mothers initiate breastfeeding, continuation during the early postnatal period remains a challenge. One of the most commonly reported reasons for early supplementation or discontinuation is perceived insufficient milk supply (PIMS) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePIMS refers to a situation in which a mother believes that her breast milk is not adequate for her infant, despite normal physiological milk production [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This perception is often influenced by misunderstanding of normal newborn behaviour. Frequent feeding, cluster feeding, and crying are typical in the early days after birth and play an important role in establishing lactation. However, when mothers are not adequately prepared for these behaviours, they may interpret them as signs of inadequate milk supply [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom a clinical standpoint, differentiating perceived insufficiency from true lactation failure is essential. Objective indicators such as urine output, weight patterns, and feeding effectiveness provide reliable evidence of adequate intake in most cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Nevertheless, maternal anxiety, lack of confidence, and external influences\u0026mdash;particularly from family members\u0026mdash;can strongly shape perception and decision-making.\u003c/p\u003e \u003cp\u003eWhile these clinical indicators are well established in the literature, their consistent use in routine bedside assessment is not always observed. This case illustrates how a structured clinical approach, combined with appropriate counselling, can help distinguish perceived from actual insufficiency and support positive breastfeeding outcomes.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 24-year-old primiparous woman delivered a healthy term infant at 39 weeks of gestation by normal vaginal delivery. On postnatal day 2, she expressed concern that her baby was not receiving sufficient breast milk. The infant\u0026rsquo;s birth weight was 2.9 kg, and the weight on day 2 was 2.7 kg, corresponding to a 6.8% weight loss, which is within expected physiological limits [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mother reported that the baby was feeding frequently, approximately every 1\u0026ndash;2 hours, and crying often. She interpreted these behaviours as indications of inadequate milk supply. On clinical examination, the infant appeared active, alert, and well hydrated. Urine output was 6\u0026ndash;8 times per day, and the stool pattern was appropriate for age.\u003c/p\u003e \u003cp\u003eDirect observation of breastfeeding showed effective latch, coordinated suckling, and audible swallowing. The mother had no medical conditions known to affect lactation. However, she expressed low confidence in breastfeeding, and concerns from family members appeared to reinforce her doubts.\u003c/p\u003e \u003cp\u003eTaken together, the clinical findings were reassuring. Normal weight loss, adequate urine output, and effective milk transfer suggested that milk intake was sufficient. Based on these findings, the situation was identified as perceived insufficient milk supply rather than true lactation failure.\u003c/p\u003e \u003cp\u003eThe mother was counselled regarding normal newborn feeding behaviour and reassured using objective clinical indicators. Guidance on positioning and attachment was reinforced. At follow-up on postnatal day 5, the infant\u0026rsquo;s weight had increased to 2.81 kg. The mother reported improved confidence and continued exclusive breastfeeding.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Summary of the Case\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDay 2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 2 weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7 kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDay 5 weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.81 kg\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine output\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;8/day\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeding pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent (1\u0026ndash;2 hourly)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKey concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerceived low milk supply\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExclusive breastfeeding continued\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePerceived insufficient milk supply is a frequent concern in early postpartum care and continues to be a major contributor to unnecessary supplementation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This case highlights how maternal perception, in the absence of supporting clinical evidence, can lead to misinterpretation of otherwise normal feeding patterns.\u003c/p\u003e \u003cp\u003eIn the early neonatal period, behaviours such as frequent feeding and crying are expected and play an important role in establishing and maintaining lactation. However, without adequate preparation or explanation, these behaviours are often perceived as indicators of inadequate milk intake [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This disconnect between normal physiology and maternal understanding remains a key challenge in clinical practice.\u003c/p\u003e \u003cp\u003eIn contrast, the clinical findings in this case were clearly reassuring. Effective latch, audible swallowing, appropriate urine output, and expected weight changes provided consistent evidence of adequate milk transfer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These objective indicators should form the basis of clinical assessment and decision-making.\u003c/p\u003e \u003cp\u003ePsychosocial influences were also evident. The mother\u0026rsquo;s low confidence, along with concerns expressed by family members, contributed to her perception of insufficient milk supply. In many settings, such external influences can significantly affect maternal beliefs and feeding practices. Addressing these concerns requires a supportive and empathetic approach, rather than simple reassurance.\u003c/p\u003e \u003cp\u003eThe positive outcome in this case following counselling reflects the importance of timely and targeted support. Counselling not only provided information but also helped build maternal confidence and trust in the breastfeeding process. This is consistent with evidence demonstrating that structured support can improve breastfeeding outcomes and reduce unnecessary interventions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, this case underscores the need for a structured approach to breastfeeding assessment in routine postnatal care. Incorporating direct observation and using simple clinical indicators can help healthcare providers differentiate between perceived and actual problems more effectively. Equally important is the provision of anticipatory guidance, which can prepare mothers for normal newborn behaviour and reduce anxiety.\u003c/p\u003e\n\u003ch3\u003eClinical Relevance\u003c/h3\u003e\n\u003cp\u003eThis case represents a common situation encountered in early postpartum care. A structured assessment approach, combined with appropriate counselling, can improve clinical decision-making, prevent unnecessary supplementation, and support successful breastfeeding.\u003c/p\u003e"},{"header":"IMPLICATIONS FOR CLINICAL PRACTICE","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePrioritise objective clinical indicators when assessing breastfeeding adequacy\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInclude routine observation of breastfeeding in postnatal care\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProvide anticipatory guidance on normal newborn feeding patterns\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUse counselling strategies that enhance maternal confidence\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecognise and address psychosocial and family influences\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAvoid unnecessary supplementation unless clinically indicated\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"LIMITATIONS","content":"\u003cp\u003eThis report is based on a single clinical case and may not be generalisable to all populations. Follow-up was limited to the early postnatal period, and long-term breastfeeding outcomes were not assessed. However, the clinical principles described are relevant to routine practice.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePerceived insufficient milk supply is a common concern in the early postpartum period but is often not associated with true lactation failure. This case demonstrates that maternal perception alone should not guide clinical management. Instead, assessment should rely on objective indicators such as feeding effectiveness, urine output, and weight patterns.\u003c/p\u003e \u003cp\u003eWhen these findings are reassuring, counselling plays a central role in management. Providing clear explanations and supporting maternal confidence can help prevent unnecessary supplementation and promote continued breastfeeding. Early recognition and appropriate management of PIMS are therefore essential in improving postnatal care outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient for publication of this case.\u003c/p\u003e\n\u003cp\u003eConflict of interest:\u003c/p\u003e\n\u003cp\u003eThe author declares no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2021) Infant and young child feeding. WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF (2020) Improving breastfeeding, complementary foods and feeding practices. UNICEF, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Y, Ouyang YQ, Redding SR (2021) Perceived insufficient milk supply: a systematic review and meta-analysis. Matern Child Nutr 17(1):e13066\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKent JC, Gardner H, Geddes DT (2016) Breastmilk production in the first weeks postpartum. J Hum Lact 32(3):489\u0026ndash;499\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGatti L (2008) Maternal perceptions of insufficient milk supply in breastfeeding. J Nurs Scholarsh 40(4):355\u0026ndash;363\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown CRL, Dodds L, Legge A, Bryanton J, Semenic S (2014) Factors influencing why mothers stop breastfeeding. Can J Public Health 105(3):e179\u0026ndash;e185\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRowles G, Keenan J, Wright NJ et al (2025) The impact of breastfeeding difficulties on maternal mental health: a qualitative study. Sci Rep 15:13572\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcademy of Breastfeeding Medicine (2017) ABM clinical protocol #3. Breastfeed Med 12(3):188\u0026ndash;198\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcFadden A, Gavine A, Renfrew MJ et al (2022) Support for breastfeeding mothers. Cochrane Database Syst Rev 10:CD001141\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemirci JR, Bogen DL, Holland C, Tarr JA, Rubio D (2022) Breastfeeding discussions at prenatal visits. J Hum Lact 38(2):255\u0026ndash;264\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;rez-Escamilla R, Segura-P\u0026eacute;rez S, Lott M (2023) Feeding guidelines for infants. Int Breastfeed J 18:12\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Department of Obstetrics and Gynecology Nursing, KMCH College of Nursing, India","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, perceived insufficient milk supply, lactation counselling, postnatal care, maternal health","lastPublishedDoi":"10.21203/rs.3.rs-9602258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9602258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePerceived insufficient milk supply (PIMS) is a common concern in the early postnatal period and is one of the leading reasons for early breastfeeding supplementation and discontinuation. In many instances, this perception arises even when milk production is adequate and is often linked to misunderstanding of normal newborn behaviour.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo describe how perceived and actual insufficient milk supply can be differentiated clinically in the early postpartum period and to explore the implications for maternal health practice.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA clinical case from the early postnatal period was examined. Maternal concerns, infant clinical indicators, breastfeeding assessment findings, and the response to counselling were reviewed alongside existing evidence.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eMaternal concern was primarily triggered by frequent feeding and infant crying. However, clinical assessment showed reassuring findings, including effective latch, audible swallowing, normal urine output, and weight loss within expected physiological limits. Following counselling and reassurance, maternal confidence improved, and exclusive breastfeeding was maintained. Subsequent weight gain confirmed adequate milk intake.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eIn early postpartum care, perceived insufficient milk supply often reflects misinterpretation rather than true lactation failure. Careful clinical assessment combined with timely counselling can prevent unnecessary supplementation and support continued breastfeeding.\u003c/p\u003e","manuscriptTitle":"Perceived insufficient milk supply in early postpartum: clinical differentiation, counselling challenges, and implications for maternal health practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 02:40:10","doi":"10.21203/rs.3.rs-9602258/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f0b9dfe-22e0-406b-a210-bc110be3f2cc","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67506570,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2026-05-05T02:40:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 02:40:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9602258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9602258","identity":"rs-9602258","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}