Besides nipple pain, low milk supply is probably the biggest concern mothers have while breastfeeding. It is also one of the more common reasons cited by mothers for premature weaning.

First, it’s important to know that virtually all mothers—if given the right information and education—can make enough milk for their babies. True low milk supply (as in, the mom’s body cannot produce enough milk) is actually somewhat rare. Still, some mothers and babies do struggle with supply issues and need lots of support.

How do you know if you have a milk supply issue? If your baby is growing appropriately on your milk alone (no formula), then you have enough milk and your baby is getting it!  You can skip this article and go nestle down with your bundle of joy.

It’s important to note that the most accurate way to determine if your baby is getting enough milk is to have your baby weighed naked on a baby scale by your doctor, midwife, or lactation consultant. The other ways that mothers measure milk intake can be useful, but simply aren’t objective enough to determine milk supply issues.

So, whether your breasts feel full; how big your breasts are; and whether you leak milk between feedings are not accurate ways to determine your milk supply. Neither is how big your baby seems to be getting, or even how many pees and poops your baby makes. All of these things are helpful, and can be part of the larger picture, but are too subjective to determine whether or not you have low milk supply.

So, what if something truly is wrong: what if your baby isn’t growing well? Don’t worry. There are almost always ways to remedy milk supply issues. Almost all cases of low milk supply can be fixed by two basic things: more frequent nursing, and good latching. Cases that aren’t remedied this way are usually fixable as well.

It’s important to know the cause, and get skilled help in remedying it. Going out and buying special nursing teas or lactation cookies will do nothing if you don’t know what’s wrong.

Here are some common causes of low milk supply in the first few weeks of nursing (low milk supply after the first few weeks isn’t the focus of this article, though some of the causes overlap), and simple solutions. Again, frequent nursing (with a good latch) will fix almost all of these problems.

1. Weight loss in the first week of breastfeeding. All babies lose a little weight in the first three days of life, before a mother’s milk comes in. It is normal for a breastfed baby to lose 5-7% of his or her birthweight. When a mother’s milk comes in 3-4 days after birth, the baby should start to gain weight. If this doesn’t happen, a mother should seek help right away so that the problem doesn’t worsen.
2. Infrequent nursing. New babies need to come to the breast VERY FREQUENTLY—pretty much anytime they aren’t sleeping, they should be nursing. Pay attention to their feeding cues, and put them to your breast anytime they are interested. Newborns average 10-12 nursing sessions per 24 hours. Even after the first few weeks, babies need to nurse frequently to keep up your milk supply. It is also important to keep in mind that babies need to nurse in the middle of the night to keep up a mother’s milk supply.
3. Poor latching. A baby who isn’t latched on well will not drain the breast completely. Babies need to latch deeply, with a wide, open mouth. Get in-person latching help if you suspect this as the cause of your troubles.
4. Use of supplements. If you had been concerned about your milk supply and were offering formula supplements, you may have inadvertently caused a milk supply issue. The reason why is that milk supply is a supply-and-demand system: the more milk you take out, the more you make. So if you were giving your baby formula, he or she wouldn’t have been hungry as frequently, and wouldn’t have come to the breast as frequently, thereby driving down your milk supply. It is best to wean off formula supplements gradually, nursing more frequently as you go.

Here are some of the more complicated causes of low-milk. Some of these issues are more easily solved than others. I highly recommend you work with an experienced lactation consultant if you suspect any of these issues.

1. Tongue Tie. A tongue-tied infant can’t use his or her tongue properly to drain the breast of milk. If your latch looks good from the outside, but your baby still isn’t getting enough milk, it’s worth having a skilled professional look for a tongue tie. The tongue tie can be released by a simple procedure called a frenotomy. Click here for a good summary of how tongue-tie can affect breastfeeding.
2. Retained placenta. After birth, the delivery of the placenta tells the body to start the process of milk production. If even a small piece of the placenta doesn’t get delivered, milk production can be halted. Signs of retained placenta include excessive maternal bleeding along with low milk supply. The retained placenta may come out on its own, but should be removed by a health professional if it is causing milk supply issues.
3. Maternal thyroid and hormone issues. Hypo- and hyper- thyroid issues can have an impact on milk supply. Thyroid issues can be present before birth, but can also develop in the weeks after childbirth. If you have looked into the more common causes of your milk supply, but haven’t found a solution, have your thyroid tested. Mothers who suffer from Polycystic Ovarian Syndrome (PCOS), Luteal Phase Defect, or other hormonal imbalances can have lower milk supplies. These can often be remedied by medications as well.
4. Maternal Diabetes. Mothers who have diabetes are more likely to have their milk come in late, or have milk supply issues. Even women with a pre-diabetic condition called Insulin Resistance are at risk for low milk supply. This is another area to have tested if you have tried all the common tricks. Diets and medication can help here.
5. Insufficient Glandular Tissue. It is not breast size, but the amount of milk-making tissue in the breast (glandular tissue) that determines how much milk a breast can produce. A small portion of women do not have a large enough portion of glandular tissue in their breasts. Signs of this are breasts that did not grow much during pregnancy, widely spaced breasts, asymmetrical breasts, and breasts with a tubular shape. This is best investigated in-person by a skilled practitioner. Frequent nursing and pumping, along with supplementation may be necessary. There are certain herbs and medications that can be helpful here too.
6. History of Breast Surgery. Breast reduction surgery, breast augmentation surgery, as well as other breast surgeries can have an impact on milk supply. It depends on the location of the incisions and how much milk-making tissue was removed. There is a wide variety of breastfeeding success rates for women who have had these surgeries. It is best to be seen by a lactation consultant who can help you figure out your best chances for success.

This is not an exhaustive list of causes for low milk supply. And even if you have some of these diagnoses it doesn’t mean that you will have an issue with milk supply. Besides the remedies mentioned, some mothers find that frequent breastfeeding isn’t enough to bring their milk supply to the place where it needs to be. The use of hospital grade (rental) pump in addition to frequent nursing can prove very useful.

Some of these conditions respond well to herbs and medication—the herbs and medications appropriate to each situation is beyond the scope of this article. I highly recommend the book Making More Milk by Diana West and Lisa Marasco, for a detailed list of foods, medications, herbs, and other techniques to increase milk supply.

Even in the more complicated cases, good latching and frequent breastfeeding can make a huge difference, and are the most important ways to work through supply issues. 

It can’t be emphasized enough that meeting with a lactation consultant is a requirement for mothers who are struggling with milk supply. True milk supply is often a complex situation, often involving both maternal and infant factors, so all aspects of the nursing relationship need to be addressed.

Finally, even if you are one of the mothers who end up not making enough milk for your baby to thrive, you should know that breastfeeding isn’t “all or nothing.” Any amount of breastmilk—even a few drops—contains a multitude of antibacterial and antiviral agents and excellent nutrition. And breastfeeding—more than anything—is a relationship, an exchange of love. Even if you have to supplement your baby, breastfeeding can be the glue that binds you together. So define your own goals, get support, and keep at it.

***

Need some extra breastfeeding help and support? Schedule a virtual lactation consultation with me.

***

A version of this post first appeared in Natural Child Magazine