Low milk supply

I don’t think I’m producing much milk. Should I worry?

Many new mums worry that their body isn’t making enough milk. It’s a common reason given for giving up breastfeeding (McAndrew et al 2012, NHMRC 2012, UKMi 2014).

The good news is that nearly all women are capable of making plenty of milk for their baby (NHMRC 2012, UKMi 2014). A good way of telling if your baby is getting enough milk is by keeping track of his weight gain.

It’s natural for newborns to take a little dip in their body weight. Your baby will probably have lost between five and 10 per cent of his birth weight in his first few days.

But after a few days, babies that are feeding well tend to start to put on weight again. If your baby is weighed when he’s between four and six days old, he’ll most likely be starting to grow (NHMRC 2012).

Sometimes a caesarean or a stressful birth can cause your milk to take slightly longer to come in. This may mean that your baby will start to regain his birth weight a little later than other babies. Most babies have regained their birth weight by the time they’re two weeks old (NHMRC 2012, UK DH 2010).

How else will I know that my baby is getting enough breastmilk?

There are other ways to tell if your baby is thriving, too.

You can be reassured that he’s getting enough breastmilk by the end of the first week if he:

• wets at least six nappies a day
• looks healthy and alert
• does two substantial soft or runny, yellowish poos each day
  (NCT 2010a, b, UNICEF UK nd)

At this stage, his poos will have changed from sticky black meconium to mustard-coloured (NCT 2010a, b, UNICEF UK nd). After the first few weeks, your baby may start pooing less often, sometimes going up to two weeks without a poo. This is normal and, as long as his poo is still soft and yellowish, not a sign that he’s not getting enough milk.

You may think that you’re not producing enough milk if:

• Your letdown reflex feels weaker, or your breasts feel less full. But this is just a sign that your body is adjusting to your baby’s feeding needs.
• Milk stops leaking from your nipples. This also happens when your body adjusts to your baby’s feeding pattern.
• Your baby seems to want more milk than usual. It could be a growth spurt. Check that your baby is latching on well. Try changing breastfeeding positions, to make sure he’s able to feed comfortably.
• Your baby’s feeds have become shorter. Some babies just become more efficient and faster at feeding. So you may assume that you’re not satisfying your baby, when he’s simply filling his tummy more quickly.

What causes a low milk supply?

Your breasts produce milk to match your baby’s demands. The more he feeds, the more milk you’ll produce. So if your supply does dip temporarily, there will be a good reason.

It’s possible that your milk supply could dip if breastfeeding is disrupted, for any of these reasons:

• your nipples are sore, and feeding hurts, or you’re using nipple shields
• you’re giving your baby a dummy, or topping up with formula milk, which cuts the amount of time that he’s at your breast within each 24 hours
• you’re trying to feed on a four-hourly routine, rather than on demand
• your baby is sleepy, and needs coaxing to feed
• you’re sick, or, very rarely, suffering from under-nutrition
• you smoke or take other drugs
  (NHMRC 2012, UNICEF UK nd)

Milk supply is sometimes affected by medical conditions. See your GP or lactation consultant if any of these apply to you:

• You have a hormonal disorder, such as a low or high thyroid level.
• You’ve had breast surgery or a breast injury in the past.
• You lost a large amount of blood during or after labour. Your milk supply may be affected until you recover.
• There’s a fragment of placenta still lodged in your uterus (womb). This may stop your breastmilk production until it’s passed or removed. If you have a lot of bleeding after you’ve had your baby, and your baby isn’t feeding well, seek help immediately.
• You’re taking certain medicines, such as the combined contraceptive pill, or a cold remedy with a decongestant, such as pseudoephedrine.

But in most cases of suspected low milk supply, the real problem is not about how much milk you have, but how much milk your baby is able to get at. If your newborn is very sleepy, you may need to wake him and gently encourage him to feed more often. This will stimulate your breasts to produce more milk.

How can I encourage my baby to feed well?

If your baby is difficult to wake, or doesn’t feed well, try expressing some colostrum or milk to give to him. This will satisfy your baby’s needs, and encourage your milk supply to build up at the same time.

If it’s very early days, and your baby is a reluctant feeder, you may need to give him drops of colostrum from a pipette, dropper or spoon, or from the end of your clean finger. If your milk has come in, you may be recommended to use a cup to feed him, rather than a bottle. Some experts think that swapping between feeding from a teat and suckling at your breast may confuse your baby, but the evidence is mixed (Flint et al 2007).

If your baby isn’t latching on well, he’ll struggle to get enough of your milk. See our visual guide to help you decide if your baby is latching on properly.

There’s also plenty of expert help available. Ask your midwife or child health nurse if she can recommend a lactation consultant, or contact a breastfeeding organisation.

What else can I do to boost my milk supply?

Once you’ve checked your baby is latched on properly, you could also try the following:

• Share lots of skin-to-skin contact with your baby.
• Let your baby feed on demand, as often and for as long as he wants. Always allow him to finish the first breast before offering him the second. You could even try giving him each breast more than once each feed.
• Give your baby only breastmilk. It may be tempting to top him up with a bottle of formula. But if you satisfy your baby’s hunger with formula, he’ll need less breastmilk, and you won’t produce as much.
• Try not to give your baby a dummy.
• Make sure you’re drinking lots of water and staying well hydrated.
• Eat a well-balanced diet, and avoid excessive exercise and weight-loss diets.
• Try expressing your milk after each feed. Draining your breasts as much as possible will stimulate your body to produce more milk.
  (NHMRC 2012)

A breastfeeding specialist may also recommend trying a galactagogue. Galactagogues are substances that may help increase your milk supply. Medical galactagogues include the anti-nausea drugs domperidone and metoclopramide (NHMRC 2012). Some women swear by herbal galactagogues, such as fenugreek, blessed thistle and fennel, but there’s limited evidence that these work or are safe for you and your baby (ABM 2011, NHMRC 2012). Read more in our article on galactagogues.

It may help to take some time out to focus purely on breastfeeding your baby, resting and eating well. If possible, ask your partner, family or friends to help you by looking after your other children, cooking meals, doing the grocery shopping and taking care of other tasks.

Will a low milk supply affect my baby?

If your baby often needs more milk than he gets, he may grow more slowly than other babies of his age (failure to thrive). Call your doctor and make an appointment right away if your baby isn’t gaining weight, or is losing weight. In most cases, improving your baby’s position during breastfeeding will solve the problem.

More breastfeeding tips

• Watch our video on getting a comfy attachment.
• Find out how to ease painful breasts.
• Get advice on what to do if your baby won’t breastfeed.
• Read some tips for breastfeeding in public.
• Discover if there's anything you can take to increase your milk supply.