Many mums worry they have a poor milk supply, but it can be hard to know for sure. Read on to find out whether you really have low milk supply and what you can do about it.
“Have I got enough breast milk?” is something new mothers often worry about – but chances are, if your baby’s healthy and growing well you’re doing great. However, if you’re concerned about your breast milk supply, it’s important to seek advice early. If it turns out things are fine, you’ll quickly be reassured. Plus, you’ll avoid the trap of giving your baby formula unnecessarily, which may cause your own milk supply to drop.
Reasons for low milk supply
A small number of new mums have difficulty producing enough breast milk due to medical reasons, which include:
- Excessive blood loss (more than 500 ml/17.6 fl oz) during the birth or retained fragments of the placenta can delay your milk coming in (which usually happens around three days after the birth).1
- A history of polycystic ovarian syndrome, diabetes, thyroid or other hormonal disorders. Mums with these conditions sometimes experience a low milk supply.2
- The rare medical condition mammary hypoplasia, in which there isn’t enough milk-producing glandular tissue within the breast.3
- Previous breast surgeries or breast trauma – although many mums who have had surgery go on to breastfeed successfully.4
If any of these conditions applies to you, see a lactation consultant or breastfeeding specialist.
How breast milk supply works
Once your breast milk has come in, your breasts start to make milk through a process of ‘supply and demand’. Each time milk is removed, either by your baby feeding or by expressing, your breasts make more.
That’s why giving bottles of formula can reduce your milk supply – your body isn’t getting the message to produce more breast milk, because none is being removed.
The way your baby nurses also affects your supply. The more frequently and effectively she breastfeeds, the more milk you’ll make. If your baby doesn’t take enough milk during a feed, it’s essential to express regularly to protect your milk supply – see below for more advice.
Signs your baby isn’t getting enough milk
Even though low milk supply is rare, your baby may still struggle to get enough for other reasons during her first few weeks. She may not be breastfeeding frequently enough, or for long enough, particularly if you’re trying to stick to a breastfeeding schedule rather than feeding on demand. She may not be latching well, or might have a condition that makes it harder to take in milk.
The following are signs your baby isn’t getting enough milk:
- Poor weight gain. It’s normal for newborns to lose 5% to 7% of their birth weight in the first few days – some lose up to 10%. However, after that they should gain at least 20 to 30 g (0.7 to 1 oz) per day and be back to their birth weight by day 10 to 14.5,6,7 If your baby has lost 10% or more of her birth weight, or she hasn’t started gaining weight by days five to six, you should seek medical advice immediately.
- Insufficient wet or dirty nappies. The number of poos and wees your baby has per day is a good indicator of whether or not she is getting enough milk – see our article explaining the pattern your baby should be following in Breastfeeding your newborn: What to expect in the first week. Seek medical advice if you’re concerned or if you have noticed her dirty nappies decreasing in wetness and heaviness.
- Dehydration. If your baby has dark-coloured urine, a dry mouth or jaundice (yellowing of the skin or eyes), or if she is lethargic and reluctant to feed, she could be dehydrated.6 Fever, diarrhoea and vomiting, or overheating, can cause dehydration in infants. If you notice any of these symptoms, seek medical advice quickly.
Misconceptions about low milk supply
Newborns typically feed very often – around 10 to 12 times a day, or every two hours – and this is not a sign that you don’t have enough milk. Don’t forget that your baby also nurses for comfort, and it’s difficult to tell how much milk your baby takes during each feed – amounts can vary.
The following are all perfectly normal and are not signs of a poor milk supply:
- your baby wants to feed frequently
- your baby doesn’t want to be put down
- your baby is waking in the night
- short feeds
- long feeds
- your baby will take a bottle after a feed
- your breasts feel softer than they did in the early weeks
- your breasts don’t leak milk, or they used to leak and have stopped
- you can’t pump much milk
- you have small breasts
What to do if you have low milk supply
If you suspect your baby is not getting enough milk, see a lactation consultant or breastfeeding specialist. They will assess whether you have low milk supply and observe a breastfeed to see if your baby is latched on well and taking in enough milk. They may suggest adjusting your feeding position or your baby’s latch so she can feed more efficiently.
You could also try having more skin-to-skin contact with your baby before and during feeds to stimulate the hormone oxytocin, which gets your milk flowing. Or use relaxation techniques, such as listening to your favourite calming music, to reduce any anxiety that could be affecting your supply.8
With support, most mums with low milk supply are able to partially breastfeed their babies, and some will manage to develop a full milk supply.
If your baby is not yet taking enough milk directly from the breast, perhaps because she was premature or has special needs, you may need to express to protect your milk supply, and your healthcare professional may prescribe galactogogues (medication to increase milk production).
If you’re not yet able to express enough breast milk for your baby, you’ll need to supplement her with donor milk or formula, under the guidance of a medical professional. A supplemental nursing system (SNS) can be a satisfying way for her to get all the milk she needs at the breast.
How to increase milk supply with a breast pump
If you need to encourage your milk supply in the first five days after birth, you can use a double electric breast pump with initiation technology, such as the Medela Symphony. This type of pump is designed to mimic the way a baby stimulates the breasts while feeding, and has been found to increase longer-term milk production.9
Although every mum is different, it’s often a good idea to express milk straight after, or an hour after, a feed. This may seem counterintuitive, because it’s usually easier to pump from a full breast. But you should think of your pumping session as ‘putting in a milk order’ for the next day.
At first you may only collect small amounts, but don’t be discouraged – with regular pumping, this will increase. Aim to be removing milk (by breastfeeding as well as pumping) eight to 12 times a day, including one session at night when your levels of the milk-producing hormone prolactin are highest. The more frequently milk is removed, the better. After two or three days of regular pumping you should see a significant increase in supply. For advice on getting more milk from each pumping session, read breast pumping tips.
Hands-on pumping to increase expressed milk
If your baby is not breastfeeding directly at all, or you can’t yet pump enough milk for her, a technique called ‘hands-on pumping’ can be useful. It has been shown to increase the amount of milk mums can express in a session.11,12 The whole process takes around 25 to 30 minutes. Remember, the emptier your breasts, the more quickly they’ll make milk.
Follow these simple steps:
- Massage your breasts.
- Double pump using an expressing bra to keep your hands free.
- While pumping, use your fingers and thumb to compress your breast for a few seconds. Release and repeat. Use compressions on both breasts until your milk flow slows to a trickle.
- Massage your breasts again.
- Finish by hand expressing or single pumping, using breast compressions and switching between breasts to drain them as fully as possible.
Once your baby is gaining weight and you’ve increased your supply, then you can move on to feeding her exclusively at the breast.
- Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.
- Vanky E et al. Breastfeeding in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2008;87(5):531-535.
- Neifert MR et al. Lactation failure due to insufficient glandular development of the breast. Pediatrics. 1985;76(5):823-828.
- Neifert M et al. The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 1990;17(1):31-38.
- C Tawia S, McGuire L. Early weight loss and weight gain in healthy, full-term, exclusively-breastfed infants. Breastfeed Rev. 2014;22(1):31-42.
- Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p.
- World Health Organisation. [Internet]. Child growth standards; 2018 [cited 2018 Feb]
- Keith DR et al. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012;12(2):112-119
- Meier PP et al. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012;32(2):103-10.
- Prime DK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med. 2012;7(6):442-447.
- Stanford University School of Medicine [Internet]. Stanford, CA, USA: Maximizing Milk Production with Hands-On Pumping; 2017. [Accessed 30.04.2018].
- Morton J et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009;29(11):757-764.