There’s nothing as frustrating as investing a massive amount of time, physical independence, and emotional energy into breastfeeding, just to feel like it isn’t even working.
Many breastfeeding moms worry about producing enough milk, and they want to increase milk supply. But low milk supply is not as common as you might think. Most of those moms are totally fine.
Do you really have a low milk supply?
There are two main signs of a low supply:
- Baby isn’t gaining enough weight.
This shows that he’s not getting enough nutrients to grow properly. Check with your pediatrician if you’re worried about your baby’s weight gain, especially if he had a low birth weight.
- Baby isn’t making enough diapers, or they’re the wrong color.
You should see at least 2 dirty diapers and at least 6 wet diapers in 24 hours. (If your baby is younger than 6 days, he may have fewer wet diapers.)
The wet diapers should be light yellow, not dark yellow. Dark yellow is a sign of dehydration.
Other, smaller signs include:
- Baby is still fussy after a meal.
- You can’t hear your baby swallowing while he eats.
- Other signs of dehydration; lethargy, dry mouth, few tears, yellow skin or eyes (jaundice).
If your baby is gaining weight, eating properly, and filling up diapers, then your milk supply is fine!
How can you tell if you have a low milk supply?
You might not know how to evaluate your supply—many moms don’t. If you have a low supply, your baby will struggle with weight gain and diapers. If not, your supply is likely sufficient. Low supply is a common worry, but it’s not a common condition.
Some other signs make moms worry, but they shouldn’t. Here are some things that are not signs of low supply:
The way your breasts feel.
During the first month, your breast might often feel engorged, full, firm, and/or uncomfortable. If that stops happening and your breasts feel softer, you may worry that they are making less milk. But not to worry! It just means you’ve settled into a good rhythm and you’re producing exactly what your little one needs (instead of occasionally overproducing).
Lack of leaks.
Same thing here—leaks aren’t a good indication of milk supply. Even if your breasts used to leak, and then they stopped leaking, it’s not a problem. It just means your breasts have hit their stride. (Enjoy having one less thing to worry about!)
The let-down feeling.
If you don’t feel that strange tingly sensation when your baby starts eating and your milk starts flowing, it doesn’t matter. Some moms feel it every time. For others, it fades over time. Some never feel it! It’s not a requirement for the actual let-down procedure.
If your baby sucks normally, then you can be sure that your milk flows, even if you didn’t feel it let down.
How often you nurse the baby.
If it seems like your baby is hungry all the time, you might worry that he’s not getting enough milk. But eating frequently helps establish your supply. Plus, some babies just like to eat frequently. Others gain comfort from sucking and from getting snuggles with their mamas.
Breastfed babies do get hungry quicker than their formula-fed counterparts. Breastmilk is digested in about two hours, whereas formula can last twice as long. But before you’re tempted to switch, keep in mind that breastmilk digestion is also easier on your baby’s tummy.
Make sure your baby is getting a full meal each time, i.e., fully emptying your breasts, from foremilk to hind milk (which has the richest fat content). As long as that’s happening, frequent feeding isn’t a problem (at least, it’s not a supply problem!).
IMPORTANT NOTE: You cannot spoil a baby.
Some people think that feeding your baby too frequently will spoil him. These people are completely wrong. Sucking, contact with mom, and having his needs met all make your baby feel safe, secure, and loved. That helps him grow healthy and strong.
More frequent or longer feedings.
This doesn't mean you don't have enough breastmilk. It just means baby is having a growth spurt. Her suckling will tell your breasts how much to make to keep up.
Don’t supplement when your baby seems hungrier than usual. Otherwise, your body won’t know how much to increase breastmilk production, and then you will have a low supply.
Less frequent or shorter feedings.
This doesn’t mean baby’s given up on you. It just means she’s gotten more efficient! Breastfeeding is a skill for both of you, and the longer your baby has breastfed, the more effective her sucking is going to be.
Long clusters of nursing sessions, accompanied by lots of fussing.
This is called cluster feeding, and it’s common even if it’s exhausting. It usually happens in the late afternoon or evening, and it’s not a medical problem or even a side effect of breastfeeding. It’s just something a lot of infants do, somewhere between 3 weeks and 4 months.
Poor milk production when pumping.
If you usually breastfeed directly, then pumping isn’t a good way to evaluate your milk supply. The pump isn’t as skilled as your baby at getting milk out of your breasts, and you’re probably not as skilled at manipulating the pump as you are at breastfeeding. Maybe your breast pump isn’t that great, either.
Altogether, a pumping session is just not a good test. If you pump and only get an ounce, that doesn’t mean your baby’s only getting that amount of milk when he nurses.
General fussiness or crying.
Some babies are fussier than others. It doesn’t necessarily mean there’s a medical problem, or even any problem. Ask your pediatrician if you’re concerned about your baby’s fussing—but if he doesn’t sound like he’s in pain, and he’s crying less than 3 hours a day, then the crying is probably normal. (Crying more than 3 hours a day is a sign of colic.)
What causes a low supply of breastmilk?
Supplementing with formula.
If you give your baby formula, that will set your breasts on a course towards low supply. Of course, if your healthcare provider recommends you supplement with formula, then you should. Or if combo feeding works best for your family, then ignore this advice and do what you decide is the right choice for you and your baby.
But if your goal is exclusive breastfeeding, then shy away from formula.
Supplementing is a quick fix that causes long-term stress. Your breasts won’t be able to keep up with your baby’s needs anymore, because they won’t be getting his cues about how much milk he’ll need.
It’s all about supply and demand. If you take away some of the demand, you’ll have less supply. Then you’ll need to supplement, since you don’t have enough, and then you’ll make less… it’s just a messy situation.
Breastfeeding is 100% your choice, but if you want to stick with it, stay away from formula.
Bottle-feeding (with formula or breastmilk).
Although researchers keep coming up with ways to make bottles more like breasts, the technology is far off. It’s a very different sucking mechanism. The bottle flows faster (even with most low-flow nipples), and it’s easier to get the milk out. The flow is also constant, whereas breastfeeding flow varies throughout the nursing session.
So if baby gets used to having a bottle sometimes, then he might get frustrated with the slower, inconsistent flow of breastmilk. This is called nipple confusion. If your baby eats better from a bottle, you’ll tend toward giving him a bottle, and then… it deteriorates from there.
Just like with the bottle, sucking the pacifier is very different from sucking on your breast. It causes two problems: One, your baby learns poor sucking habits, leading to a bad latch. Without a good latch, he’s not going to get all the milk out of the breast.
Two, he finds comfort from the pacifier and is less interested in your breast. You need to channel all his sucking energy into breastfeeding to establish or increase your supply.
Back to supply and demand: you’ve got to feed on demand. Trying to get your baby to stick to a feeding schedule (e.g., only feeding every 3-4 hours) has many problems, but one of them is that it can lead to low supply. Your baby isn’t allowed to follow his own hunger cues, so how could your breasts follow them?
Incomplete breastfeeding sessions.
Again, make sure your baby drains your breasts each time he eats. If he only skims a little off the top, then two things happen. He misses the richer, fattier hindmilk, and he doesn’t get enough nourishment. And your breasts don’t get a full signal that they need to make more. Instead, it seems like they had a surplus.
And after your baby finishes one breast, offer the other. It’s ok if he doesn’t finish it, but it still tells your body that some more was needed (and it keeps your baby satisfied and healthy).
Baby’s health problems.
If your baby has jaundice or any other health condition that causes lethargy or drowsiness, then feedings will be slower and less effective—leading to less supply.
A tongue tie can also make it difficult for your baby to suck effectively, so even a long session won’t stimulate enough milk production (and you’ll probably both end up frustrated). Your baby’s tongue should have been checked at the hospital when he was born, but sometimes a tie is overlooked. If you’re concerned, ask your pediatrician to check your baby’s mouth.
Mom’s health problems and decisions.
Smoking, postpartum complications, medications (including birth control), mastitis, hormone problems (including thyroid problems), diabetes, insufficient mammary glandular tissue, breast surgery, and breast injury can negatively affect breastmilk supply. That’s not an exhaustive list—if you have any health problems, check with your doctor or lactation consultant to find out whether they could be the culprit.
Nipple shields can be a lifesaver, but unfortunately they can also contribute to low supply. They diminish the sensation in the nipple, and they can also diminish the supply-and-demand message your breast receives.
We’re not saying you should stop using the nipple shield—again, lifesavers—but ask your lactation consultant if she has suggestions for finding an alternative or weaning off it when appropriate.
A drowsy baby.
In the first month, you’ll probably have to wake your baby to eat sometimes. (Although you shouldn’t use scheduled feedings to spread feedings out, you sometimes need to schedule them closer together!)
Baby is still adjusting to the world and is overwhelmed, overstimulated, exhausted, and growing FAST. She needs a ton of sleep! But she also needs to eat—and your breasts need her signals.
So feed her at least every 2 hours during the day and every 4 hours at night. Even if she’s sleeping oh-so-sweetly and looking angelic and giving you peace and quiet, pick her up and gently wake her.
How to get help if you have a low milk supply
If you do have a low supply, then you’ve got to do these three things, in order:
- Call your pediatrician or healthcare provider.
Talk to her about your baby’s weight, diaper numbers, and diaper colors, and ask her for medical advice. She will help you decide whether you need to intervene immediately by supplementing, or you can focus on establishing a steadier supply.
If you do need to supplement, use pumped milk if possible, so that your breasts still respond to your baby’s needs. But the most important thing is that your baby is healthy, so follow your doctor’s orders and make sure your baby is well fed.
- Contact an IBCLC-certified lactation consultant.
Lactation consultants can work wonders with stubborn breasts and struggling babies. You can find endless resources available online, but blog posts and articles can’t examine you in person, hear your specific story, watch your baby suck, or adjust your hand.
If your supply is low, then you need extra support, and your lactation consultant will love to provide it.
- Work to increase your supply.
There’s a long list below, which should be encouraging—not overwhelming. You don’t have to do them all. But you have plenty of options. If the first two don’t work, try the 7th or 11th.
Ways to increase your breastmilk supply
If you have a low supply, you don’t have to give up breastfeeding, and you don’t have to supplement. There are a lot of things you can do to increase your supply.
Avoid supplementing with formula.
Supplementing cuts off the signal that triggers milk production. Since your baby isn’t asking your breasts for more milk (because he’s getting it from a bottle), they won’t make more milk.
Supplement your own body.
Try a galactagogue—a nutritional substance that helps stimulate milk production, like Maade’s [product name]. All you have to do is eat or drink it, and it helps your body start increasing your supply.
Galactogogues include fenugreek, flaxseed, and brewer's yeast. You can get these in the form of pills, teas, or lactation cookies.
If there are no other obvious causes of your low supply and other measures aren't helping, you may be able to get a prescription for domperidone, a medication that can increase milk production.
Help your baby nurse correctly.
If your baby has a bad latch or a bad suck, he will struggle to drain your breasts properly. Then your breasts won’t receive the signal to make a lot more milk.
Ask your lactation consultant for help. She can make sure your baby is latching correctly, and she can help you move your hand, breast, and baby until you have the connection you need, and baby is sucking efficiently.
Express milk or pump milk.
If your baby doesn’t finish a meal because he’s not nursing correctly, then express or pump at the end of the feeding. If he doesn’t want to eat for a while, express or pump between feedings. This tells your body to make more milk, even if baby isn’t the one doing the telling.
Feed on demand, i.e., feed any time baby shows hunger cues. Let her nurse as long as she is actually taking in milk and not just comfort sucking. It can be tiring to feel like you’re nursing all the time, but it makes a huge difference in supply.
If you discourage breastfeeding or space out sessions, you’re sending the wrong message to your breasts.
Even one glass of alcohol can interfere with the let-down reflex.
As mentioned above, pacifiers teach poor feeding habits and discourage breastfeeding. Chuck the binky.
Bottles teach babies to grow impatient at the breast and to lose their latching abilities. If you can avoid bottles, do.
Stick to breastmilk.
Not only should you avoid formula, but also you should avoid solids (if your baby is 6 months or younger) or cut down on them (if your baby is older than 6 months). If breastmilk is the only or main thing that your baby eats, the higher demand will lead to a higher supply.
Offer both breasts.
Let your baby top off his meal. After he drains one breast, offer the other.
Keep baby awake.
Take care of yourself!
Give your body the support it needs so that it’s easy to share nutrients and liquid with your baby. Eat well, stay hydrated, and sleep when you can (I know, tall order).
More breastfeeding = more breastmilk.
Keep at it, and your supply will increase. It may take some work, but it’ll work.