Low Milk Production

by Jenna Congdon, RN, BSN, brightsidewriting.com

How Do I Know When I Have Low Milk Supply?

As you begin breastfeeding or chestfeeding your new baby, you’ll have lots of questions. Many parents wonder about their milk supply: how do I know that I’m producing enough milk? 

Remember that your worth and success as a parent are not connected to how much milk you produce. Many parents worry that they’re not making enough milk, but only about 5-15% of lactating parents experience low milk supply. It’s important to address these worries, and The Midwest Center for Breastfeeding Medicine is here to help.

How Do I Know I’m Making Enough Milk?

Low milk production is defined as not producing enough milk to meet your baby’s nutritional needs. Milk is made on a supply-and-demand basis: the more your baby nurses or you pump or express, the more your body knows to produce. Your milk volumes should slowly increase until your baby is about one month old. By then, you’ll typically produce 24 to 30 ounces of milk per 24 hours. If you stop nursing or pumping, your body knows to make less milk, and milk production will eventually stop.

Your baby will signal that they’re getting enough to eat. You’ll know they’re getting enough when: 

• Baby nurses 8-12 times per day, or roughly every 2-3 hours

• You’re able to see and hear them swallow while they’re feeding

• They seem satisfied after nursing (but remember, babies cry for many reasons, not only when they’re hungry! A fussy baby doesn’t always mean a hungry baby).

• They are making enough wet and dirty diapers each day. Generally, a baby makes as many wet diapers as the number of days they are old. For example, by day 5-6 after birth they should have roughly 5-6 wet diapers per day. 

• Baby is gaining weight right on schedule. It is natural for them to lose a small amount of weight after birth, but they should regain their birth weight by two weeks, and then gain about 1 ounce or 30 grams per day until age four months. 

Signs that Seem Like Low Milk Supply, But Aren’t

Lots of parents believe that certain signs mean they’re not making enough milk, but this isn’t necessarily the case. Let’s go over these concerns:

Baby is eating very frequently or cluster feeding.

Cluster feeding is when your baby eats many times close together, rather than nursing at evenly spaced intervals. They may feed every hour, rather than every three hours. This is normal for infants who are only a few days to a few weeks old. For older babies, cluster feeding may still happen at certain times of the day, such as in the evening when milk supply is generally lower than early morning hours. Your baby may also cluster feed when they’re looking for comfort from you. However, if cluster feeding is happening all day, every day, it may indicate a problem. 

My breasts feel “soft”, or they’re not leaking.

Breasts and chests of all shapes and sizes can produce an adequate milk supply. Not all lactating breasts look or feel a certain way. Even if they’re not “hard” or leaky between feedings, you can still be making enough milk.

I’m not pumping much milk. 

Colostrum is the super-concentrated milk that your body produces for around 2-5 days after birth. Each feeding of colostrum is around 5 ml, or a single teaspoon. A newborn’s stomach is only about the size of a cherry, so their tiny tummies can’t hold much. If you’re pumping and notice that it sure doesn't look like much, remember that portion may look small to an adult, but for a newborn, it’s plenty. Colostrum is packed with nutrients and helps to boost your baby’s immune system. It has everything they need in a concentrated package.

As baby grows, feedings become larger, but even if the amount of milk you pump doesn’t “look” like much, chances are it’s still a good-sized serving for an infant.

Many parents pump after nursing to build a milk supply for when they need to return to work. If you’re pumping after nursing and baby is feeding effectively, it’s possible they just drank it all! That means you’re making enough to keep them satisfied. Keep in mind: sometimes pumping after feeding can increase your supply too much and create an issue with oversupply.

My baby lost some weight in the first few days after birth.

This is normal. Babies lose around 7-10% of their weight in the first few days after they’re born. After that, they should begin steadily gaining weight. 

When Should I Be Worried? 

Watch for these signs that low milk supply may truly be a problem. 

• Baby is not gaining weight on schedule. 

• They make fewer than 6 wet diapers per day, or they have small or infrequent poops.

• They’re showing signs of dehydration, such as dry mouth or a sunken fontanelle (the soft spot on their head).

• Baby is lethargic or overly sleepy. They don’t interact or seem to have much energy. 

• You don’t see or hear baby swallowing as they’re nursing. 

Get immediate assistance if you notice these signs. Reach out to us at The Midwest Center for Breastfeeding and Postpartum Medicine or your primary doctor right away.

What Causes Low Milk Supply? 

Low milk supply is rare, but there are reasons why it happens to some parents. 

Certain medical issues can cause low milk supply. Hormonal problems like PCOS, thyroid disorders, or diabetes can impact milk supply. Age of parent at time of pregnancy and birth can impact ability to produce sufficient milk. Premature birth, losing a lot of blood during delivery, or having a piece of the placenta left inside your uterus after birth can also decrease your body’s ability to produce milk. Having breast surgery or taking certain medications can also lower your milk supply. Sometimes, breastfeeding medicine doctors can help confirm the diagnosis of insufficient glandular tissue when there are not enough milk making glands in the breasts to produce enough milk for baby.

To make enough milk, you need to pump or nurse frequently. This demand signals to your body to produce more milk. If you’re not nursing or pumping often enough, or you supplement with formula and do not pump, your milk supply will decrease. If you are expressing milk adequately and still struggling to make enough milk, please reach out to a breastfeeding medicine physician to support you in next steps.

Your baby can also have issues that make milk production more difficult. If they have a poor latch or ineffective suck, this may make it difficult for them to draw milk from the nipple. Conditions such as tongue tie can be resolved with gentle osteopathic bodywork with Dr. Angela, or a simple procedure at your doctor’s office. If your infant is very sleepy, was born prematurely, or is ill, they may struggle to nurse effectively, which can lead to a declining milk supply. 

Once you and your doctor find the cause of your low milk supply, you can work together to address the problem. 

What Can You Do If You Suspect Low Milk Supply? 

Don’t wait and worry - reach out to your primary care doctor or The Midwest Center for Breastfeeding and Postpartum Medicine early on. If your milk supply is adequate, they can help to soothe your anxiety so you can get back to bonding with baby. If you do have low milk supply, it can frequently be improved with the right support. 

Be sure to feed or pump every 2-3 hours. This stimulates milk production. Skin-to-skin contact with baby stimulates oxytocin, which is a hormone that helps you make more milk. Most importantly, remember that lots of rest, good nutrition, and adequate hydration are key. Producing milk is a lot of work! Your body needs sleep, food, and lots of water to keep up a healthy supply. 

Certain foods, herbs, and medications can help to increase milk production. These should be taken only under the direction of a medical professional. 

The Bottom Line

Breastfeeding/chestfeeding can truly be a challenge, but help is available, and The Midwest Center for Breastfeeding and Postpartum Medicine is here to lend a hand. Be open with your concerns, and give yourself grace as you learn along the way. Many other parents have faced these issues, so reach out to friends and family whenever possible. Lean on your community for support, make use of the resources you have, and remind yourself that you’re doing your very best.