Low Milk Supply: Understanding the Causes and Finding Solutions

Hey there, mumma! Are you worried about or experiencing the distress of low milk supply? I’ve been there, so I feel you! The hurt, stress, guilt, and shame of not having enough milk for my baby was intense and deeply upsetting. If you’re feeling this way, you’re not alone. Low milk supply is the most common reason given for stopping breastfeeding sooner than the recommended 2 years. Considering 85% of mums have stopped breastfeeding their baby by 6 months, that seems to indicate A LOT of low supply issues! So, why is this happening so much when our bodies are designed to breastfeed and nourish our babies? In this post, we’ll have a heart-to-heart about the nitty-gritty of low milk supply. We’ll dive into what might be causing it, and, more importantly, we’ll explore some practical solutions.

 

Perceived Low Supply

Before we dive into the nitty-gritty, we need to address a big reason for the high numbers of reported low supply I mentioned above: perceived low supply. It’s totally normal to have moments of doubt, especially when you’re new to breastfeeding. Those moments when you’re convinced your baby isn’t getting enough can be extremely disheartening. But here’s the thing, mumma – it might not be as dire as it seems.

Often mums think they have a low supply because of certain behaviours baby is showing, like cluster feeding or being unsettled especially in the late afternoon or evening, or baby not sleeping for long periods and waking often to feed. These are actually very normal baby behaviours and don’t reliably tell us how much milk bub is getting. Other reasons mums think they have low supply are their breasts feel soft or don’t get engorged anymore, their breasts don’t leak, or they can’t express much milk. Again, these things don’t tell us anything about bub’s milk intake.

How to Tell for Sure You Have Low Supply

Okay, let’s address the elephant in the room – how can you be sure you’re dealing with low supply? There are some evidence based and reliable signs that show your baby is getting enough milk:

• Your baby is having at least 5 heavily wet nappies each day.
• Your baby is doing 3 runny/soft poos each day (babies older than 6 weeks may do less, but they should still be runny/soft)
• Your baby is gaining enough weight.
• Your baby is growing in length and head circumference.
• Your baby is generally content (remember, all babies have fussy periods throughout the day)
• Your baby is meeting all their developmental milestones.

If your baby is not showing all of these signs, you may have a low supply. I know that is a stab in the heart to read, but this does not mean the end of your breastfeeding journey if you don’t want it to be! There is help out there. A consultation with an International Board Certified Lactation Consultant (IBCLC) can be a game-changer. They can assess the situation, offer advice, and help you devise a plan to boost your milk supply. You can book a home visit or online video call with me here. If you’re still not sure if your supply is ok, book in with a lactation consultant anyway so you can get some clarity, stop your stressing and worrying and get breastfeeding back on the right track if that’s needed.

 

What causes low milk supply?

Now, let’s talk about some of the factors that can genuinely lead to low milk supply. 

 

Mother related reasons for low supply

In these cases, it’s not that you’re doing anything wrong but about some underlying issues.

Hormonal conditions or imbalances can mess with your milk production and cause low supply

• Retained placenta
• Prolactin deficiency (genetic or acquired – including Sheehan’s syndrome caused by massive postpartum haemorrhage)
• Theca lutein cyst
• Hypothyroidism (untreated)
• Pregnancy
• Polycystic Ovarian Syndrome (PCOS)
• Diabetes
• Obesity (possibly related to insulin resistance)

 

Anatomical differences or damage

• Breast surgery
  • Breast reduction often causes low supply because the milk making tissue has been removed. The ducts that carry milk to the nipple are often severed so no milk can get to the nipple. Often the nerve that senses nipple stimulation and triggers milk flow is severed as well.
  • Breast augmentation can sometimes be associated with low supply, especially if the reason for having the surgery was breast hypoplasia/insufficient glandular tissue.
• Nipple piercing: these can cause scarring to the nipple and ducts which block milk flow and cause low supply. In saying that, many mums with pierced nipples can breastfeed with no issues.
• Breast hypoplasia or insufficient glandular tissue (IGT): underdeveloped breast tissue, leading to limited milk production capacity. It’s often characterised by smaller, widely spaced, or tubular-shaped breasts, with minimal changes in size or fullness during pregnancy and breastfeeding.

 

Illness

Excessive bleeding during childbirth can lead to low milk supply because it places stress on mum’s body. Breastmilk is made from your blood, so if your blood volume is lower than it should be, your milk supply can be low as well.

 

Mums often notice a temporary dip in their supply when they’re sick, even with something common like a bad cold or gastro. This usually resolves itself within a few days.

 

Medications

These medications can have a negative affect on your milk supply.

• Contraception (make sure your doctor prescribes the right kind that is least likely to affect your milk supply).
• Pseudoephedrine
• Bromocriptine
• Cabergoline
• Clomiphene
• Antihistamines (Only a concern in the first couple of months of breastfeeding. They usually don’t have any effect on a well-established supply).

It’s important to let your doctor and pharmacist know that you’re breastfeeding so they can make sure medications you’re prescribed won’t affect breastfeeding.

 

 

Baby Related Reasons for Low Supply

Let’s not forget about your precious bundle of joy! Sometimes, the issue isn’t your milk but how your baby is latching and sucking. A poor latch or a weak suck can make it tough for your baby to get the milk they need which over time causes low supply (remember, supply = demand). Don’t hesitate to get some expert advice on this front. Lactation consultants can help you find ways to get baby latched on and breastfeeding well.

 

What causes baby’s suck to be ineffective?

• Poor latch: Most commonly, breastfeeding positioning and latch is not quite right. Check out these blog posts for tips on helping bub get a good latch so they can feed well: 5 tips to help get a good latch and How to fix a painful latch. 
• Tongue Tie: Can restrict the movement of baby’s tongue, making it difficult for them to latch well and get milk from the breast efficiently, which can lead to low supply.
• Cleft lip and/or Palate: Can interfere with the baby’s ability to create the necessary suction for effective breastfeeding, often resulting in bub not being able to get milk out of the breast properly which leads to low milk supply.
• Undersized Lower Jaw (micrognathia): An undersized lower jaw can limit baby’s latch and suck, making it challenging for them to breastfeed effectively, which may ultimately reduce milk supply.
• Preterm Birth: Premature babies often have underdeveloped sucking and swallowing reflexes, which can reduce their ability to breastfeed effectively, potentially affecting milk production due to reduced stimulation.
• Jaundice: Jaundice can cause baby to be super sleepy with low interest in feeding, leading to less frequent breastfeeding and potentially lowering milk supply due to reduced demand.
• Congenital or Neurological Disorders: Babies with congenital or neurological disorders may face difficulties with coordination and muscle control necessary for effective breastfeeding, contributing to a lower milk supply.
• Cardiac Abnormalities: Babies with cardiac issues can get tired very quickly during breastfeeding, leading to shorter, less effective feeds and potentially affecting milk production due to reduced stimulation.
• Other Temporary Illness: Temporary illnesses like colds or urinary tract infections can make breastfeeding uncomfortable for baby, causing them to feed less often or less efficiently, potentially impacting milk production of ongoing. Illnesses like this can also use a lot of baby’s energy and their weight gain can slow because they’re burning more calories than usual.

 

Other causes of low milk supply

Enforcing Feeding Routines and Not Feeding According to Baby’s Need

Sticking to rigid feeding schedules and note letting baby feed when they’re genuinely hungry, decreases your milk supply since they’re not emptying your breasts enough. This gives your breasts the message to slow down milk making (supply = demand).

 

Limiting Sucking Time

Someone might have told you, “Stick to 10 minutes on each side,” but your baby doesn’t wear a stopwatch. If you cut their sucking time short, it might mean your breasts aren’t fully emptied, which can signal your body to produce less milk. So, let your little one take their time – it’s not a race. If you started limiting time because bub was taking forever to feed, get in touch with a lactation consultant to figure out why and help you fix it without accidentally dropping your supply. Book a home visit or online video call with me here.

 

Feeding From Only One Breast Each feed

When feeding from only one side, you might not be stimulating the other one enough. This can mean your supply doesn’t build as it should because there’s not much demand (emptying of the breasts). In saying that, some babies only ever need one breast and grow just fine, so this isn’t a definite cause. It all depends on your breast capacity (how much milk your breasts hold) which is different for every mum. 

 

Early Introduction of Formula, Water, or Solids

The temptation to sneak in a little formula or baby cereal to help them sleep or ’cause grandma said so. But here’s the scoop: introducing these too early can make your baby less interested in the breast, leading to fewer feeds and, yep, you guessed it, potentially impacting your milk supply. Research also shows that these things don’t actually increase baby’s sleep anyway and it can actually be dangerous for baby’s health. So, hold off on those extras and stick to the breast as much as possible!

What to Do If You Have Low Supply

So, if you’ve determined that your milk supply needs a little TLC, what can you do about it? Here are some practical steps:

1. Work with a lactation consultant to help you figure out what’s going on and help you make a plan to get breastfeeding back on track.

2. Make sure bub is getting enough milk for their growth and development

This might mean giving them some of your pumped milk, donor milk or formula temporarily while you work on building your supply. Check out my Boosting Your Low Supply blog post for breastfeeding techniques and info that help you make sure bub is getting enough without interfering with your supply further.

3. Build your supply

You need to give your breasts the message that they need to make more milk! Do this by:

Feed and Pump More Often

The golden rule is to empty your breasts more often. Whether it’s through breastfeeding or pumping, the more you empty your breasts, the more milk your body will produce.

Stay Hydrated and Make Sure You Eat

Good nutrition and proper hydration are like fuel for your milk-making engine. Load up on wholesome meals and keep that water bottle handy (don’t overdo it though, that can actually lower your supply more!).

Cuddle Up

Skin-to-skin time with your baby is not just heartwarming; it’s also a great milk-boosting tactic. Plus, it’s an excellent opportunity to bond.

Lean On Support

Don’t go it alone, mumma! Reach out to a lactation consultant for personalised guidance. Boosting your supply is definitely possible, but it can be really hard work. So, it’s important that you get support from a lactation consultant to make it as simple and effective as possible. And don’t forget those local breastfeeding support groups – they can be a lifeline!

Consider Galactagogues

Some herbs and foods like fenugreek or oats are thought to help increase milk supply though there’s not much research to say that it actually works. Galactogogues are night right for every situation, so be sure to talk to your lactation consultant and your doctor before using any supplements or medications. There are also some medications you can take that can help to boost your supply (you’ll need to get a script from your GP). Foods, herbs, and medications can’t do it alone though. The most important thing is to empty the breasts effectively and often. Without doing this, the medication won’t make a difference.

Stay Patient and Persistent

Building a milk supply takes time. Be kind to yourself and your body. Stress can put the brakes on milk flow (and therefore production), so make rest a priority.

My Boosting Your Low Supply blog post goes into more detail on these techniques, so give it a read.

 

4. Address the underlying cause

Doing all the techniques above can get you nowhere if you don’t address the underlying cause of your low milk supply. In some cases, the cause can’t be fixed, but there are often different ways of doing things to help baby feed better or get more milk. This is where the knowledge of a lactation consultant can come in so handy!

Hormonal conditions or imbalances

Restore the proper hormone balance as much as possible. This can sometimes require medication which is usually safe for bub. Speak to your lactation consultant and GP as soon as possible if you think this is the cause of your low milk supply.

 

Mum’s anatomical differences or damage

• Surgery – unfortunately, there isn’t usually a fix for this one! Having had breast surgery doesn’t always mean that you won’t be able to make any milk at all, so giving breastfeeding a try is always worth it (give bub as much of that white liquid gold as you can!), but you may end up needing to give bub some extra milk (donor breastmilk or formula) as well as breastfeeding to make sure they get what they need to grow and develop well.
• Nipple piercing – Similar to breast surgery, if piercings are causing supply issues, there’s usually not much that can be done for your supply, and you may need to give bub extra donor milk or formula. If you only have one nipple pierced, you may be able to breastfeed on the unpierced side. It is possible to build enough supply in one breast to feed bub in many cases.
• IGT – Because there’s not enough milk making tissue in the breast, mums with IGT can usually only make a partial milk supply and often need to give extra donor milk or formula to their babies. We grow more glandular tissue with each pregnancy and in the few weeks after birth, so you might find that you are able to make more milk if you have another baby.

 

Illness for mum

• Excessive bleeding during or after birth – restoring blood volume (with a blood transfusion and IV fluids if necessary), drinking enough water and taking iron supplements to restore iron levels can help your body recover so you can work on building your supply.
• Temporary dips in supply from temporary illnesses like bad colds and gastro usually resolve once you’re feeling better. Keeping up your fluids and continuing to feed baby according to their need (on demand) can help this happen as quickly as possible.

 

Medications

If you think a medication you’re taking could be affecting your supply, speak to your doctor about it ASAP. There are only a few medications that are truly incompatible with breastfeeding, so your doctor should be able to find an alternative that’s safe. LactMed is an evidence-based database of medications and how they affect pregnancy and breastfeeding. You might like to check your medication there to find out whether it’s safe. There are also some medicines information lines you can call. You can find all the numbers (for Australia) here.

 

Looking after you

Many of the above conditions are not in your control, but on the flip side, some factors are under your control, mumma. Stress, dehydration, not eating, and not giving yourself a break can all throw a wrench into your milk-making machine. So, remember to sip on that water bottle, indulge in some healthy snacks, and give yourself permission to rest. A well-nourished, relaxed mum is more likely to have a good milk supply.

 

Baby latch issues

• Tongue tie: A lactation consultant will be able to assess your baby’s oral function and refer you to someone to assess and release your baby’s tongue tie if that’s causing a problem for their latch and your supply. This involves snipping the tight tissue with scissors or cutting with a laser. There are some GP’s, paediatricians and dentists that have had special training in assessing the function of baby’s tongue and releasing the tie. Make sure you’re dealing with someone who does have this special training though, as ties are often missed by health professionals who don’t quite know what to look for.
• Cleft lip – Experimenting with different positions help you find a way to help bub make a complete seal onto the breast. Some mums find they can plug the hole in the lip with their finger and bub can feed just fine.
• Cleft palate – this can be trickier to manage because bub will have difficulty making a seal on the breast so that they can suck. Babies with clefts often need to have extra milk (ideally your own pumped milk) to make sure they get what they need to grow. You can build and maintain your supply using the techniques mentioned above. Working with a lactation consultant will be helpful so that you can get personalised suggestions for yours and your baby’s individual situation. The Australian Breastfeeding Association has some great info here. You can find a detailed ebooklet at the bottom of that page you might find helpful too.
• Recessed jaw – upright positions often help bub get a better latch. The laid-back position (baby led attachment) and koala positions often work well here. Once bub can latch well, your supply should build naturally from them emptying your breasts, but you may need to do some breast compressions, switch feeding and some pumping to get things going.
• Premature baby – while bub grows, builds their strength, and develops their sucking reflexes, you may need to pump your milk temporarily to boost and maintain your supply until your baby is ready to feed at the breast. If they can feed at the breast but are not getting enough milk, you can use a supply line to help them get more milk without having to work as hard, while still stimulating and emptying your breasts to boost your supply. If bub has a feeding tube, your expressed milk can be given through the tube as a top up after a breastfeed if needed.
• Jaundice – frequent feeds help to clear the jaundice so feeding at least every 3 hours is important until the jaundice is resolved. Jaundiced babies are often very sleepy, so that can be the hard part about feeding bub. Try breast compressions and switch feeding to keep bub awake and interested. You could also use a supply line to give pumped milk, donor milk or formula temporarily if needed.
• Congenital or Neurological Disorders – there is no one particular thing that I can suggest for these conditions since they can be so variable. Often the laid back (baby led attachment position can be helpful and breast compressions and/or a supply line so that bub doesn’t have to work so hard.
• Cardiac Abnormalities: As above, there is not one single thing that is helpful for all mums and babies in this situation. Laid back and upright positions can often be helpful. The Australian Breastfeeding Association (ABA) has some info that you might find helpful here.

Other Temporary Illness for Baby

Supply issues from bub not feeding well when they’re sick with a cold or gastro usually resolve on its own when bub is better as long as you keep feeding according to baby’s need (on demand).

 

Enforcing Feeding Routines and Not Feeding According to Baby’s Need

Follow baby’s lead! They will tell you when they’re hungry. It’s normal for breastfed babies to feed frequently (usually 2-3 hourly, but this varies a lot). Letting bub feed whenever they want to instead of stretching out feeds will help build your supply.

 

Limiting Sucking Time

Let bub finish on the first side before switching sides. Some babies will let go of the breast when they’re done so it’s clear that they’re finished, but other babies will hang out there as long as you let them (which is NOT a problem or a bad habit!). If you have a bub that likes to hang out at the breast, watch for their swallows. If they have spent most of their time at the breast swallowing (swallowing is different to sucking – learn the difference here) but now they’re doing short little sucks, you can use your little finger to break their suction and take them off and switch sides. Make sure they have finished swallowing before you do this though! You might need to do some temporary breast compressions, switch feeding and/or pumping to get your supply back up to where it needs to be.

 

Feeding From Only One Breast Each Feed

Offer both breasts with every feed (let bub finish on the first side before switching). It’s ok if bub isn’t really interested in the second breast, as long as they’ve fed well on the first side. You may need to do some temporary breast compressions, switch feeding and/or pumping to get your supply back up to where it needs to be.

 

Early Introduction of Formula, Water, or Solids

Stop or reduce the formula top ups unless they’re actually necessary for bub’s growth (you may need to do this gradually while you build your supply up to take the place of the top ups). You will probably need to use breast compressions, switch feeding and pumping to build your supply back up to where it needs to be for bub to get enough without the top ups. Solid foods and water are not necessary until bub is 6 months old and showing signs of readiness for solids (more info here). If bub is younger than 6 months, stop the solid foods and water and breastfeed whenever bub wants it (on demand), and use breast compressions, switch feeding and pumping to build your supply back up.

 

In the rollercoaster ride of motherhood, low milk supply can be one of the steepest drops, but remember, you’ve got this! Whether it’s health conditions, lifestyle factors, or baby-related issues, there’s often a solution to the challenge. So, mumma, if you found this chat helpful or have questions, feel free to DM me on Instagram. I’d love to hear about your journey and what you’ve taken away from our chat. Keep up your amazing work breastfeeding your baby with love! 💕🤱

References:

Brodrib, W. (2019). Breastfeeding Management in Australia, 5th edition. Australian Breastfeeding Association.