Updated: May 5, 2019
This article provides information for mums who are experiencing low milk supply, its causes, and treatments for low milk production.
There can be several different reasons why your milk production is low. It is important to find out what causes your low milk supply before you go ahead with techniques to increase your milk production. Professional guidance is often needed to implement a strategy for their resolution.
Fortunately, in most cases, your milk supply is determined by the baby. In other words, it is your baby who regulates your milk production and the more your baby suckles on your breast, the more milk is removed. The more milk is removed, the more milk your body will produce (supply and demand). Your breast is like a toilet reservoir tank. The more you flush your toilet, the more water will flow back in. If you don't flush the toilet, the tap will not open, and water will not flow to the tank. Your breast is even more sophisticated than that. If your baby does not remove the stored milk in the breast, your body will eventually reabsorb this stagnating milk, and will produce less and less milk.
Let us have a look at potential reasons which can cause or contribute to low milk supply:
Many parents make the mistake of giving their baby a bottle of a formula milk. I know how tempting it is. I have been there and have done it myself. Breastfeeding can be hard in the first few days and weeks. You are sleep deprived, tired, still healing after giving birth, and would do anything to have a few hours of sleep. But don't forget that breastfeeding is a supply and demand process. The amount that your baby breastfeeds lets your body know how much milk is required. Every bottle (of formula or water) that your baby gets means that your body gets the signal to produce that much less milk.
Furthermore, a bottle teat can confuse a very small baby who is still learning to breastfeed. A bottle requires a very different way of sucking than feeding from a breast. Some babies, but not all, refuse the breast after introduction of a bottle, either because they find the bottle easier to suckle on or they prefer the constant faster flow.
Sucking on a dummy can also affect the baby's ability to suckle from the breast. A dummy can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.
Feeding by the clock can interfere with the supply & demand cycle of milk production which can lead to a reduced milk supply. Breastfeed as often as possible. Nurse your baby whenever she is hungry or whenever your breasts feel uncomfortably full. The more you feed and empty the breast, the more milk your breast will produce.
Restricting the lengths of feeds or timing feeds can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight.
Offering only one breast per feeding can lead to low milk supply. Some mum's breasts have a large storage capacity and feeding only from one breast per feed works well for them. However, most mums, especially in the early days, will need to offer both breasts to their baby, to establish or increase their milk supply.
Not feeding at night
Your milk supply will start to drop if you are not breastfeeding at night. The level of prolactin, which is the hormone essential for milk production, is higher during night feedings. A drop in prolactin levels will result in lower milk production. It’s hard to resist the lure of more sleep, but for many mothers, those nightly feedings are essential to keep milk production high.
You might be reading this article and you are thinking: "My baby has long feeds, is always on my breast, I feed day and night and she or he never seems to be satisfied."
Before we go any further, I would like to clarify first, what is a normal feeding pattern. Babies ask for a feed not only when they are hungry, but also when they are thirsty or need comfort. It is normal for a baby to ask for a feed between 8 and 12 times in a 24 hours period and have a period of cluster feeds mainly in the evenings. Some feeds will be further apart (4 hours), and sometimes your baby will ask for feeds very frequently (every hour). Some feeds will be very short (5 min), and some feeds will be long (45 min).
if most feeds are taking over an hour or
baby is never satisfied after a feed or
baby is not frequently passing stool and urine (at least 2 dirty and 6 wet nappies in 24 hour period) or
lost more than 8% of its body weight on day 3, 4 or 5; or
has not returned to its birth weight by day 14; or
is very slow to gain weight and his or her weight dropped two centiles on a WHO's growth chart, it indicates that the feeding is not going well.
Again, there can be several reasons for this. Either baby is not removing milk adequately from the breast, which can lead to low milk supply or oversupply, or your health is preventing your body from producing enough milk.
I would like to reassure you that, in nearly all cases, the reason for a low milk supply is caused by the baby and not you.
A shallow latch is the most common reason for low milk supply. Your baby’s ability to drain milk from your breasts is strongly dependent on how well he or she is attached. The aim is to get your breast and nipple positioned deeply in your baby's mouth. It is a practical skill which you might need help with from a midwife, health visitor, or a lactation consultant.
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It is important to know that a baby who is well latched on gets milk more easily than one who is not. A baby who is poorly latched on can get milk only when the flow of milk is rapid.
In the first 3-6 weeks of life, many babies tend to fall asleep at the breast when the flow of milk is slow, not necessarily when they have had enough to eat and not because they are lazy or want to pacify. After this age, they may start to pull away at the breast when the flow of milk slows down. However, some pull at the breast even when they are much younger, sometimes even in the first days and some babies fall asleep even at 3 or 4 months when the milk flow is slow.
Sucking difficulties due to oral-motor dysfunction, neurological conditions or anatomical issues like tongue-tie or high or cleft palate.
The problem may lie with your baby. He or she may struggle to get the milk from your breast. There might be several reasons for that. Your baby might have been affected by drugs you used in labour, which would make him/her sleepy. Your baby might have had a traumatic birth which could lead to injury or pain in the jaw, or your little one might have a tongue-tie (thin membrane of tissue at the bottom of his/her mouth, preventing the tongue to move freely to extract milk efficiently). Neurological conditions such as a disorganized suck/swallow/breathe reflex may also hinder the baby’s feeding.
Premature babies sometimes need time to develop their suck, swallow and breathe reflex. Those babies need lots of sleep to grow instead of expending energy and using calories on breastfeeding.
Fussy behaviour at the breast
Food sensitivities, allergies, pain from reflux or colic can cause a baby to be fussy and unsettled while breastfeeding, which can lead to low milk supply as the baby is not draining the breast properly.
Your health issues
In very few cases the reason for low milk supply might be due to your health or the combination of both, yours and baby's.
Hormonal imbalance (e.g. hypothyroidism, hypopituitarism, polycystic ovary syndrome, ovarian theca lutein cysts, diabetes, retained placenta or placental fragments, Sheehan's Syndrome) can cause low milk supply.
If your milk supply is persistently low, your GP should order blood tests to find out any hormonal imbalances (thyroid stimulating hormone test - TSH, prolactin levels, test for human chorionic gonadotropin (hCG) and testosterone levels.
Using hormonal contraception which contains estrogen can also inhibit milk production.
Insufficient glandular tissue (IGT)
Breast surgery, especially reduction
Also large amounts of sage, parsley or peppermint can affect your milk.