Is your milk supply really low?
New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds. There are many reasons for babies to be unsettled and breasts usually get softer after the first few weeks – these are not proof of low milk supply. If your baby is growing as expected (at least 20-30g a day, on average, during the first three months) just on your milk, then your milk supply is fine. If your baby does not grow well on your milk alone, then you may be making less milk than your baby needs.
The most common reason for genuine low milk supply is a slow start with breastfeeding, when not enough milk was removed from your breasts in the early days after birth. It may be possible to turn this around, with prompt action. Some other causes of low milk supply, such as previous breast surgery and some hormonal conditions, may mean that there is a limit to how much milk you can produce. Many nursing parents can make more milk than they are making, and you never know what you can do until you try!
Increasing low milk supply is hard work. It takes time, energy and commitment. It is important to be realistic from the start about your goal and how much time and energy you are able to invest. It works best when you have lots of practical and emotional support, so you can concentrate on your baby and your milk supply. Remember that this won’t be forever – it is a short-term investment for long-term gain. Set yourself short-term goals, e.g. 48-72 hours, then review your progress. If you are not able to increase your milk supply as much as you would like, or decide that it is not realistic to try, you can still have a close, happy feeding relationship with your baby.
While you are working on your milk supply:
- Find skilled feeding support. LLL is here to help! You can find information about ways we can support you here. We can also help you connect with other women who have experienced low milk supply.
- Track how you are doing. Keep a record of how much milk you express and the amount of formula or donated breastmilk your baby takes (if relevant) and how many wet and dirty nappies your baby produces. Tracking changes over time is useful to show how well your plan is working and can help you decide what to do next.
- Monitor your baby’s health and growth. Your baby needs to be weighed regularly while you are working on your milk supply. Your midwifery or health visiting team will usually do this. For more complex feeding issues, you may be referred to a local specialist infant feeding team or clinic. Any baby who is not growing as expected should be under the care of a doctor. This is because occasionally, slow growth can be caused by underlying health issues in the baby, rather than low milk supply.
How milk production works
Milk production starts in the middle trimester of pregnancy. After birth, milk continues to be made in the breasts in response to milk being removed. The most common reason for low milk production is a slow start with breastfeeding – not enough milk being removed from the breasts in the early days after birth.
Milk supply usually reaches its peak around four weeks after birth, with most of the increase happening in the first two weeks. If not enough milk is removed during this time, your breasts may end up making less milk than your baby needs. It may be possible to increase milk production, by removing more milk from your breasts. The earlier you start this, and the more energy you put into it, the higher your chances of making more milk. Even if more time has passed, it may still be possible to increase your milk production to some extent, but unfortunately there is no guarantee of being able to make a full milk supply.
Any amount of milk you are able to produce is valuable to your baby. Breastfeeding is about much more than just milk and you can enjoy nurturing your baby at the breast, however much milk you are making.
For more detailed information about how milk production works see How Milk Production Works.
Risk factors for low milk supply
- Previous breast surgery (especially reduction) or radiation
- Retained placenta
- Unusually small/thin/unequally sized/widely spaced breasts
- A history of infertility with hormonal cause
- Hormonal conditions like thyroid problems or polycystic ovary syndrome (PCOS).
If you have any risk factors for low milk supply, you may be referred to an infant feeding specialist. Some of these conditions are treatable. Even if you have underlying factors that can’t be treated, you may still be able to make more milk than you are currently making.
A baby who isn’t deeply attached at the breast may not be able to get enough milk, and feeding may also be uncomfortable for you. Squashed (“new lipstick”) nipples after a feed, skin damage and pain that lasts throughout feeds are all signs of shallow attachment. You can read more about positioning and attachment here.
Face to face help (including via video call) is usually best when working on attachment. If feeding doesn’t become more comfortable and/or effective even with skilled help, your baby may be referred for an oral assessment (a thorough examination of their mouth) to check for tongue tie, which is a problem for a small number of babies and can be treated. You can read more about this here and here.
Hold your baby skin to skin
This helps your milk-making hormones to work well, keeps your baby calm and happy, helps you and your baby feel connected and encourages interest in feeding. You can read more about holding your baby skin to skin here.
How often and when to feed
While you are working to increase your milk supply, you will want to encourage your baby to feed as often as possible. Signs of interest in feeding include your baby turning their head and opening their mouth (rooting), licking lips, mouthing hands, restlessness and making small sounds. Try to offer a feed when your baby is first interested, before they become upset. If your breasts are feeling full or you just feel like feeding your baby, you can offer your baby a feed, even if they are not asking.
- You may want to avoid using a dummy, a baby swing, or swaddling your baby, as these can make it difficult to tell if your baby is interested in feeding.
- Don’t give your baby water, tea or any other non-milk drinks.
- Breastfeeds don’t have to be regular (e.g. every 2-3 hours). Your baby just needs to have enough feeds in 24 hours, whenever they are awake enough and interested. Most young babies need at least 8-12 feeds in 24 hours. Don’t watch the clock – watch your baby and count feeds.
Keep your baby feeding actively when they are at the breast
Knowing when your baby is feeding actively at the breast, with deep sucks and swallowing after every one-two sucks, can be very helpful. While you are working to increase your milk supply, you will want to make sure that milk is removed from your breasts as effectively as possible. If your baby is mostly doing light, fluttery sucks with very little swallowing (three or more sucks per swallow), they are not removing much milk. If your goal is to increase the amount of milk removed from your breasts, you may want to end the feed and use a breast pump instead to maximise efficient milk removal.
Breast compressions and switching sides can help to keep your baby actively feeding for longer. Start compressing your breast as soon as your baby stops actively feeding. You can read about how to do compressions here. When your baby is no longer actively feeding even with compressions, repeat on the other side. Offer as many breasts as your baby will take – it can be more than two!
Some babies seem to want to feed all the time and protest when you take them off the breast. If they are not growing well, it may be because they are not yet breastfeeding effectively. To increase your milk supply, you may temporarily need to limit their time at the breast, to give you more time to express your milk.
Increasing breast stimulation by expressing your milk
If the steps above do not result in increased milk supply, the next step is to increase stimulation of your breasts by expressing your milk:
- An LLL Leader and/or your local infant feeding specialist will agree with you how many times in 24 hours to aim for at first. For more impact, you can increase the number of sessions. For maximum effect, you would aim to express 8-12 times in 24 hours (this is the number of times most babies need to feed).
- A double electric breast pump, preferably a large “hospital grade” pump, is usually the best tool for this job. Smaller single electric and manual pumps are designed for occasional expressing, not the big task of increasing milk supply.
- You don’t need to pump after set intervals (most babies don’t feed after set intervals either), just as often as you can. The important thing is how many times you express in 24 hours – it’s up to you when you do it. It’s fine to take a break for a few hours to go out or to sleep! More, shorter expressions often work better than fewer, longer ones and it’s fine to stop in the middle of pumping, if you need to do something. Even if you only have a few minutes, it’s worth pumping. Notice the times of day or night when you can express most and aim to pump more often then. First thing in the morning and in the quiet hours of the night can work well. Experiment to see what works best.
- Use your hands as well as your pump. Try massaging your breasts before and during pumping. You might want to buy or make a “hands-free pumping bra” to hold your pump in place. Some women find that they can express lots of milk by hand after they have finished pumping. You can see how to use your hands to express more milk in this video.
- Try covering the collection bottle with a sock so you can’t see it. Frustration about how slowly it is filling with milk can make it even slower!
- Try visualisation, e.g. a flowing fountain, or milk pouring into a bottle.
- Many women find that they get most milk in the first few minutes of pumping. To make the most of this, it can work well to pump very frequently for short periods, stopping and starting as many times as possible. This is sometimes called ‘power pumping’.
- Try pumping with a piece of your baby’s clothing near enough to smell, or while looking at your baby, or holding your baby skin to skin.
You can find more tips on how to express milk here.
Balancing breastfeeding and expressing
The priority at this stage is to increase your baby’s milk intake and your milk supply. This may mean limiting your baby’s time at the breast, for now, to free up enough time to express. Your baby has lots of time to learn to breastfeed. Your milk supply will become more difficult to increase as time goes on, so it is important to act quickly. This might feel all wrong – you want to breastfeed, not pump! Remember that it is an investment of your time now to help your baby breastfeed later. As your milk supply increases, breastfeeding will get easier and more rewarding for your baby. When breastfeeding is going well, you will be able to let your baby feed as much as they want.
How to feed expressed milk to your baby
Keeping the breast a happy place for your baby
If your baby is upset, try offering some extra milk before offering the breast. This helps your baby to associate the breast with feeling full and happy, rather than hungry and frustrated.
- Babies enjoy ending a feed by falling asleep at the breast. You can offer expressed or formula milk between breasts, allowing your baby to finish with the second breast.
- You can give milk by bottle or cup with your baby’s cheek against your breast.
- If a supplementer is used, your baby can drink expressed milk while breastfeeding.
This is a prescription medication that can help to increase milk supply in some women, whilst they are taking the tablets. It is not suitable for everyone, e.g. it is not safe for those with certain heart conditions. Because of this, doctors are currently discouraged from prescribing domperidone to anyone. However, the NHS states that domperidone may be appropriate in some cases, so if you would like to try it, it’s worth discussing with your GP, and taking along some information for them to read.
The most important thing to do to increase milk supply is to remove more milk from your breasts, so don’t worry if you can’t or prefer not to take domperidone.
Some babies need extra milk for a short time or longer term if their mother is not making a full milk supply. If donated human milk is not available, the only safe alternative is infant formula milk. You can find LLLGB’s information on milk sharing here.
It is never safe to suddenly stop or reduce supplements of formula or donor breastmilk. This needs to be done gradually, to allow your own milk supply time to increase. and it is very important that your baby is weighed regularly, to make sure that they continue to get enough milk. It would usually be appropriate to weigh your baby every 1-2 weeks while working on reducing supplements. You can read about how to use donor milk or formula to support breastfeeding here.
Whether or not you are producing all the milk your baby needs, you can still have a great feeding relationship with your baby. The breast can still work beautifully to calm, comfort and soothe your baby, even if your milk supply remains low. Any amount of your milk that your baby gets will be beneficial to them. Some of the immune components of milk become concentrated so that babies get the same amount, no matter how much of your milk they get each day. Whatever feeding looks like for you and your baby, we are here to support you.
Stage 1 – make sure your baby is feeding as effectively as possible
- Consider risk factors for low milk supply.
- Make sure that your baby is well positioned and attached at the breast. This will include checking for any reason the baby might not be able to attach and feed well (e.g. tongue tie).
- Hold your baby skin to skin as much as possible.
- Offer the breast as soon as your baby shows any signs of interest in feeding, at least 8-12 times in 24 hours, waking baby if necessary.
- Switch sides and use breast compressions to increase milk flow.
Stage 2 – if milk supply has not increased enough
- Express your milk at a frequency agreed with an LLL Leader and/or infant feeding specialist.If your baby is still not growing well, increase the number of expressions. For maximum effect, aim for at least 8 times in 24 hours. This may mean temporarily limiting your baby’s time at the breast, to give you enough time to express.
- Feed as much expressed milk as your baby wants to drink by cup, paced bottle-feeding, finger feeding or nursing supplementer.
- Aim to keep your baby’s time at the breast happy and relaxed, and to end feeds with your baby at the breast (if necessary, after giving your baby extra milk at the start or in the middle of the feed) as often as you can.
- Consider using the medication domperidone, which may help increase your milk supply.
- If necessary, use enough formula milk to make sure your baby grows as expected and seems satisfied.
Getting breastfeeding back on track after a difficult start
How milk production works
My baby needs more milk
Expressing your milk
Relactation and induced lactation – bringing back milk supply after a break or bringing in a milk supply when you haven’t been pregnant.
Making More Milk, by Diana West & Lisa Marasco (2019)
Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West (2001)
Breastfeeding Without Birthing by Alyssa Schnell – for non-gestational parents who are inducing lactation.
Written by Jayne Joyce and Emily Tammam, LLL Oxfordshire, February 2021