Low Breast Milk Supply: Causes, Signs, and Solutions

"Am I making enough milk?" It's one of the most common worries for breastfeeding parents—and one of the most misunderstood. Many parents who think they have low supply actually don't. Let's sort out what low supply really looks like, what causes it, and what you can do about it.

First: Do You Actually Have Low Supply?

This is important because perceived low supply is much more common than actual low supply. Most people who think they don't have enough milk actually do. AAP

These are NOT signs of low supply:

• Baby wants to nurse frequently (normal—especially during growth spurts)
• Baby is fussy after feeds sometimes (normal—not always about hunger)
• Your breasts feel soft or not full (normal after the first weeks as supply regulates)
• You can't pump much (pumps are not an accurate measure of supply)
• Baby takes a bottle after nursing (babies often take a bottle even when full)
• Baby nurses quickly (some babies become efficient nursers)
• You don't feel let-down (many people don't feel it)
• Baby isn't sleeping through the night (normal for most of the first year)

These ARE reliable signs of low supply:

• Baby isn't gaining weight appropriately
• Baby is having fewer than 6 wet diapers per day (after day 5)
• Baby isn't producing regular stools (in the first month especially)
• Baby seems truly unsatisfied after most feeds and is difficult to settle
• Baby's urine is dark or concentrated

The bottom line: If your baby is gaining weight well and producing plenty of wet diapers, you almost certainly have enough milk—regardless of what your breasts feel like or what comes out when you pump.

True Low Supply: What Causes It?

When supply is genuinely low, there's usually an identifiable cause: AAP

### Milk Removal Issues

The most common cause of low supply is not removing enough milk from the breasts frequently enough. Breast milk works on supply and demand.

Contributing factors:

• Not nursing frequently enough (especially in the early weeks)
• Baby not latching well or transferring milk effectively
• Scheduled feedings instead of feeding on demand
• Using pacifiers or bottles too early, which can reduce breast time
• Supplementing with formula without pumping (reduces demand)
• Returning to work without adequate pumping schedule

### Anatomical Factors

In baby:

• Tongue-tie or lip-tie (restricts milk transfer)
• High palate or other oral anatomy issues
• Prematurity or medical conditions affecting feeding

In parent:

• Insufficient glandular tissue (rare, but breasts may look tubular or widely spaced)
• Previous breast surgery (especially reduction or lumpectomy)
• Previous breast radiation
• Flat or inverted nipples (usually manageable but can affect latch)

### Hormonal and Medical Factors

• Thyroid disorders (hypo- or hyperthyroidism)
• Polycystic ovary syndrome (PCOS)
• Diabetes (Type 1, Type 2, or gestational)
• Obesity (can affect prolactin levels)
• Retained placenta (rare, but prevents hormonal shift to milk production)
• Sheehan syndrome (rare—caused by severe postpartum hemorrhage)
• Hormonal birth control (especially if started early; avoid estrogen-containing methods)
• Pregnancy (yes, sometimes people get pregnant while breastfeeding)

### Lifestyle Factors

• Smoking (nicotine decreases prolactin)
• Excessive caffeine or alcohol
• Significant stress or exhaustion
• Dehydration or inadequate nutrition
• Certain medications (decongestants, some herbs)

Evidence-Based Ways to Increase Supply

If you truly have low supply, these strategies can help: AAP

### Priority 1: Increase Milk Removal

This is the most effective approach—more demand creates more supply.

Strategies:

• Nurse more frequently (8-12 times per day minimum)
• Don't skip night feeds (prolactin is highest at night)
• Offer both breasts at each feeding
• Allow baby to fully drain one breast before switching
• Add pumping sessions after nursing
• Try "power pumping" (pump 20 min, rest 10, pump 10, rest 10, pump 10—once daily)
• Use breast compression during feeds to help milk flow

### Priority 2: Optimize Latch and Transfer

Make sure milk is actually getting into baby effectively.

Actions:

• See a lactation consultant for latch assessment
• Have baby evaluated for tongue-tie or lip-tie
• Try different nursing positions
• Address any nipple pain (pain often means poor latch)

### Priority 3: Address Underlying Causes

Work with your healthcare provider to identify and treat any medical issues.

Consider:

• Thyroid function testing
• Evaluation for PCOS or other hormonal conditions
• Medication review (what might be affecting supply?)
• Check for retained placental fragments if supply never came in

### Priority 4: Support Your Body

Create optimal conditions for milk production.

Basics:

• Eat enough—at least 1800 calories daily; don't diet while establishing supply
• Stay well-hydrated (but excessive water doesn't increase milk—drink to thirst)
• Get as much rest as possible (easier said than done, we know)
• Reduce stress when you can (stress can inhibit let-down)

### Galactagogues: What Actually Works?

Galactagogues are substances believed to increase milk production. Evidence is mixed: AAP

Herbal galactagogues (limited evidence):

• Fenugreek: Most studied, may help some people; can cause maple syrup smell
• Blessed thistle: Often used with fenugreek
• Brewer's yeast: Sometimes in lactation cookies
• Oatmeal: Widely used, minimal evidence but harmless

Important caveats:

• Herbs are not FDA-regulated and quality varies
• Some can have side effects or interactions
• They should supplement, not replace, increased milk removal
• Always discuss with your healthcare provider before using

Prescription galactagogues (used in some countries):

• Domperidone: May increase prolactin; not FDA-approved in US for this use
• Metoclopramide (Reglan): Can increase supply but has significant side effects

These are generally reserved for specific situations under medical supervision.

When to Seek Help

Don't wait—get support early if: AAP

• Baby isn't back to birth weight by two weeks
• Baby isn't having enough wet/dirty diapers
• Breastfeeding is consistently painful
• Baby seems hungry and unsatisfied after most feeds
• You're worried about supply and want reassurance

Where to get help:

• Lactation consultant (IBCLC is the gold standard)
• Your pediatrician
• Breastfeeding support groups (La Leche League, hospital groups)
• Peer counselors (WIC, community programs)

If Supply Doesn't Increase

Sometimes, despite best efforts, supply remains low. This is not a personal failure. AAP

Options for low supply:

• Combination feeding (breastfeed + supplement with formula)
• Exclusive pumping with supplementation
• Using donor milk
• Formula feeding

What matters most:

• Your mental health
• Baby getting adequate nutrition
• A sustainable feeding plan you can maintain

Any amount of breast milk provides benefits. Exclusive breastfeeding isn't the only way to nourish and bond with your baby.

What Other Parents Ask

"Will eating lactation cookies or drinking certain teas help?"
Maybe, maybe not. There's limited evidence for most galactagogues. They're unlikely to hurt (unless you're allergic to ingredients), but they're not a substitute for frequent, effective milk removal.

"Should I pump after every feed even if nothing comes out?"
If you're trying to increase supply, yes—pumping signals your body to make more milk, even if little comes out initially. The stimulation matters more than the output.

"My supply dropped suddenly—what happened?"
Possible causes: starting hormonal birth control, pregnancy, returning to work without adequate pumping, illness, stress, or baby going through an efficient nursing phase. Sometimes it's temporary; sometimes it needs investigation.

"Can I rebuild supply after it has dropped?"
Often, yes—especially if you catch it early. The same principles apply: increase demand through frequent nursing and pumping. The sooner you act, the easier it is.

The Bottom Line

True low supply is less common than you'd think, but it does happen and it's not your fault. If your baby is growing well and making plenty of wet diapers, trust your body. If you're truly struggling, get help early—lactation support can make an enormous difference.

Whatever your feeding journey looks like, know that your worth as a parent isn't measured in ounces. You're doing your best for your baby, and that's what matters.

Clara is here to help you work through feeding concerns and figure out your next steps.