The benefits of breastfeeding your baby are well documented, hence why the World Health Organization (WHO) now recommend breastfeeding for the first 6 months of life continued until at least 1 year to achieve the benefits.

However, for many mothers, a low milk supply or at least a milk supply perceived to be too low is a common barrier to successful breastfeeding. In fact, these are the main reasons many breastfeeding mothers stop breastfeeding exclusively or quit earlier than the recommended duration.

Being aware of the role that perceived insufficient milk (PIM) plays in disrupting breastfeeding is useful to understand if you are beginning to question your own milk production, as it may help both you and your baby.

Of course, this does not mean that you may not have low milk production, but it is useful to be aware that it may not be low at all. In order to determine if you do have a low milk supply, it is useful to understand the role maternal perceptions play in determining milk supply and how you can accurately measure your milk supply.

Reasons Women Believe their Milk Supply is Low

As previously mentioned there are many reasons breastfeeding mothers may believe their milk supply is low, here we list some of the most common.

1. Your Baby Feeds Frequently

Babies naturally feed at regular intervals and this is perfectly normal, typically newborns need to feed 8 to 12 times a day. This is because the breast milk is digested at a fast rate, usually around 1 to 2 hours, which is much faster than formula, hence why bottle-fed babies do not feed as often.

Additionally, frequent suckling is required to stimulate milk production and establish a healthy supply.

2. Your Baby Suddenly Started Feeding More Often

It is natural for a baby’s appetite to fluctuate, especially during sudden growth – commonly referred to as growth spurts. This phase can last several weeks and in order to ensure you produce enough milk it is important to stimulate your breasts by ensuring milk is removed more often.

This can be a time when many mothers can become tempted to start supplementing with formula; however, it’s important to be aware that this will result in less breast stimulation, resulting in your body producing less milk.

3. Your Breasts Feel Softer and Less Full

Typically, breasts are very full and sometimes even hard for the first few days after labor due to the milk “coming in”. It is normal for your breasts to adjust over time in accordance with your babies feeding demands and in fact, softer breasts will make it easier for your baby to latch on and feed.

As long as your baby is feeding well, then soft breasts are nothing to be concerned about.

Signs Your Baby is Getting Enough Milk

There are a number of trustworthy signs that you can watch out for in order to determine if your baby’s milk consumption is sufficient. These can often be very reassuring to mothers worried whether they are getting enough milk.

1. Stool Output

If your baby is taking in a sufficient amount of milk from breastfeeding, then it will be digested and you will notice a stool and urine output at regular intervals.

In newborns, the stools are initially loose and later – typically during the first five days, they will transition in color from black to mustard yellow.

Babies that are breastfed vary in terms of stool patterns but by three days old they usually have at least two to three bowel movements in a 24 hour period. Older babies will also differ, with some having a bowel movement every day, while others will have one every few days.

2. Urine Output

Urine output is also frequent in breastfed babies and more so in those who are given water to drink as well milk. Typically this adds up to anywhere from 5 to more wet diapers in a 24 hour period and is usually pale, diluted urine.

3. Weight Gain

Weight gain in babies varies and every baby’s growth and weight gain patterns tend to differ. It is not possible to determine if your baby is growing normally, therefore, monitoring your baby’s weight should be done on a regular basis. Ideally, this should be done a few times over several days.

Newborns will sometimes lose weight during the first few days after birth as they use up the reserves they are born with. By two weeks of age, they should begin to recover and put the weight back on.

After the two week period, breastfed babies typically gain anywhere from 500g to 1kg every month.  If a baby is below their birth weight after the second week the usual procedure is a reassessment by a medical professional.

Who to Contact if You Suspect your Milk Supply is Low

If you struggling to breastfeed your baby then you can seek advice from a trained lactation practitioner, who will be able to guide you and offer you the necessary support. In any case, if you suspect your baby is not gaining weight or may have some other underlying medical issue then you should consult your doctor as soon as possible.

Possible Causes of a Low Milk Supply

There are many possible causes to a low milk supply, including those health conditions that impact milk production itself, emotional aspects of the mother as well as the physical state of baby, mother or both.

1. Breastfeeding Determinants

A major cause of low milk production is due to a variety of aspects related to breastfeeding itself including technique, routine, and supplementation. In simple terms, breasts require stimulation in order to produce sufficient milk, therefore, the most common reason for low milk production is related to the amount of milk the baby expels from the breast. These include the following:

• Delayed Initiation

If breastfeeding is not started shortly after birth, within the first few days it is possible that when breastfeeding is initiated the breasts will not immediately produce enough milk to meet the demand of your baby.

• Supplementation

It is quite common for mothers to supplement their own breast milk with formula, which can result in your baby not wanting to suckle as much, however, since the breasts need regular stimulation to produce milk this can result in reduced milk breast milk production.

• Infrequent Feeds & No Night Time Feeds

Babies need to suckle on a regular basis as the breasts need regular stimulation in order to maintain enough production to meet their baby’s needs.

Babies are often sleepy and it can be tempting to let them sleep, however, breastfed babies should be woken every 3 to 4 hours to feed and after two months 5 to 6 times in a 24 hour period.

• Short Feeds

If the mother has a particularly busy lifestyle and finds herself struggling to make the time to make feeds, she may find herself cutting the feeding time short. This can result in her breasts no producing the sufficient amount of milk and can result in the baby not obtaining a sufficient intake of milk.

• Scheduled Feeds

Sticking to a scheduled feeding plan does not allow for frequent feeds, which are recommended. This often results in babies crying until the scheduled time, which can result in him or her using up considerable energy meaning they very sleep during the feed.

• Pacifiers and Bottles

Babies naturally want to suckle, so by giving them a pacifier or bottle, you are providing them with a distraction that may result in them suckling the breast less. There is also some evidence that pacifiers may be associated with breastfeeding failure and may lead to babies being able to attach to the breast less effectively.

2. Physical State of the Mother

Some mothers have other underlying conditions that can affect the production of milk and therefore lead to a low or in some cases complete absence of milk production. Some of the most common causes include the following:

• Endocrine Problems
• Inadequate Breast Development
• Low milk production that is not responsive to improved breastfeeding technique
• Pregnancy
• Alcohol consumption

3. Physical State of the Baby

If a baby is failing to gain weight then there could be other underlying health issues not related to low milk production. Typically these issues impact a baby’s ability to feed effectively and stimulate milk production. Related health issues include prematurity or congenital abnormalities as well as kidney dysfunction.

How to Increase Milk Intake/Transfer

The breasts need repeated stimulation in order to produce milk, so it’s important that your baby efficiently removes milk from the breasts in order for them to continue producing enough. That is why both milk production and milk transfer are related.

• Ensure Your Baby is Correctly Attached  

There are a number of ways you can increase milk consumption, this includes making sure your baby is correctly latched onto the breast and suckling. If you are struggling with this, you can always seek advice from a lactation consultant or medical professional such as your midwife.

There are also lots of videos online that many mothers find helpful in improving their breastfeeding technique.

• Increase the Frequency of Feeds

In order to ensure your baby is getting sufficient milk and that you produce enough milk ensure you breastfeed at regular intervals and make sure to wake them to feed. Remember breastfed babies ought to be woken every 3 to 4 hours to feed and after two months 5 to 6 times in a 24 hour period.

• Increase Skin to Skin Contact

Skin to skin contact with your baby stimulates the release of a hormone called prolactin, which is involved in breast milk production. Therefore in between feeding times make sure you spend a lot of time with your baby and make sure they are only in a diaper to ensure maximum skin to skin contact.

• Avoid Pacifiers and other Imitation Teats

Whenever your baby looks like they want to suckle you should offer them your breast. Allowing your baby to use pacifiers and other artificial teats can act as a distraction and reduce the frequency of feeding.

• Avoid Supplementation

It is common for mothers who perceive they have low milk production to supplement their baby’s feed with formula milk. However, in the long term, this is not always a good idea for breastfeeding mothers since it will reduce the frequency that your baby wants to feed and therefore will reduce your milk production.

• Learn your Babies Feeding Cues

Common baby feeding cues include him or her sucking on a fist and smacking his or her lips. Stroking a newborns cheek will also arouse a natural instinct in them to turn to you with a natural sucking motion when they are hungry.

These cues will allow you to tell when your baby needs feeding and at this point, it is usually much easier to feed your baby rather than waiting until they are crying.

How to Increase your Milk Supply

Although some women do experience the low production of breast milk long term, the most common reasons why a baby may not get sufficient milk are related to poor breastfeeding technique and management that reduce the amount of milk removed from the breast.

• Take Your Time

You need to give your baby time to feed properly and intake sufficient milk. Obviously many women are busy, especially mothers who work or may have other children, but only by ensuring your baby gets enough milk will you ensure your milk production will meet demand.

Removing your baby too soon may also prevent them from consuming much of the fat-rich milk at the back, so it’s essential you give your baby plenty of time to feed. When possible you should offer each of your breasts during a single feed, if this is not possible alternate with each feed.

• Massage Your Breasts During Feeds

When your baby is feeding you can gently massage and compress your breasts to encourage the flow and expression of milk.

• Express Milk Between Feeds

You can stimulate your breasts to produce more milk by expressing milk in between feeds; to do this you can use a breast pump. This is also useful for mothers with sore nipples that need a break and for babies that struggle to feed on the breast due to a weak suck.

Having additional breast milk stored will also ensure you always have some at times when for whatever reason you may struggle to breastfeed. This will ensure you never get tempted to reach for the formula.

• Consider using a Galactagogue

Some mothers find that certain supplements, foods or herbs that contain galactagogues can help with their breast milk production. A galactagogue is a substance that can help stimulate milk production. As long as you check that they are safe to use for breastfeeding mothers then these can certainly help boost a mother’s confidence.