As an International Board Certified Lactation Consultant, one of the most common concerns I see from parents is the perception of low milk supply. What exactly is low milk supply? A low milk supply is defined as producing less than 24oz per 24-hour period for one month of life (Campbell, S. H., Lauwers, J., & Mannel, R. (2019). A 2020 New York Times article estimated that a low milk supply affected approximately 10-15 percent of mothers. If you’re concerned about low milk supply, keep reading for potential causes and tips for increasing your supply and maintaining a good supply throughout your breastfeeding journey.
Begin Breastfeeding Prep Before Baby Arrives
I frequently advise my clients that it's much easier to begin breastfeeding and then decide to stop rather than try to initiate breastfeeding a week or two after the baby is born. Therefore, preparation is a great first step to achieving a healthy supply. Before the baby arrives, explore educational resources and meet with a lactation professional to establish a plan. This is especially important if you have had any breast surgeries/biopsies, breast reduction, breast augmentation, or had a difficult time previously breastfeeding. Prenatal breastfeeding classes are excellent avenues to learn about breastfeeding benefits and management.
Advocate for Breastfeeding During Labor & Delivery
Labor and delivery play a crucial role in breastfeeding success. The “Golden Hour” is an uninterrupted time for the mother and baby to bond and establish breastfeeding. If breastfeeding is important to you, communicate with your birthing team. For context, breastfeeding-friendly hospitals prioritize breastfeeding by encouraging skin-to-skin breastfeeding within the first hour after delivery, not offering artificial teats, allowing mothers and babies to stay in the room together, and helping to achieve a good latch. When advocating for your wishes and desires, a birth doula can be a great resource and advocate to ensure breastfeeding goals are met.
The First Few Days
Congratulations! You have a new bundle of joy, and you may be experiencing a host of emotions. During the early postpartum period, it is essential to prioritize rest, healing, and feeding the baby. Offer the breast frequently. If circumstances prevent direct breastfeeding, hand expression, and a hospital-grade electric pump are excellent alternatives (See Momcozy Hospital-Grade Pump).
Whether you feed the baby directly at your breast or pump and bottle feed, remember that the goal is to feed the baby, not the freezer. Generally speaking, producing 25- 40 ounces of breast milk daily is ideal. Research shows on average, a one-month-old baby will take 2 oz. - 4 oz. (60-120mL) per feed or 24 oz.- 32oz. (720mL – 960mL) over 24 hours (Lauwers and Swisher 2021). It is important to note that a baby's intake varies significantly throughout the day. One way to think about this is that sometimes the baby just wants a snack versus a full meal. Formula-fed babies tend to take larger volumes of artificial milk. Human milk is dynamic and constantly changing to suit the needs of the growing human. Artificial milk is static, and more volume is required to try to replicate some of the benefits of breast milk.
Should I worry about my supply?
Before diving into the causes of low milk supply, I want to explore when you should begin considering low milk supply. Variations in supply are normal however, if the baby has not returned to birth weight by day ten of life, is losing weight, or has slow weight gain, consult with your lactation professional.
Low Milk Supply Causes
While every scenario is unique, below are a few things that can contribute to low milk supply:
- Not enough nipple stimulation
- Less than optimal feedings
- Less than optimal feeding frequencies
- Ineffective latch
- Higher Body Mass Index (BMI)
- Hormonal Imbalance, including insulin deregulation
- Thyroid dysfunction
Additionally, it is not uncommon to experience a dip in your supply during your menstrual cycle or when you are feeling under the weather. It is also recommended that you continue to feed during these times.
Things that can reduce your supply include letting the baby sleep through the night/skipping nighttime feeding and pumping sessions, hormonal birth control, and not regularly/frequently emptying the breast.
If you are experiencing any of the symptoms noted above, contact an International Board Certified Lactation Consultant (IBCLC) in your area. They can work with you to understand and identify your needs and prepare an individualized care plan to help you meet your breastfeeding goals.
Maintaining and Increasing Your Supply
A good start is the best way to maintain and increase your milk supply, but here are a few additional tips:
- Offer the breast frequently – feeding the baby on a schedule can hurt your supply. This restricts the baby’s input and does not take into account the baby’s feeding cues (when the baby is actually hungry)
- Be aware of your baby’s feeding cues – Recognizing and responding to baby’s feeding cues is the optimal way to feed the baby (gentle movements after waking, smacking, rooting, and suckling on their hand)
- Do not skip nighttime feedings – your milk production is highest at night, as this is when your prolactin levels are the highest
- Pump every 2-3 hours whenever away from baby
- Try gentle breast massage – massage helps to release oxytocin and push milk to the baby (or pump) (Lauwers and Swisher, 2021)
- Check-in with a lactation professional for any concerns
The Relationship Between Food and Milk Supply
While no specific foods have been proven to increase milk supply, many cultures have long relied on certain foods and herbs called galactagogues during breastfeeding. Galactagogues are not magic pills and should be used with your lactation consultant and health care provider to ensure a balanced diet.
Common Galactagogues:
(NOTE: This list is an excerpt from the book Making More Milk by Lisa Marasco, MA, IBCLC, and Diana West, BA, IBCLC. Certain galactagogues work better for different situations; therefore, it is essential to work with your Lactation consultant and healthcare provider.)
Oatmeal
- Facts: Nutritious and high in fiber, iron, and minerals; good for exhaustion, anxiety, and pituitary support
- History: Strong reputation for increasing milk in Hispanic and Asian traditions
- Pros: Nutritious and readily available
- Cons: Should be used with caution for those with celiac disease
Fenugreek
- Facts: High in fiber, protein, iron, vitamin C, niacin, and potassium
- History: Popular in North America and other countries as well; Enjoyed in India and other parts of the world as an ordinary culinary herb
- Pros: Studies show a moderate increase in milk output
- Cons: Not a good choice for those with low thyroid or abnormal thyroid function or during pregnancy
Brewers Yeast
- Facts: High in B vitamins
- History: Popular galactagogue common in lactation cookies
- Pros: Supporting animal research (but no human research studies)
- Cons: Not recommended if you are prone to yeast infections; can cause diarrhea or abdominal upset
We’re Here to Help
Breastfeeding is natural but not always intuitive. Often, small tweaks can lead to a successful breastfeeding journey. If you are struggling to maintain and/or increase your supply or have concerns about how much your baby is taking in, work with an IBCLC to evaluate and create a customized plan for your breastfeeding success.
References
- Lactation Education Accreditation and Approval Review Committee (LEAARC), Campbell, S. H., Lauwers, J., & Mannel, R. (2019). Core curriculum for interdisciplinary lactation care (1st ed.). Jones & Bartlett Learning.
- Lauwers, J., & Swisher, A. (2021). Counseling the nursing mother (7th ed.). Jones & Bartlett Learning.
- Marasco, L., & West, D. (2019). Making more milk: The breastfeeding guide to increasing your milk production, second edition (2nd ed.). McGraw Hill.
