Low Milk Supply

What is low milk supply?

Low milk supply (hypolactation) is when you produce less milk than your baby needs. It’s a common issue, and one that can be very stressful for parents trying to make sure their baby gets enough nutrition. Many things affect milk flow. And some babies struggle with breastfeeding (chestfeeding) for reasons that have nothing to do with how much milk you’re producing.

If you think you have low milk supply, contact a lactation support provider, such as a lactation consultant or breastfeeding medicine specialist. Together, you can determine if a low milk supply or other factors are impacting your baby’s ability to nurse or gain weight. And together, you’ll find solutions.

What are the signs of low milk supply?

Your milk supply may be lower than expected if your baby:

• Isn’t growing or gaining weight.
• Doesn’t seem to be swallowing during nursing sessions. They may suckle at the breast but not swallow.
• Isn’t making enough wet or poopy diapers. In general, once your baby is about 4 days old, they should make at least six wet diapers and three poopy diapers per day.

The signs below may be confused for signs of low milk supply. However, they’re often normal behaviors or changes that occur regardless of milk supply:

• Your breasts feel softer as the weeks go by.
• Your baby nurses often, or feedings are clustered together occasionally or in the evenings only.
• Your baby pulls away sooner than you expect or seems uninterested in nursing as they get older and more efficient at feeding.

It’s still a good idea to mention any and all observations to your healthcare provider.

Perceived vs. actual low milk supply

Perceived low milk supply is when you believe you’re not producing enough milk. Sometimes, perceptions don’t match reality, and in fact, your supply is adequate for your baby’s needs. Taking care of a newborn is stressful, and it’s common to worry something is wrong.

But other times, your perceptions might be accurate. Still, rest assured there are solutions to low milk supply, and your lactation support provider can help.

What causes low milk supply?

Lactation is complex for something that may look easy, and many things affect how much milk you produce. These include:

• Your baby isn’t removing enough milk from your breasts, so your breasts respond by producing less milk.
• You and your baby are separated for long periods (for example, if you’re at work), and so you can’t breastfeed often enough to keep up your supply. The more stimulation your breasts receive, the more they’ll produce milk. Less stimulation means less milk production.
• You have a medical condition that affects your milk supply.

Medical conditions and factors that may affect a breastfeeding parent’s milk supply include:

• Pregnancy (yes, you can still get pregnant while breastfeeding).
• Certain over-the-counter (OTC) and prescription medications.
• Placental encapsulation.
• Breast hypoplasia (your breasts don’t have enough glandular tissue to produce enough milk).
• Previous breast surgery.
• Polycystic ovarian syndrome (PCOS).
• Hypothyroidism.
• Retained placenta.
• Postpartum bleeding that leads to a drop in prolactin.
• Other hormonal conditions.

Heavy use of tobacco, marijuana or alcohol may also lower your milk supply.

How is low milk supply diagnosed?

Your healthcare provider will give both you and your baby physical exams. They’ll talk to you about your breastfeeding experiences and what you’ve observed. A lactation support provider may ask to observe you during breastfeeding, as well.

Is pumping an accurate measure of milk supply?

No, it’s not. Your baby removes milk differently (and usually more efficiently) than a breast pump. So, it’s not accurate to assume the amount you pump is the same as what your baby removes, although it’s likely close and can be helpful information. Your milk output might seem low when measured by pumping even if your baby is receiving enough for their needs.

It’s important to avoid self-diagnosing or comparing yourself to other parents. You may hear advice to measure your milk output by pumping exclusively for 24 hours straight. This won’t accurately show how much milk your baby is taking in. Plus, guidelines you might see on how many ounces your baby should receive per day are based on formula feeding, not breastfeeding.

That’s why it’s important to talk to a lactation support provider about your concerns. They’ll offer the answers and support you need.

What is the treatment for low milk supply?

Treatment for low milk supply depends on the underlying cause. Your lactation support provider will work closely with you to identify the cause and decide the best treatment. In general, you can expect your provider to:

• Talk to you about your medical history and do a physical exam to check for all possible causes of low milk supply. These might include certain medical conditions or the use of certain substances (like alcohol or tobacco). Your provider will treat any underlying conditions as needed and/or recommend lifestyle changes.
• Discuss how often and how well your baby removes (drains) milk from your breasts. Your provider may give you advice for improving milk drainage.
• Talk to you about any anxiety or discomfort you’re feeling related to breastfeeding. They’ll offer advice on how you can make breastfeeding a more relaxed and comfortable experience.
• Recommend a galactogogue, in select cases.

What are galactogogues?

Healthcare providers use the word galactogogues to refer to substances that people use to keep or increase their milk supply. For hundreds of years and across cultures, people have tried everything from herbs (like fenugreek or milk thistle) to various foods and beverages (like beer) to boost milk production.

It’s important to know this right away: don’t use galactogogues as a treatment for low milk supply without talking to a physician first. You should proceed with caution because:

• Many of these substances can interact with other medications you’re taking, and some of these interactions can be dangerous.
• Risks and side effects may outweigh the supplement’s benefits. Some may be serious.
• In the case of many herbal galactogogues, there’s not enough scientific evidence to show a certain galactogogue works and/or is safe. Plus, there aren’t standard dosage guidelines.

As of 2023, the U.S. Food and Drug Administration (FDA) hasn’t approved any medications to treat low milk supply. Some healthcare providers prescribe medications to help improve milk flow. These are considered “off-label” uses of the medication. That means the medication is FDA-approved to treat something else, but your provider believes it may help with low milk supply. They’ll only do this if they believe the benefits of the medication outweigh any possible risks for you.

Should I pump to increase milk supply?

Your lactation support provider may recommend you incorporate pumping to help increase your supply or if your baby isn’t emptying milk from your breasts effectively.

Your provider will offer guidance based on your and your baby’s unique needs.

Can low milk supply be prevented?

It may not be possible to prevent a low milk supply. But you can work with a lactation support provider to identify factors that might affect your milk supply. It’s never too early to start this conversation. Talking about milk supply and breastfeeding during pregnancy can help you prepare and know what to expect.

Maintaining a weight and lifestyle that are healthy for you and staying up to date on the management of your chronic health conditions can sometimes help prevent low milk supply.

What can I expect if I have low milk supply?

Your provider will work with you to help you increase your milk supply and/or find other options for feeding your baby. Having a low supply isn’t your fault, so don’t blame yourself or feel like you’ve somehow failed. Try to avoid comparing yourself to other parents or thinking you’re not doing enough to help your milk supply.

Instead, work with your lactation support provider to find solutions that work best for you and your baby. In some cases, this may mean supplementing with formula. Or, you may need to pump and use bottle-feeding to supplement the milk your baby gets from the breast. Your provider will offer guidance and also a listening ear as you navigate this time.

How should I take care of myself?

Right now, self-care might seem like an impossible dream. But doing whatever you can to care for yourself — physically and mentally — is important for both you and your baby. This is a time to lean on family and friends for support. Here are a few ways you can do that:

• Ask a trusted friend to come over and babysit so you can take a nap.
• Recruit the cooks in your life to prepare some meals you can freeze to have on hand during the week.
• Ask your partner or someone else to help with bottle feedings at night so you can sleep for more than a couple of hours in one stretch.

A note from Cleveland Clinic

If you think you have low milk supply, it can be hard to direct your thoughts anywhere else. And if you mention your concerns to others, you might get bombarded with advice — and even well-meaning friends showing up at your door with raspberry leaf tea. But sometimes the more you hear, “I swear this works!”, the more you feel overwhelmed and unsure of what to do.

While there are plenty of times when your loved ones’ advice will come in handy, in this case, trying to treat low milk supply on your own might not do much to help. And it might even have unwanted side effects. Instead of trying to handle things on your own, reach out to a lactation support provider. They’ll tailor advice and treatment to your needs and help you find a way forward.