Low Milk Supply: How to Tell and How to Build It Up

First, is supply actually low?

Many parents worry about supply when it is fine. These are normal and don't mean low milk: - Soft breasts after the first 6-12 weeks, or no longer leaking. - Cluster feeding in the evening or during a growth spurt (see the growth spurts guide). - Short feeds once a baby gets efficient, or pumping only 0.5-2 oz (15-60 mL) in a session.

What does tell you the baby is getting enough: - Back to birth weight by about 10-14 days, then gaining roughly 5-7 oz (150-200 g) a week in the first months. - At least 6 heavy wet diapers a day after day 5, and yellow stools in the early weeks. - Swallowing you can hear, and a baby who seems content after most feeds.

Common reasons supply runs low

• Milk not removed often or well enough: a shallow latch, a sleepy or preterm baby, tongue tie, scheduled feeds, long night stretches early on, or bottles replacing feeds without pumping.
• Health factors in the nursing parent: heavy blood loss at birth, retained placenta, thyroid problems, PCOS, diabetes, past breast surgery, or breasts with less glandular tissue.
• Medicines and habits: estrogen-containing birth control, some decongestants, and smoking can all lower supply.

Building supply, step by step

1. Get a feed watched. An IBCLC can check latch, transfer and weight, sometimes with a weighed feed.
2. Feed more often: at least 8-12 times in 24 hours, including at night.
3. Use breast compressions: squeeze gently when sucking slows, to keep milk flowing.
4. Switch sides two or three times per feed when the baby gets drowsy.
5. Add milk removal: hand express or pump for 10-15 minutes after some feeds. Hands-on pumping (massage and compression while pumping) adds output.
6. Try a power pumping hour once a day for a few days: pump 20 minutes, rest 10, pump 10, rest 10, pump 10.
7. Eat and drink to thirst. Extra water doesn't raise supply.

Supplements, herbs and cookies

The ABM finds the evidence for herbs, teas, lactation foods and prescription galactagogues weak. They never replace more frequent milk removal. Talk to a clinician before taking anything, including herbal products. One medicine sometimes used abroad is not approved for this use in the US because of heart-rhythm concerns.

When you need to supplement

A fed baby comes first. Use your own expressed milk first, then pasteurized donor milk or formula, and protect supply by pumping when the baby gets a supplement. A supplementer at the breast lets the baby nurse while getting extra. See the combination feeding guide and the donor milk guide.

Feelings matter too

Low supply can bring grief and guilt. Any amount of breast milk counts, and combination feeding is a full, valid plan, including for adoptive and non-birthing parents inducing lactation.

When to check in

• See an IBCLC within a few days if feeds hurt, the baby seems hungry after most feeds, or you plan to boost supply.
• Ask the pediatrician for a weight check if wet diapers drop, the baby isn't back to birth weight by 2 weeks, or seems too sleepy to feed.
• Mention thyroid symptoms, heavy postpartum bleeding or past breast surgery to your own clinician.