Low milk supply: is it common?

by Bryony Firth-Bernard |

‘Is my baby getting enough milk?’ is a common question when you first start breastfeeding, especially if you’re worried that you have a low milk supply.

The reality is you’re probably producing plenty of milk and that this is a mind over matter situation, however, if you’re concerned your newborn isn’t getting enough milk speak to your midwife or doctor.

We answer all your questions surrounding low milk supply during your breastfeeding journey.

What are the signs of having low milk supply?

Lyndsey Hookway, author and International Board Certified Lactation Consultant for The Maternity Collective, says there are two main signs that signal low milk supply - inadequate weight gain and nappy output. However, some people confuse behaviours such as frequent feeding, cluster feeding and your newborn only wanting to be held in your arms as an indicator of low milk supply.

“One of the reasons for the confusion is that with true low supply and inadequate milk intake, babies will be fussy, cry more, want to feed a lot, or cry at the breast,” says Lyndsey. “But, this will also be accompanied by low or no weight gain, and scanty nappies.

“Most of the time, it isn't actually a true low supply, but a perception of low supply. The truth is that babies are sometimes fussy or feed frequently because these are all just normal infant behaviours that may be related to development, having a fussy day, or needing more comfort.”

You may try and offer your baby a bottle of expressed milk or formula and if they drink from this and not your breast, you may think this is a sign that you have low milk supply, but Lyndsey says this not a good way to assess milk supply.

“Babies have a strong suck reflex, and when given a bottle, they will drink milk that comes out of the teat reflexively. So the fact that a baby drinks an offered bottle is not an indication of low supply.

“One of the problems of giving a bottle due to a perceived low supply is that milk production works on a demand and supply basis. So, if a baby is given a large drink of formula, they will demand less milk from the breast. This turns a perceived low milk supply into an actual low milk supply - it's a self-fulfilling prophecy.

"If you're worried about your supply, look at the objective facts. If your baby is under 4-6 weeks old, they will do at least two poops per day, and at least six wet nappies. After this age, the frequency of pooping slows down because there is a small shift in the type of protein in breastmilk, which slows down digestion. You can also get your baby weighed by your health visitor or midwife if you're worried. The bottom line - you can't always judge milk supply based on behaviour."

What are the causes of low milk supply?

The most common cause of low milk supply is infrequent or ineffective milk removal.

“Milk only continues to be made if it is removed from the breast, if a baby is not feeding well, or feeding often enough, this can lead to a low supply,” says Lyndsey.

“If your baby is unwell, or sleepy, your milk supply can be protected by expressing milk by hand, or with a pump. If your baby is not well enough attached/latched, this will not only cause nipple pain, but also usually means that babies aren't going to get all the milk they need either. Nipple soreness is a clue that you need urgent breastfeeding support from your midwife, peer supporter, health visitor, breastfeeding counsellor or IBCLC. Keep asking until you get the help you need to sort your problem out.”

Other causes of low milk supply can include:

  • Hormonal problems, such as polycystic ovary syndrome (PCOS) and hypothyroidism

  • Diabetes

  • Breast reduction surgery or chest surgery

“If you have a condition that you are worried might affect your chances to be able to produce a full milk supply, arrange a one to one session with an experienced lactation supporter who can listen to your history and concerns and help you make a plan,” says Lyndsey.

Can low milk supply be reversed?

This really depends on what the underlying cause of your low milk supply is, as the treatment will need to be targeted to the cause of the problem.

“For example, if you have hypothyroidism, getting this properly diagnosed and then treated with medication will resolve the milk supply problem for most people,” says Lyndsey. “If the cause was a shallow latch, then being shown and supported to achieve a deep latch might fix the problem. If your baby can't feed effectively due to tongue-tie, then having their tongue-tie treated may help to manage the issues.

“There is a greater chance of building the supply back up again the earlier the problem is identified, and the less supplement is being given. Having said that, many IBCLCs and experienced lactation supporters have supported parents with very low supply, or even no supply to work back up to a full milk supply.

"Success depends on many factors that will be individual to each woman, baby and family.”

Why is my breast milk supply lower in the evening?

This is completely normal as breast milk volumes and composition constantly varies throughout the day and is usually higher in the morning. It does not mean you’ve ‘run out of milk’.

“Your baby actually gives your breast tissue messages via their saliva, telling the breast about environmental exposures,” says Lyndsey. “The breast then responds by manufacturing specific antibodies. Some people find their baby feeds more frequently in the evening, but again, this isn't because you have run out of milk, or there's nothing left, or that you have low supply - it's just normal behaviour.

“In fact, the milk supply stays remarkably constant between 1-6 months. Many people are surprised by this, because formula-fed babies drink more milk as they get bigger and older. This isn't true of breastfed babies, because the composition is always changing to meet their changing needs. The great news here is that if your baby has grown normally in the first month, and is putting on weight as expected, they're already on the maximum amount of milk that they will be drinking until they start solids at 6 months. So there is literally no need to worry about low supply - you've done the hard part of establishing a full milk supply by the time your baby is just 4 weeks old.

"Any change in behaviour, such as fussing, or frequent feeding, therefore, usually has very little to do with milk supply and much more to do with your baby's emotional state, and development.”

How will I know if my baby is getting enough milk?

There’s only a couple of ways to be certain your baby is getting enough milk and Lyndsey says this is weight gain and nappy output.

“While your baby will grow out of their clothes, or may need a bigger nappy, these changes can be subtle, and occur over a longer time. Nappies and weight are the changes that you can measure quickly.

“If your baby is less than 4-6 weeks old, they will do at least six wet nappies, and at least two dirty nappies every day. After about 4-6 weeks, it is not unusual for a breastfed baby to only poop every few days. This is ok, as long as there are no other concerns.

“You may also find that a baby who is gaining weight normally is content after most feeds (not all - it's common and normal for babies to be cranky after some feeds!), and they will also be alert in between feeds, and want to interact with you. But these are all highly subjective and variable signs, and should not be used to judge whether a baby is getting enough milk.”

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