Help, my milk supply is low! Or is it?

By Tanya Lieberman, IBCLC

Ever wish your breasts had little ounce markings? If so, you’re not alone. One of the more confusing things about breastfeeding is determining how much milk you’re making. You can’t see how much is going into your baby, so how can you tell if your milk supply is enough for your baby?

On this page we share the best ways to determine if your milk supply is in fact low, and describe the many things that can make you think that your supply is low when it actually isn’t.

 

Below are some normal experiences that can trick you into believing that your supply is low:

“My baby wants to eat all the time.” It’s normal for babies to eat frequently, generally in the range of 8 to 12 times in 24 hours for many months. This means many hours of feeding a day, and it may feel constant at times. It’s also normal for babies to “cluster feed” at times during the day. If your baby is feeding significantly outside of the 8-12 times range, contact a lactation consultant or other breastfeeding support person.

“My breasts feel softer than they used to.” Toward the end of the first month of breastfeeding many women notice that their breasts have decreased from the size they were when their mature milk came in. This is normal, and does not indicate anything about milk supply.

“I don’t feel that ‘let down’ sensation.” Some women have a “let down” sensation when they make milk, and some don’t. It doesn’t seem to have any bearing on the amount of milk a mother makes, so don’t worry if you don’t feel anything.

“My baby suddenly wants to eat all the time.” Babies go through growth spurts. They do this in order to increase your milk supply to meet an increased need for calories. To do this, they go on a feeding rampage for a few days – eating more often than usual and sometimes acting unsatisfied and fussy after feedings. During a growth spurt it’s common to question your supply. After a growth spurt you’ll find that you have more milk than ever!

“I can’t pump very much.” Pumping output is usually not a good measure of milk supply. Why? Because your body doesn’t always make milk for the pump (it has to be tricked into believing that the pump is your baby!) and when it does the pump doesn’t remove milk as well as your baby does. So don’t gauge your milk supply based on your pumping output. You almost always have more than you pump.

“My baby is fussy when she nurses.” There are many causes of fussiness at the breast. And while hunger is one of them, your baby may be fussy because of gas, pooping, a flow that is too fast or too slow, or a host of other reasons. If you believe that your baby is fussy because he or she isn’t getting enough milk, or if the fussiness is causing you distress, consult a lactation consultant or other breastfeeding support person.

“My baby is suddenly waking up at night a lot.” Night waking can be due to hunger, but it can also be due to teething or “reverse cycling,” (when babies eat less during the day and more at night, often due to a change in routine like a return to work, or distracted behavior during the day).

 

Here’s how to tell if your milk supply is actually low:

1) Your baby’s weight. The best measure of whether your baby is getting enough milk is his or her weight gain.

If you are concerned about your milk supply, have your baby weighed and re-weighed using a baby scale. Scales will always be a little different, so be sure to compare only weights taken on the same scale. Except in critical situations, weight checks every few days or weekly is generally sufficient.

In the first three months of life babies gain an average of 1 ounce per day. That slows to at least approximately a half an ounce per day between 4 and 6 months. 

Occasionally your health care provider may suggest a “test weight,” in which your baby is weighed on a sensitive scale before and after a feeding (with the same clothes on) to determine how much milk the baby received at that feeding. This can give you a snapshot of a feeding, but be cautious in drawing conclusions from the data. The amount of milk babies take in at different feedings can vary widely, so bear this in mind if you do a test weight of your baby.

 

2) Diaper output. You can get a sense of how much your baby is taking in by what comes out. After the first few days, babies generally have at least three poops that are bigger than a quarter in size each day. This frequency may decline after several weeks. And your baby should have five very wet diapers per day. It can be difficult to measure output in very absorbent diapers, which is why your baby’s weight is considered the ‘bottom line.’

 

3) Swallowing. You may also take comfort in how much your baby is swallowing when nursing. This is not a definitive measure of your supply and should be confirmed with information about your baby’s growth, but a period of rapid swallowing (one swallow per one or two sucks) during a feeding shows you that your baby is getting milk. To check out your baby’s swallowing, listen for a ‘cah’ sound or a squeak or gulp, and look for a longer and slower movement of the jaw, often with a brief pause at the widest point. 

 

What to do if your milk supply is indeed low:

If your milk supply is low, be sure to get help from a lactation consultant (IBCLC) or other qualified breastfeeding support person. There are many steps you can take to build your milk supply, and these support people will be able to guide you through that process. You can find a lactation consultant by going to www.ilca.org.

 

Resources:

The Breastfeeding Mother’s Guide to Making More Milk. Diana West and Lisa Marasco, McGraw Hill, 2009.

La Leche League, International: www.llli.org

Kellymom: www.kellymom.com

Find a lactation consultant: www.ilca.org

 

Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms in hospital and pediatric settings.  She writes and produces podcasts for several breastfeeding websites, including MotherwearMotherlove Herbal Company, and the Best for Babes Foundation.  Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish-speaking moms.  Prior to becoming a lactation consultant she was senior education policy staff to the California legislature and Governor, and served as a UN civilian peacekeeper.  Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

This resource page was made possible by Motherlove Herbal Company.

 

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Comments

  1. My daughter would latch onto my wife but she didn’t seem to be getting enough milk. At first, she wasn’t gaining alot of weight and was at the low percentiles for size. The doc told her to pump, which she has been doing for the past year. It’s worked out well, and she’s right where she needs to be now.

    We also had a funny experience with a few lactation consultants here in Nashville. From a guy’s point of view, it was an interesting meeting, having someone try to fit a pump to your wife.

    Not sure if you allow links on your comments, but on my site, daddybydefault.com, I’m giving away a tommee tippee electric breast pump, for moms who want to pump while they feed, or in addition to, like my wife did. Your readers can enter here: http://daddybydefault.com/tommee-tippee-electric-breast-pump-and-baby-bottle-giveaway/

  2. antiLorna says:

    I second daddy by default with this. My ds didnt get back to bw until week 6, he is tt and had serious latch issues. On thing i worried about most was my supply decreasing because of his poor latch. I got to the point i felt obliged to top up at week 4 because of weight concerns. So i started pumping which i found had several benefits. It took a long time to establish a good pumping supply but it was very confidence boosting to see all that milk, you cant physical see the milk when you are feeding, so to see a bottle (you can of course use cups, droppers or spoons) of ebm being drained i found that very encouraging. I also felt i was doing something positive to avoid supply issues by pumping (some people find hand expressing more efficient), again this was also very encouraging. It also meant i had a small bank which meant i could take time to myself while someone else fed him, even if it was just to shower and sort out my pump, it gave me a break from constantly feeding! More demand – more supply, I highly recommend pumping and upping feed frequency. Good luck! Lx

  3. Shay says:

    See i know the stuff above…read it…experienced it…but as a mom of now my second “low weight” babies (not a birth but the rest of the time) it is really frustrating. I am WOHM who has to pump…and the 2-4 oz i pump while i’m away from her doesn’t give me enough to feed her only bm while she’s away from me. So frustrating!! :(

  4. brandi says:

    still not sure what went on with our son… he is about to become one year old, and is nursing fine, growing well, but is thin; he probably always will be, both my husband and i are. anyway, he was not gaining weight, and he even began to lose some. we spent time with a great lactation consultant who helped us to get the latch correct, and i took and drank every kind of herb said to promote lactation. we tried again. he was still losing weight. our pediatrician checked the output of his diaper to find it was the correct color, showing no signs of malnourishment, but he was still losing weight. we had to supplement with formula, which broke my heart, but great, supportive friends and the MOST wonderful and loving husband kept me positive that he was still getting my milk, and not to worry. for three months, i nursed, then pumped while my husband gave our son the pumped milk from the previous session, and we then gave him formula. round the clock feedings, almost no time for sleeping or eating, but he finally started gaining weight. he still is a lot smaller than his baby friends of the same age, but he is healthy, happy, and strong, and still nursing! mamas, don’t give up! the milk is there if you keep at it, and believe!

  5. Karly says:

    This is a great article! I, however, am one of those mommies who didn’t have enough milk. Our boy was born at 8 lbs and in 1 weeks time was down to 6lbs 13oz. That’s a lot. He had also stopped pooping. Nothin’ goin’ in, nothin’ comin’ out. My milk never really “came in”. I did and took everything anyone could think of to increase milk supply!! I took to pumping temporarily and mixing the 1 pitiful oz of breast milk with 1 oz of formula. I was heartbroken to have to resort to some formula, but the child was starving! I visited La Leche consultants and learned all I could… the result? I have PCOS… and the hormonal imbalances/abnormalities associated with it seriously impared the ability to produce milk. Herbs, potions & wishing were not going to fix a biological problem. It took 6 weeks of serious stress & heartache for a friend to research this and tell me. No lactation consultant nor La Leche Leaguer would have had a clue!! The La Leche people pretty much dismissed the idea that someone might actually NOT produce enough milk to feed a child. I am a bit bitter about that. I got up to enough production that he only needed 2 oz of formula a day, which was quite an acomplishment! But my supply couldn’t grow with the demand as he grew. Regardless, I continued to nurse him for 6 months and added formula to fill in the gaps. I never gave up! ANY breast milk is better than NO breast milk! Take heart, mommies with medical issues… I’ve already been there.

    • Tundra says:

      Don’t forget that since the dawn of time, women have practiced communal breastfeeding, with lactating women breastfeeding infants whose mothers were sick or dead or unable to produce milk. I have personally met individuals who remember being breastfed well into their toddler years by their aunts or grandmothers. Unfortunately, our society is so focused on individualism that the well-meaning lactation consultants expect every woman to produce the same results. That would be like expecting every woman to grow the same size breasts.

  6. Recently gave birth and been breastfeeding. This was definitely one of my concerns and posts like this helped me a lot during my little one’s 6th week (growth spurt). For worried moms, it also helps to weigh in your baby. I had to wait for our doctor’s visits before I can be reassured that he’s getting enough because he’s actually gaining good weight.

    Cheers!

  7. Laura says:

    Like Carly I also have PCOS and couldn’t produce enough milk for my daughter. She started off at 6 lbs 3 oz dropping to 4lbs something when we ended up in hospital due to her weight loss. The doctors thought it was a problem with her liver or her kidneys. It was a week before they realised it was due to my low milk supply. I told several professionals that I had PCOS but was told every time that this wasn’t linked to breastfeeding. There doesn’t seem to be enough information available to the professionals about this! I am currently 35 weeks pregnant with my second child and this time I am under a breastfeedinf consultant – I will be given medication (domperidone) to help produce more milk… so fingers crossed this time I can do a bit more breastfeeding and a bit less worrying!

  8. Wolf_Mommy says:

    This is such basic information. Every Mama should be given this information when they give birth…or ideally *before* they give birth. It would save a lot of heart ache. Great article. Thank you.

  9. Wolf_Mommy says:

    This is such basic information. Every Mama should be given this information when they give birth…or ideally *before* they give birth. It would save a lot of heart ache. Great article. Thank you.

  10. Wolf_Mommy says:

    This article prompted me to write an even longer response over at Nursinginpublic.com It’s such a good article–but I’m just concerned that this is not basic physiological information that all women have prior to having babies. I understand why it’s not, but what I don’t understand is how we fix this problem. Thanks Leaky B@@b for helping to inform and educate women–now how do we put this back into our cultural knowledge?

    Check out my article: http://www.nursinginpublic.com/breastfeeding-advocacy/how-do-we-get-women-off-to-a-good-start-with-breastfeeding-help-my-milk-supply-is-low-or-is-it/

  11. Jen the ex wren says:

    My son was induced at 36 weeks due to gestational hypertension. He was low bithweigh (2.2kgs) He had a rocky start in special care with supspected NEC, jaundace and no passing meconium. He was too poorly to breastfeed to begin with so I pumped every few hour but it took almost a week for me to produce ANY milk. I was put on prescription motillium and herbs to help the supply. He did not tolerate formula so had to go onto IV until my milk came through. I struggled with breastfeeding as he was often too lethargic and I could only do one BF to 2 nasal tube feeds. I could never pump more than about 10mls at a time – no where near the 60 I needed, so we were stuck in special care until he was fully on BFs (2 weeks). Once home I still BF upto 15 times a day but he was very very slow to put on weight. (and I was never able to pump more than 20 or so mls despite trying) We started giving him a lactose free formula top-up at around 2 months (just one bottle before bed and one during the night so I didn’t have to get up every 2 hours to feed overnight- my husband could give hime the formula). I started him on solids at 4 months with doctors advice to help him put on weight, as he ahd now dropped under the 1 percentile. He is now just over a year old, I still BF 3-4 times a day and will continue to as long as I can or he wants it, even though I knew from about 4 months old that my breast milk wasn’t enought to sustain him, I still bonded with him in this way and he still got the goodness from it. He is now 8kgs (still tiny but still putting on weight). My advice is keep going. Even if your supply is definately low BF can be a beautiful thing. I struggled with giving him formula, and for ages felt like a failure trying to produce milk, but once I’d gotten over this I could enjoy BF fully!

  12. Holli says:

    My daughter is 8 months and I have noticed the last 2 nights that my milk supply is so low for her nightime before bed feed, she is trieing to get a let down forever, gets fussy, pushed me away, I pump to try and bring let down but even that doesn’t bring it on! I’m having to be careful at what times I nurse her, for example she goes to bed at 10pm so I can’t feed her at 8pm and at 10pm because there isn’t enough. I have noticed in general my supply has diminished a bit, she is on solids but I still nurse her every 4 hours or so for extra nutrients. Anyone experience this? I want to nurse as long as I can and it’s worrieing me..

  13. Holli says:

    My daughter is 8 months and I have noticed the last 2 nights that my milk supply is so low for her nightime before bed feed, she is trieing to get a let down forever, gets fussy, pushed me away, I pump to try and bring let down but even that doesn’t bring it on! I’m having to be careful at what times I nurse her, for example she goes to bed at 10pm so I can’t feed her at 8pm and at 10pm because there isn’t enough. I have noticed in general my supply has diminished a bit, she is on solids but I still nurse her every 4 hours or so for extra nutrients. Anyone experience this? I want to nurse as long as I can and it’s worrieing me..

  14. Miranda says:

    I had supply issues with both my kids. My son had so many allergies that they think I just didn’t get enough calories to produce adequate milk, and he went to a prescription formula at 3 months. With my daughter, I was determined. Then she was born with a very rare genetic disorder and the doctors said she would always be small. Our first pediatrician was very concerned with her weight gain and we did pre- and post-feeding weight checks and he sent me to a lactation consultant that had me start taking more milk plus and she still wasn’t gaining weight the way her doctors wanted. Then we moved and her new pediatrician has been much more supportive of breastfeeding, though she still gets weighed more than normal. She is 15 months old and weighs about 15.5 lbs, so she’s very small. I think that part of how kids grow runs in families. My mom says that my brother and I weren’t on the growth charts until we were 3 or 4, and my 3.5 year old son is only 29 lbs. I know that I worried more about my supply with my son, but I think you just have a little more experience the second time around and trust your instincts a little more. My daughter still nurses 5-6 times a day, and I quit taking the supplements about a month ago. I think that she is mostly nursing for comfort these days. One thing that I’ve never really been good at is telling when she’s swallowing. She’ll nurse for 10-15 minutes and I’ll only hear her swallowing for 30-45 seconds.

  15. Maggi says:

    I have 1 month old twins and learned at their appointment today that they aren’t gaining weight and my boy has actually lost 4 oz in the past two weeks.
    I’ve been taking fenugreek for 3 weeks and my boy nurses pretty much constantly.
    Their pedi has told me to start giving them formula, 3 oz, then offer the breast after they’ve finished the formula but that just seems backwards to. I think I’ll give them the breast first, 20 min each, then offer formula.