What causes low milk production?

Sometimes a delay in the time when your milk comes in turns into an ongoing problem with low milk production. You may have been producing enough milk. But then milk production slowly or suddenly decreases. It's normal to worry about your milk production. But know that there are a few normal things that happen when breastfeeding.

First, about a few weeks to a month after birth, a nursing parent's breasts will feel softer and seem smaller than before. This is normal and doesn't mean your milk supply is too low for your baby's needs. Also, your baby may sometimes increase how often they nurse in order to increase your milk supply. This is called cluster feeding. It's normal and doesn't mean there's a problem with your supply. True milk supply problems can often cause a baby to show signs of hunger, fussiness, or poor weight gain. 

Some of the conditions linked to a delay in your milk coming in may also have an ongoing effect on milk production, including:

• Conditions from a baby's delivery, such as having a caesarean section, premature birth, stress during birth, and certain medicines

• Excessive bleeding (severe postpartum hemorrhage)

• Some pieces of the placenta stay in the nursing parent's body (retained placental fragments)

• Thyroid conditions, polycystic ovarian syndrome, diabetes, or obesity

• Past breast surgery that cut some of the nerves, milk-making tissue, or milk ducts

• Not enough glandular breast tissue

Other things that can also lead you to have low milk production include:

• Smoking or drinking

• Some medicines and herbs

• Hormonal forms of birth control. This is especially true for birth control that has estrogen. But some nursing parents have a drop in milk production even after taking progestin-only birth control during the first 4 to 8 weeks after delivery.

• Nursing or pumping less often

• Getting sick

• Feeling stressed

• Getting pregnant again

If low milk production seems to be a problem, but your baby seems to be sucking effectively, talk with your healthcare provider or certified lactation consultant (IBCLC). They may advise you to:

• Make sure your baby is latched on and both of you are positioned comfortably

• Offer both breasts at each feeding. Have your baby stay at the first breast as long as they are still sucking and swallowing. Offer the second breast when the baby slows down or stops feeding at the first breast.

• Breast feed often. Increase the number of times you breastfeed or pump to 10 to 12 times in 24 hours.

• Increase the amount of skin-to-skin contact you have with your baby. Take off your shirt and baby's shirt and place your baby on your chest with a sheet or shirt over both of you.

• Review your health history with your healthcare provider or lactation consultant. This may help to find out if a health condition, treatment, or medicine is interfering with milk production.

You also may want to:

• Pump your breasts for a few minutes after breastfeeding.

• Think about renting a hospital-grade pump if you think you'll need to pump for a long time. 

• Ask your provider or IBCLC about taking a galactagogue. This is a medicine or herb that increases breastmilk production.

• Don't feed your baby formula or cereal in addition to breastmilk, especially in the first 6 months of life. The extra food may make your baby lose interest in your breastmilk. Less frequent breastfeeding can decrease your milk supply.

Think positive. Low milk production often can be reversed. But any amount of milk you produce is valuable for your baby.