What causes low milk production?

Occasionally, a delay in the time when milk "comes in" turns into an ongoing problem with low milk production. Sometimes, a mother has been producing sufficient amounts of milk, and then milk production slowly, or quite suddenly, decreases. Before worrying too much about your milk production, know that there are a few normal things that happen when breastfeeding. First, about a few weeks to a month after birth, a nursing mother's breasts will feel softer and seem smaller than before. This is normal and does not mean the milk supply is too low for baby's needs. Also, every so often a baby will increase how often he or she nurses in order to increase the mother's milk supply. This is called "cluster feeding." It is also normal and does not indicate a problem with a mother's supply. True milk supply problems may usually cause a baby to show signs of hunger, fussiness, or poor weight gain. 

Some of the conditions associated with a delay in milk "coming in' may also have an ongoing effect on milk production, including:

  • Conditions from delivery of a baby, such as Caesarean delivery, premature birth, stress during birth, and certain medicines

  • Severe postpartum hemorrhage (excessive bleeding)

  • Retained placental fragments

  • Thyroid conditions, diabetes, or obesity

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

Other factors can also lead to insufficient milk production. Maternal smoking and alcohol consumption has been shown to result in less milk. Some medicines and herbal preparations can also decrease milk production. Hormonal forms of birth control, especially any containing estrogen, have been found to have a big impact on milk production. However, some mothers report a drop in milk production even after receiving or taking a progestin-only contraceptive during the first 4 to 8 weeks after delivery (postpartum). Milk production may also decrease if you nurse or pump less often than you did before, get sick, are stressed, or become pregnant again.

If insufficient milk production seems to be a problem, yet the baby seems to be sucking effectively, your healthcare provider or certified lactation consultant (IBCLC) may recommend the following:

  • Increase the number of breastfeedings or breast pumpings 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 discover if a health condition, treatment, or medicine is interfering with milk production.

You also may want to:

  • Pump your breasts for several minutes after breastfeeding.

  • Consider renting a hospital-grade pump if you think you'll need to pump for a prolonged period of time. 

  • Ask your healthcare provider or a certified lactation consultant (IBCLC) about taking a galactogogue. This is a medicine or an herbal preparation found to have a positive effect on milk production.

Think positive. Although insufficient milk production usually can be reversed, any amount of milk you produce is valuable for your baby.