How do I know if my milk supply is actually low?

Many parents worry about low milk supply when their supply is actually normal. Signs your baby is getting enough milk include steady weight gain, regular wet and dirty diapers, and contentment after most feeds. Pump output alone is not a reliable indicator of milk supply.

What are the most common causes of low milk supply?

Low milk supply can be caused by ineffective latch, infrequent milk removal, hormonal conditions such as PCOS or thyroid disorders, retained placental fragments, prior breast surgery, or inadequate pumping techniques. Stress and sleep deprivation may also contribute.

How can I increase my milk supply while breastfeeding?

To increase milk supply while breastfeeding, nurse frequently (8–12 times per day), ensure a deep and effective latch, offer both breasts at each feeding, use breast compressions, and avoid unnecessary supplementation unless medically indicated.

How can I increase milk supply when pumping?

To increase milk supply when pumping, pump every 2–3 hours including overnight, use correctly sized flanges, double pump, add power pumping sessions, and optimize pump settings for comfort and effective milk removal.

Does drinking more water increase milk supply?

Staying hydrated supports overall health, but drinking excessive amounts of water does not increase milk supply. Milk production depends primarily on frequent and effective milk removal.

Can certain foods or supplements increase milk supply?

Some parents find galactagogues such as oats or herbal supplements helpful, but evidence is mixed. Supplements should not replace frequent milk removal and should be used under guidance from a lactation professional or healthcare provider.

How long does it take to increase milk supply?

Milk supply may begin to increase within 3–7 days after increasing breastfeeding or pumping frequency, though full improvement can take several weeks depending on the underlying cause.

Is it possible to increase milk supply after the first few weeks postpartum?

Yes. Milk supply can often be increased weeks or months postpartum by improving milk removal, addressing medical factors, and following a consistent breastfeeding or pumping plan.

When should I see a lactation consultant for low milk supply?

You should see a lactation consultant if your baby is not gaining weight well, feeding is painful, milk supply is not improving despite frequent milk removal, or if you have medical risk factors that affect lactation.

Understanding Low Milk Supply: Causes, Evidence-Based Strategies & When to Seek Help

Jennifer Gerard, APRN, FNP, IBCLC
Jan 16
4 min read

Updated: Jan 24

Written by Jennifer Gerard, APRN, FNP, IBCLC | Medically Reviewed

Low milk supply can be a concern for many breastfeeding or pumping parents. While perceived low supply is common, true physiological low milk production is less frequent and often related to specific causes that can be addressed. This article explains potential factors, evidence-based approaches to support supply, and when professional evaluation is recommended.

What Is Low Milk Supply?

Low milk supply refers to a situation in which a parent’s milk production may not sufficiently meet an infant’s nutritional needs. Signs that may suggest low supply — when taken together rather than in isolation — include:

Steady or poor weight gain that falls below expected growth patterns
Fewer wet or soiled diapers than typical guidelines
Persistent dissatisfaction after feeds or lethargy in the infant
Breast changes such as minimal fullness beyond early postpartum

It is important to note that pump output alone is not a reliable indicator of true milk supply, because babies are generally more effective at extracting milk than breast pumps.

Common Causes of Low Milk Supply

Milk production is influenced by the principle of supply and demand — the more frequently and effectively milk is removed, the stronger the physiological signal for ongoing production. Factors that can interrupt this process include:

1. Infrequent or Ineffective Milk Removal

Breastfeeding or pumping less frequently than every 2-3 hours can lead to reduced production. Ineffective latch or poor milk transfer also reduce stimulation.

2. Anatomical or Functional Challenges

Issues such as untreated oral restrictions (e.g., tongue tie), flat or inverted nipples, or breast hypoplasia (insufficient glandular tissue) may contribute to reduced milk transfer.

3. Medical Conditions

Hormonal conditions such as polycystic ovary syndrome (PCOS), hypothyroidism, retained placenta, or postpartum hemorrhage affecting prolactin levels may influence supply.

4. Supplementation Practices

Early or frequent use of formula or pacifiers can reduce breastfeeding demand, potentially diminishing physiological supply signals.

5. Maternal Stress and Fatigue

High stress or significant sleep deprivation can affect feeding patterns and may reduce oxytocin release during milk ejection.

Evidence-Based Strategies to Support Milk Supply

The following strategies are grounded in lactation physiology and clinical experience. Individual responses may vary, and a tailored plan is often needed.

Increase Effective Milk Removal

Aim to remove milk frequently (8–12 times per 24 hours) through nursing or pumping.
Offer both breasts at each feeding to provide additional stimulation.
Consider breast compression during feeds to help transfer more milk.

Assess and Improve Latch

A deep, effective latch enhances milk transfer and stimulation. A lactation specialist such as an IBCLC can observe feedings and recommend positioning adjustments.

Optimize Pumping Technique (if Pumping)

Use a double electric pump if feasible.
Pump every 2–3 hours, including at least one nighttime session if possible.
Ensure correct flange size to maximize efficiency and comfort.

Nutrition, Hydration & Self-Care

Maintain a balanced diet with adequate calories for lactation.
Stay hydrated, but remember that hydration supports overall health rather than directly increasing milk production.
Rest when possible and enlist help to reduce stressors.

Galactagogues Under Medical Guidance

Some foods or prescribed medications may be considered in specific cases, but evidence is mixed and these should not replace frequent and effective milk removal. Always discuss with a healthcare provider or lactation consultant before starting supplements.

When to Seek Professional Support

Consider a consultation with a qualified lactation professional or healthcare provider if:

Your baby’s weight gain is slower than expected
You see signs of dehydration (e.g., low urine output)
Feeding is consistently painful or stressful
Supply concerns persist despite frequent, effective removal
There are underlying medical or hormonal conditions affecting lactation

A comprehensive evaluation can help identify unique factors and create a personalized care plan.

Summary

Understanding low milk supply involves recognizing common contributing factors and applying evidence-based strategies centered on frequent and effective milk removal, appropriate latch, and targeted support. When concerns persist, a specialized evaluation can help tailor care and improve outcomes.

This content is for educational purposes and does not replace individualized medical advice, diagnosis, or treatment. For personalized care, consult a qualified healthcare provider or lactation specialist. This article is supported by evidence-based clinical guidelines and medical literature. Additional references are available on our Resources page.

📌Evidence-Based Resources

The following resources provide additional evidence-based guidance on the medical evaluation and management of low milk supply.

Clinical Protocol #9: Use of Galactagogues (Academy of Breastfeeding Medicine)
Clinical Protocol #3: Supplementary Feedings (Academy of Breastfeeding Medicine)
Physiology of Lactation (NIH / NCBI)
Breastfeeding challenges (MedlinePlus)
Low Milk Supply (Cleveland Clinic)

These references are provided for educational purposes and reflect current evidence-based medical guidance. They do not replace individualized medical care.

Frequently Asked Questions

Is pumping output a good measure of supply? No. Pumps are less efficient than babies at milk removal, so low pump volumes do not always reflect low physiological supply.
Can milk supply be improved later postpartum? Yes. Even weeks or months after birth, supply can often be increased by improving removal and addressing underlying factors.
Do herbal supplements work? Some parents find herb-based galactagogues helpful, but evidence is limited and inconsistent. These should be used under professional guidance.
When should I see a lactation consultant for low milk supply?
You should seek professional help if your baby is not gaining weight adequately, feeds are painful, milk supply is not improving despite frequent feeding or pumping, or if you have a medical history that may affect lactation. An IBCLC can provide individualized assessment and support.

🩺 Need help evaluating supply issues or need pumping tips for low supply? I offer holistic lactation consults and Breastfeeding Medicine virtual visits that combine evidence-based care with functional testing when needed.

Jennifer Gerard, APRN, FNP, IBCLC, PMH-C

www.advancedlactationcare.com

Jennifer Gerard, FNP, IBCLC is a Family Nurse Practitioner and International Board Certified Lactation Consultant specializing in breastfeeding medicine and complex lactation care through virtual consultations.