Low Milk Supply Overview
There are many possible causes of low milk supply, and in many cases, it's a combination of factors that contribute to less than ideal output.
Nothing is more discouraging than following the typically suggested advice of "pump more often or for longer," and troubleshooting flange fit, to find yourself with little to no discernible increase.'
Here's something most people won't tell you-
For many with true low supply, solely adding more frequent breast stimulation will NOT create a robust milk production.
Here's another thing a vast majority of lactation professionals refuse to be candid about -
Not all parents will ever make enough to meet their baby's daily intake needs, and we don't yet know all the reasons why this happens.
The great news is that even though we don't have ALL the necessary information to help every parent completely overcome their supply issues, research has identified a wide range of causes.
Having a clear understanding of the causes of low supply means that most parents can get answers as to why their milk volume is low and eventually see some improvement in daily output when they work with a highly skilled & experienced International Board Certified Lactation Consultant (IBCLC).
What is low supply?
Low supply refers to a current state of being unable to meet the full daily needs of your baby.
Sometimes parents worry that they are not making enough despite their baby’s gaining appropriately on breastfeeding alone, so they may replace direct breastfeeding with bottle feeding. In many of these cases, a parent’s ABILITY to provide for their baby’s need is fine and is not indicative of a low supply.
There is a wide range of what constitutes low supply and the term “low supply” does little to provide context to the range of experiences.
For example, the parent of a baby who requires 30 ounces of breast milk a day may be considered to have low supply if they make 25 ounces. However, that same parent would not have low supply if they had a baby that only required 25 ounces a day.
Some parents, however, make a volume that would be universally considered low supply, such as making roughly half of their baby’s intake needs (15 ounces when baby needs 30 ounces).
The term “micro-producer”, which is not a real term used exception of by parents who self-identify as such , refers to daily milk production volumes of a couple ounces per day.
It’s important to note that even though there is a wide range of experiences, low supply is low supply and it can be devastating regardless of how close one is to meeting their baby’s full intake needs.
What causes low supply?
A disruption in milk supply can occur at many stages in a lactating parent's life, to include the period before the onset of breast development.
There are three significant stages in which problems can develop; before breast development, during breast development, or after breast development is complete.
Additionally, there are three main categories under which problems stem from; underlying health issues (preglandular), reduced glandular tissue (glandular), and not enough breast stimulation/milk removal (postglandular).
Many parents struggling with supply have causative factors that occured at various stages and stem from various categories.
Confusing I know!
In an attempt to make finding possible causes easier for parents, I created this LOW SUPPLY CHECKLIST, which will shed light on factors that may be contributing to your low supply and help you identify what you might need to adjust to improve your milk supply.
Each topic below will link to a more in-depth explanation and will be updated regularly. Please check back frequently if your suspected causes are not currently covered.
Underlying health issues that contribute to low supply (Preglandular)
Endocrine disorder: Diabetes Type 1 or 2
Hormonal disruption
Low or absent prolactin production: Damage to the pituitary glands such as Sheehan's syndrome, adrenal insufficiency (Addison's disease), Hypothalamus dysfunction due to disordered eating such as Anorexia
Thyroid issues: Hyperthyroid, hypothyroid, Hashimoto's disease, Grave’s disease
Insulin resistance
Polycystic Ovarian Syndrome
Pineal Gland Dysfunction
Oxytocin Insufficiency
Nerve damage to the spinal cord
Delayed Puberty
Hyperreactio luteinalis: Theca lutein ovarian cysts
Fertility Issues
Pregnancy
Placental Insufficiency
Reduced Glandular Tissue/ Breast procedures (glandular)
Breast reduction surgery
Breast procedures/augmentation
Insufficient glandular tissue
Breast hypoplasia
Absent breast tissue
Inadequate breast stimulation/milk removal (post glandular)
Poor milk transfer due to oral dysfunction or medical issue in baby
Excessive pacifier usage
Supplemental feeds in replace of breastfeeding or pumping
Breastfeeding/pumping less than 8 x a day
Scheduled or timed feedings
Extended separation
Improperly sized flanges if pumping, especially exclusively
How do I increase my supply?
Low supply rarely occurs in isolation, which is why overcoming low supply can be a challenge without professional help.
It may be reassuring to know that most parents can obtain some increase, whether or not they eventually reach a full supply.
The best way to increase your supply will be specific to your individual set of circumstances, however many of the same steps often take place.
Typical steps in increasing milk production include
Taking a full health history starting from childhood to identify any symptoms or clues that may be relevant to known or undiagnosed health issues
Reviewing past lab work and requesting new lab work to assess the current health
Analyzing current breastfeeding practices and making necessary changes
Identifying and resolving "baby centered" causes such as tongue-tie, oral dysfunction, underlying medical issues, etc.
Developing strategies that promote breast stimulation
Discussing possible medications or herbs to take that might help improve your milk supply or identifying herbs and medicines you're currently taking that hinder your milk production
How long does it take to see improvements in milk supply?
Increasing milk supply, unfortunately, is not always a quick process.
Identifying the issue can take time and may be dependent on the willingness of yours and your baby's health care team to perceive your low supply as a pressing issue.
Many parents report providers seeing no need to assess supply issues for babies who are gaining well and primarily formula or donor milk-fed despite the parent's desire to breastfeed.
Assuming everyone is on board, there is still no set timeline. In cases of low supply after Mastitis, for example, improvements may be noticeable days after mastitis resolves. If you're taking a medication that temporarily causes a decrease in milk supply, or if the underlying cause of your low milk production is of a post glandular nature, changes in milk supply occur fairly quickly.
Preglandular and glandular issues take the longest to resolve, and reaching a full production may take months, if at all.
Having realistic expectations about the process can help you stay encouraged during the process.
What resources are available to learn more about low milk supply?
As mentioned above, there's still a lot we don't know about low supply. Thankfully, over the past few years, more people have started to share their knowledge and experiences.
Facebook has multiple communities worth joining but the one I recommend most is this one: IGT & Low Supply Support Group
The following books are jam-packed with relevant and helpful information regarding low supply. Every book may not be a perfect fit for each individual, but they all contain useful information in helping you understand low milk production.
When breastfeeding doesn't go as planned it can be heartbreaking and traumatic. The following books may be helpful as your process the loss of the breastfeeding relationship you envisioned.