Insufficient Milk Supply

This is the most common cause underlying a decision to wean the baby or supplement the breastfeeding, and yet the problem actually does not exist...

Lactation starts already in the gestational week 16. The labor and baby's suckling are sufficient signals for the lactation to start properly. Later, the lactation "machine" is self-propelled, as the suckling baby stimulates the pituitary gland to produce relevant hormones, and they control milk production and flow, mobilizing the infant to suck. And suckling, in turn, sends the signal to the brain to release prolactin responsible for milk production - and so on. In brief - baby's suckling is enough for the milk to be produced - always fresh, always on time and without any limits. Of course, there are situations when something interferes in efficient lactation functioning. Usually, however, these problems can be solved.


First, it should be explained where the suspicions about insufficient milk supply come from. Here is a list of things you should not worry about:

  1. Sometimes, people around you are to blame. Unfortunately, untrue stories about breasts being too small for the mother to breastfeed or that the mother must drink cow milk to have milk, are still circulating ... Mothers who had the C-section are still being convinced that only a natural childbirth initiates lactation. Do not believe in any of these. Size of the breasts is practically of no importance; if you doubt this, read what breastfeeding mums write on forums. Similarly, there is no link between drinking milk and producing milk (does a cow drink any milk to produce its own?). You can successfully breastfeed after the C-section, you just need to latch the baby on to the breast as soon as possible after the birth, so he stimulates the lactation (after all, everything is ready since the gestational week 16!).  

  2. Milk flowing from the breast soon after the birth is called "colostrum", the first milk. It is yellow and rather dripping than flowing, and this can worry new mums. Do not worry, everything is right! Colostrum always looks like this, its supply seems to be low, but it will be enough to satisfy the newborn, whose needs on his first day are small.

  3. Sometimes breastfeeding mums worry that their breasts (in the first weeks visibly full of milk) become soft in time. Does it mean they are empty? No! Soft breasts are usually a good sign, indicating that lactation is stable and functions correctly. After a few weeks of breastfeeding the breasts adapt to the baby's rhythm and needs, so they do not store milk "on stock", but produce it to cover current demand. Starting the milk feast at the breast works like placing an order at a fast-food restaurant – the order is handled as soon as the demand is notified. The principle of the supply strictly following the demand applies. Thus, the soft breasts do not mean there is no milk in them - it will come when the baby starts to suck.

  4. Some breastfeeding mums, trying to check if there is any milk in their breasts, try to squeeze it out, and when nothing (or only a small amount) flows out, they worry their milk is drying up. In fact, the baby's suckling technique does not resemble manual squeezing. Do not worry, the fact that you squeeze just a small amount of milk does not mean its lack. The correctly suckling baby will get from your breast as much milk as he needs.

  5. Lactation starts to work correctly on the second or third day after the birth. Until that time, you may think you have very little milk in your breasts, but it is really enough to cover your baby's needs. Latch the baby on to the breast steadily, as often as possible, and do not try to limit the time he wants to spend at your breast.  If you let your baby eat as much and as often as he wants, he will certainly get your lactation going.

  6. Newborns suck very often and long. Surprised and tired mums can reach wrong conclusions, that the baby cannot satisfy his hunger, and so he demands more and more... However, this situation is completely normal, or even planed by the nature. The newborn must suck a lot to get milk - and the intensive feeding sets lactation at a correct level. Moreover, suckling, particularly in such young babies, also has other functions - ensures mum's closeness, gives sense of security and support in this new, strange world, as well as provides everything that is needed for healthy development.

Sometimes the breasts really produce less milk. In such case, you need to react as soon as possible, find the reason and eliminate it. Otherwise, the milk amount will continue to go down. Here is a list of things you should focus on about:

  1. Giving the baby additional drinks and/or supplementing breastfeeding
    When you give the baby something else besides breast milk, you reduce the breastfeeding frequency. The baby notifies his "demand" for mother's milk less often, so its production in breasts is reduced. Remember that the "demand-supply" principle applies here: the less you breastfeed, the less milk you have.

  2. Incorrect grasping and suckling of the breast
    The baby who grasps the breast too shallowly (there is only the nipple in his mouth), cannot eat his fill, because he does not massage the areola with his tongue. In consequence, the breast is not sufficiently emptied or stimulated. This results in painful milk stasis and reduced milk production.

  3. Flat or inverted nipples
    When your nipples are flat or inverted, the baby can (but does not have to) have problems with correct grasping of the breast, See the tips in the chapter on Flat nipples.

  4. Giving up night feeding
    Newborns and younger infants should be fed also in the night, so the prolactin level does not drop. It does not mean you have to wake the baby every 2–3 hours. But a night break in feeding should not exceed 5–6 hours. Usually, such night feeding is done when you are half asleep anyway, so when the baby is full, you can sleep on.

  5. Feeding at set times
    You should breastfeed on demand, and when the baby request the breast rarely or not at all you must remember about regularly latching him on to the breast (at least 8 times per 24 hours). Otherwise, the breasts will not receive a message about the actual milk demand. They will adjust their production to less frequent feedings and in consequence the baby will get less milk.   

  6. Smoking
    Nicotine can reduce milk production, and it gets into milk, affecting the baby.

  7. Taking certain medicines
    Sometimes, the mum is very ill and must take medicines that inhibit lactation. If this is the case with you, talk to your doctor about the treatment effects on breastfeeding.

  8. Mother's stress and weariness
    When the mum is tired or nervous, milk will flow slower. This is caused by an inhibiting effect of stress and weariness on production of oxytocin controlling correct milk flow. In such a situation, milk is present but does not flow out of the breast, the hungry baby is angry and the mum suspects milk is drying up (see also Milk stasis).

  9. Placenta remains in the uterus
    Placenta fragments left in the uterus block the production of prolactin, a hormone necessary for milk production. However, this happens extremely rarely, and only during the puerperium! If you want to ensure this is not your case, talk to your gynecologist.

What you can do

Many lactation advisers say that "milk is produced in your head". And this is true. What you think and feel is important during breastfeeding. When you are sure you want to breastfeed, you will overcome the obstacles. Therefore, start with positive thinking.

  • When something worries you, do not immediately assume the worst. Remain calm and check if the baby grasps and sucks the breast correctly, and you breastfeed in a position comfortable for both of you. Tips are provided in the chapters: Incorrect way of breast grasping and suckling by the baby, How to latch the baby on correctly and Breastfeeding positions.

  • Feed "on demand", so the baby eats as much as he needs and stimulates lactation according to his needs.

  • When you have a little sleepyhead at home, make sure he eats at least 8 times per 24 hours (it is important both for your baby and for lactation to work correctly).

  • In the first 6 months of the baby's life, do not give him anything additional to eat or drink (see the chapter Baby prefers a bottle).

  • Do not give up night feedings (feed at least once in the night). When getting up is tiring, consider sleeping in one bed with your baby. Many mothers make that decision, and really find the night feedings less trying.

  • Look after yourself! Eat well, try to rest, and find some ways to relax. Do not hesitate to ask for help when you feel weary and down.

  • When the actual problem is not lack of milk, but blocked outflow (and the rest and quiet environment do not help much), you can ask your doctor for oxytocin.  In such situations, liquid oxytocin formulation (as for injections) is used, with which you wet gauze swabs and put them into your nostrils about 5 minutes before feeding/extracting; this facilitates spontaneous letdown reflex. It should not be used more than just a few times, and always after consulting your doctor or a lactation consultant.

  • Drink herbal teas stimulating lactation.

  • When the baby sucks poorly, and despite your best efforts cannot learn to grasp the breast correctly, extract milk manually or with a breast pump to maintain lactation. Try to give the extracted milk (or formula, when necessary) in a way not interfering with natural suckling rhythm.

  • When you have returned to work and want the baby to drink your milk why you are away (and to maintain lactation), you have to extract milk also at work (breaks should not exceed four hours).

  • All medicines taken during lactation must be consulted with a doctor. When you are prescribed new medicines, always remind the doctor you are breastfeeding.  

Is breastfeeding still possible?

Absolutely! Only frequent and sufficiently long suckling of the breast by the baby stimulates and maintains lactation. In special cases, when the baby cannot suck the breast, but you still want to feed him with your milk, extract milk regularly and give it to your baby.