Breastfeeding can be stressful for new moms, especially if you’re worried about producing enough breast milk to keep baby happy and healthy. Unlike bottle-feeding, where you can tell exactly how much your baby is drinking, breastfeeding is “blind”; your breasts aren’t see-through, so you can’t know how much milk you have and how much your baby is taking.
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That may lead some new moms to wonder: Am I making enough breast milk? Is my newborn getting enough to eat, or could I have a low milk supply? Here’s some help decoding the situation.
What causes low milk supply?
As early as month 3 of pregnancy, your breasts start to prepare for breastfeeding, developing the glandular tissue needed to produce milk and increasing the number of milk ducts in your breasts. By the end of the second trimester, your (amazing) body is capable of breastfeeding. But the changes don’t stop there.
Once your baby is born, a hormone called prolactin cues milk production, and another hormone, oxytocin, causes tiny muscle cells in the breasts to contract, pushing milk out. As your baby nurses, your prolactin levels increase and more milk is produced, in a continuing cycle of supply and demand: Baby drains milk from your breasts (demand), breasts respond by producing more milk (supply).
It’s not always clear what causes low milk supply. While breast milk production is influenced by the cycle of supply and demand, researchers still have a long way to go in understanding all the factors that may influence or hinder breast milk production. That said, ensuring adequate demand is a good place to start. Common “demand” culprits include:
- Supplementing. If you’ve added formula to the menu, your baby may take less milk from your breasts, which in turn could cause your breasts to produce less milk.
- Infrequent feedings. Stretching out the time between meals (to four hours, for instance) may be easier on a new mom, but it can mean your breasts won’t be stimulated often enough to produce an adequate amount of milk. If your baby is a good sleeper, for example, it’s good for getting enough shut-eye, but not so good for keeping your supply up.
- Short feedings. If you cut nursing sessions short (five minutes on each breast, for example), this not only won’t help your baby get nutritious hindmilk, but your breasts won’t be sufficiently drained. And without sufficient emptying, they won’t be stimulated to produce more.
- Pacifiers. For some (but not all) babies, time spent sucking on a pacifier means less time or inclination for suckling on the breast. Less suckling can mean less milk production.
How do you know if your milk supply is low?
Signs your baby is getting enough milk
Even though it’s difficult to tell how much milk is coming out of your breasts unless you’re pumping, there are a number of signs that your baby is fully satiated.
- Your baby’s pooping. If you’re changing at least three to four diapers filled with large, mustard-colored poops daily by the time he’s 5 to 7 days old, your baby’s getting enough milk. Somewhere around 2 to 3 months old, expect that rate to drop to one poop a day, or even one every other day — that still means he’s getting enough milk.
- Your baby’s peeing. If your baby’s diaper is wet each time you change it (at least six times a day in the early months), then you’ve got plenty of milk.
- Your baby’s pee is colorless. He’s well-hydrated (and you’ve got a good milk supply) if his pee is light yellow or colorless.
- Your baby is gulping and swallowing during feedings. That’s a sign that breast milk is going down the hatch. If he’s a silent eater but is still gaining weight, there’s nothing to worry about either.
- Your baby’s content after feedings. You know how you feel after a huge meal: content, and sometimes ready for a nap! If your baby is crying and fussing a lot after a full nursing, it could mean he’s still hungry. Keep in mind, however, that he could be fussing for reasons unrelated to hunger, like a dirty diaper, gas or colic. In general, if your baby’s active, alert and healthy overall, you’ve got nothing to worry about in the milk-making department.
- Your baby’s gaining weight. There’s no surer sign of good milk supply than a baby who’s putting on the pounds, or at least the ounces. A weight gain of 4 to 7 ounces on average per week indicates he’s getting enough milk. (Though keep in mind that many infants lose weight right after birth and may stay below their birth weight for the first seven to 10 days.)
Signs your baby may not be getting enough milk
The clearest indicator of a problem is lack of weight gain. While most infants lose weight immediately after birth, full-term babies should lose no more than 7 percent of their birth weight in the first few days after birth, according to the American Academy of Pediatrics (AAP). (However, a slightly greater weight loss can be normal, too — but it does warrant an earlier first visit to the pediatrician.)
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By the time they’re 10 days old or so, babies should return to their birth weight and start gaining 4 to 7 ounces on average per week. If your baby isn’t gaining enough or is losing weight, that’s an indication he’s not getting enough milk.
It’s worth noting that there are several unreliable ways to determine if your milk supply is adequate, including the way your breasts feel (full or empty), the letdown sensation (or lack thereof), the frequency and/or length of feedings, the fact that your baby may take a full bottle after a nursing session, the absence of leaking milk or the amount of breast milk you’re able to pump.
Research has also shown that temporary weight loss in newborn infants immediately after birth might lead moms to think they’re not producing enough milk and start supplementing right away, leading to a potential issue with breast milk supply and demand.
How to increase your milk supply
Talk to your health care provider, pediatrician or lactation specialist as soon as possible if you are concerned that you’re not producing enough milk, or if your baby’s weight gain is slower than expected. While not all cases of low milk supply are caused exclusively by demand issues, that may be the case for you.
Increasing your milk supply if you’re breastfeeding
There are a few steps you can take to help boost your milk supply if you’re breastfeeding:
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- Make sure your baby’s breastfeeding position and latch are correct (see our guide to breastfeeding positions and tips for getting a good latch).
- Allow your baby to drain the breast at each feeding (don’t look at the clock; let him decide when the meal is over).
- Feed your baby on demand (every two to three hours in the first months). Don’t stick to a rigid schedule with long intervals between feedings.
- If your baby is a sleepy feeder who drifts off at the breast, switch back and forth between breasts during feedings to make sure each one gets adequate suckling time.
- You already know that never putting baby down to sleep on his stomach is one of the sleep safety basics for babies, but if you are a stomach sleeper yourself, you may need to adjust your positioning in bed. Putting too much weight on your chest at night can slow milk production.
- Avoid supplementing with formula unless your doctor deems it necessary for your baby to gain weight, and limit pacifier use.
- Consider pumping sessions between feedings, if you’re not too exhausted, which can help increase milk production. Reward yourself by doing something fun while pumping instead of just watching the drips: Listen to a podcast, watch your favorite show or read a juicy novel to help the time fly by.
- Try “power pumping,” which boosts your milk supply by mimicking cluster feeding. Pump off and on for about an hour a day (for example, pump for 20 minutes, then rest for 10, then pump for 10, then rest for 10 and so on). It may take up to a week to see results.
- Get rest and eat well. An exhausted, underfed mom is not an efficient milk machine (see our guide to eating well while breastfeeding).
- Stay well-hydrated.
Increasing your milk supply if you’re exclusively pumping
There are a few reasons women choose to pump exclusively in order to feed their babies, including work schedules, latching problems or a baby who’s been hospitalized for an extended period. But some women also prefer exclusive pumping, which is also called “EP” or “EPing” — and some of the same supply tips as above also apply here.
EP mamas should strive to eat well, get enough sleep and drink plenty of water throughout the day to ensure good hydration. And EPers likely need a hands-free double pump in order to maximize output every time. Here are some more tips for the pumping-only set:
- Be patient. Building up your supply can take time, but it helps if you can keep an optimistic outlook and focus your energy on positive thoughts while you do it.
- Make it fun. Pumping fatigue is real. Some moms have tried Sudoku, crossword puzzles and other distractions during their pumping sessions.
- See your goal. On the other hand, distractions don’t work for everyone. Instead, quiet meditation or just closing your eyes to avoid outside noise might be just the ticket.
- Add visuals. Gazing at pictures of your baby or watching videos of him on your phone might help your body respond to the pump and release more milk.
- Use your nose. Having something with your baby’s smell still on it, like a onesie or receiving blanket, may also help with milk ejection.
- Find support. Bonding with other EP moms may not add to your daily ounce output, but having a group of liked-minded pals for tips and support is invaluable.
- Take time of you. Caring for a baby is a big job, but you still need a break to recharge. Find a moment to take a bath, go to a yoga class, read a good book or just nap.
Low milk supply is a common concern among moms new to breastfeeding and pumping — so if you’re worried, at least you’re not alone. Talk to your practitioner or a lactation specialist to get the support you need. In the meantime, know that you are a great mom because of how much care and love you give your baby — and love can’t be measured in ounces of milk.