From mid-pregnancy a woman’s breasts produce a concentrated, antibody-rich milk called colostrum. Quantities are small to suit a baby’s tiny stomach. A few days after birth, the breasts begin to produce large amounts of “mature” milk. Most mothers experience engorgement at this point, but if the baby has nursed well from birth it may be less noticeable.
How Supply and Demand Works During Breastfeeding
Breastfeeding is a matter of supply and demand. The more the baby eats, the more milk will be produced. You can compare it to hosting a crowd of guests. If you have too much lasagna left over, you will make a smaller amount next time. But if your guests finish everything and look around for more, you’ll cook more for their next visit.
Lactating breasts work in the same way. A protein in the milk called Feedback Inhibitor of Lactation (FIL) regulates the milk. When a large quantity of milk leads to FIL accumulating in the breasts, production slows. Shortened or scheduled feedings, a baby who is not transferring enough milk, and supplementing with formula can all lead to lower supply. The “leftover” milk stays in the breast and the increase in FIL limits production.
If the baby is nursing well and drawing milk efficiently from the breasts, the body will make enough milk. Frequent nursing (or pumping) from the “empty” breast increases supply, to let the body know that a hungry baby needs more food—just like guests who scrape the bottom of the serving bowl. Unlike the bowl, though, breasts are never truly empty, and the baby is getting milk whenever he nurses.
With milk supply, the bottom line is not how much the mother has but how much the baby is getting. A mother’s breasts can be dripping with milk but none gets into the baby because of a sucking problem. If the problem isn’t fixed the mother’s milk supply will gradually drop off. And sometimes a mother mistakenly believes she doesn’t have enough because her breasts feel soft or the baby nurses frequently. Yet milk is being produced constantly, quantities are subtly readjusting, and breasts may feel fuller or emptier depending on the time of day.
Tips for Making Enough Milk for Your Baby
The most common reason for “not enough milk” is a baby who does not nurse often enough or long enough, or does not nurse effectively.
Tips for keeping the milk flowing:
Nurse immediately after birth and keep baby nearby for feedings during the hospital stay (rooming in).
Avoid formula supplements, which interfere with milk supply and can impact the baby’s health.
Let the baby determine when to begin and end a feeding, watching the baby and not the clock. Babies become more flexible as they grow, but you can continue to trust them to let you know when they are hungry. A normal time frame for a newborn feeding is ten to thirty minutes on each side.
Offer both breasts at each feeding in the early weeks. Supply for each breast is determined separately.
Let baby finish the first side—he is done when he lets go, sucks infrequently, or falls asleep. Cutting baby off in the middle of a feed is like asking him to skip dessert, since milk from the end of the feed is higher in calories. And we don’t put babies on diets. Don’t worry if he doesn’t want the other breast every time.
Nurse at least 8-12 times a day in the early weeks, including at night.
Consult an expert if breastfeeding hurts or the baby is not interested in nursing. Pain may be related to poor latch that can affect supply.
If there is a question about whether the baby is getting enough milk, have the baby seen by a medical professional.
Avoid pacifiers, as they can mask signs of hunger.
Babies should return to birth weight by one to two weeks and continue to gain an average of 170 grams a week for three to four months, but for some babies lower weight gain is normal.
Other signs of plentiful milk are 6-8 cloth or 5-6 disposable wet diapers and 2-3 soft bowel movements a day, and an active, alert baby who seems satisfied after feedings (although many newborns prefer being held all the time).
While mothers need to care for themselves and listen to their bodies, insufficient milk is not caused by fatigue (what mother isn’t tired?), a poor diet, or not drinking enough except in extreme cases.
Medical Reasons for Lack of Milk
Some medical reasons for poor milk supply or low weight gain include:
Over- or underactive thyroid. Women on thyroid medication prior to birth may need their dosage adjusted.
A history of breast surgery, or underdeveloped breasts that did not expand during pregnancy and after birth.
PCOS, although this is controversial. It may also cause over-supply.
Medications including the combination birth-control pill.
Retained placenta.
Over-supply, or too much milk. Ironically, mismanagement of over-supply can lead to poor weight gain in some babies.
Hormonal issues.
Health issues in the baby, such as low muscle tone or tongue-tie. The baby’s tongue needs to reach several centimeters behind the nipple to draw out milk effectively.
Many mothers worry unnecessarily about their milk supply. But as long as baby is nursing on cue and growing and developing normally, fussiness, frequent nursing or night-waking is probably not connected to lack of milk.
Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice.
