If your doctor or lactation consultant determines that you do have a low milk supply, certain factors—which are usually quite fixable—may be at play. For instance, breastfeeding may have gotten off to a slow start if you weren't able to nurse early on or didn't nurse frequently enough. "Most of what I see is simply a case of a mom and her baby not getting into sync initially, but that doesn't mean they can't get on track and improve how much milk the baby is receiving," explains Burger. "The most common reason for low supply is that a woman just doesn't know how often to breastfeed and for how long—management issues that can be taught."
Sometimes, a baby may not draw milk efficiently from the breast because of an underlying problem—a poor latch, for example. If this is the case, you need to address the issue as soon as possible. "In that very vulnerable stage where mom's got milk but the baby isn't effective at taking it out, over time, the milk simply goes away," explains Cindi Swisher, R.N., I.B.C.L.C., owner of Alliance Breastfeeding Center in Colorado Springs, Colo. "On the other hand, if the baby is taking some milk out, then some milk will be made. The baby drives the system."
While some experts maintain that if a woman doesn't eat or drink enough it can contribute to a low supply, others believe this doesn't play such an important role. "You do need to eat and drink, but that's mainly for you, not the baby," notes Swisher.
Once your doctor or lactation consultant has ruled out the previous issues, she will focus on you. Although rare, there are some hormonal and physiological conditions that can affect a woman's milk supply. These include:
Thyroid imbalance Experts say that women with an underactive thyroid can have problems with low milk supply, while an overactive thyroid can cause problems with milk delivery.
Excessive blood loss during delivery This can delay your milk's coming in.
Placental fragments When you deliver the placenta, the progesterone level in your blood drops, allowing your body to begin making milk. If a fragment of placenta remains in your uterus after you give birth, your milk production may be affected.
Breast surgeries Any surgery to the breast—whether an augmentation, reduction or diagnostic procedure, such as a biopsy—can potentially injure the breast tissue, which, in turn, can affect milk supply. If you've had any breast surgery, seek the advice of a lactation consultant before your baby is born.
PCOS and infertility Some women with polycystic ovary syndrome (PCOS), as well as those who've had fertility treatments, may experience problems producing milk. However, Lisa Marasco, I.B.C.L.C., R.L.C., owner of Expressly Yours Lactation Services in Santa Maria, Calif., and a lactation consultant with the Santa Barbara County Public Health Department Nutrition Services, emphasizes that many women with PCOS have no problems breastfeeding. While little research has been done in this area, there appears to be a link between the hormonal imbalances that underlie both PCOS and certain types of infertility and the hormones needed for milk production.
Insufficient mammary tissue Women who lack adequate mammary tissue—a condition that can occur in breasts of any size or shape—have milk ducts and glands that have not developed well enough to function properly.