Got Enough Milk?

How to tell if you're one of the few women with a low breast-milk supply--and what you can do about it.


It's one of the most common questions among new breastfeeding moms: Is my baby getting enough milk? Not experiencing some uncertainty is difficult, since you can't actually see how much milk your body is producing, and, therefore, how much your newborn is getting. The good news? Most women do produce enough milk to nurse their babies successfully; it's estimated that only approximately 5 percent to 15 percent—or even less—of all breastfeeding mothers truly have a low milk supply.

Still, how can you know for sure that you're making enough? Read on for some surefire signs that your baby is thriving—as well as issues that can interfere with your milk supply and tips on what to do if you think there may be a problem.

Is Your Baby Getting Enough?

When you're breastfeeding, there's only one way to tell for certain that all is going well—look at the results:

He's swallowing When your baby first latches onto your breast, he will suck rapidly, which helps release the milk. Then he should progress into a deep, slow pulling motion as he swallows; you may not only feel this motion, but also see his jaw drop down and hear him as he does this. If your baby isn't getting enough milk, you may see him sucking rapidly but not swallowing slowly and rhythmically; he may also take long pauses while nursing or repeatedly fall asleep at your breast.

He's satisfied If your baby seems content and well fed after feeding sessions, all is likely going well. But a baby who appears overly lethargic—or, conversely, who is constantly screaming for food—may not be getting enough milk. "If a baby has many feedings that last longer than an hour or wants to nurse very often, with less than an hour between feedings, there may be a problem," says Susan Burger, M.H.S., Ph.D., I.B.C.L.C., a lactation consultant with New York-based Lactescence in the City.

He fills his diapers Your baby's diaper output is a reliable indicator that all is well. He should have at least six wet diapers by day six and four stools by day four. Stool color is also important: While the first bowel movements are typically black and sticky, they should be green by day three or four and yellow by day four or five. The consistency of the stools should also be seedy or watery.

He's gaining weight It's normal for your baby's weight to fluctuate a bit in the first days or week of life. A newborn may lose about 5 percent to 7 percent of weight by his third or fourth day and be perfectly fine, but if he has a weight loss of 10 percent or more, there could be a problem. By day 10, your baby should rebound to his birth weight.

If you suspect you aren't making enough milk or your baby isn't gaining weight properly, call your doctor and a lactation consultant right away.

Causes Of Low Production

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.

Making More Milk

If you are one of the few women who experience low milk supply, don't give up. With qualified help, you can generally boost your production—if not to 100 percent, then at least to a level that's beneficial for you and your baby. "Most women who are making some milk can be helped to make more milk," says Marasco. Depending on your circumstances, you might need to supplement with formula, she adds. But any amount of breast milk you give your baby is a tremendous benefit.

Every woman's situation is unique, and a skilled lactation consultant can work with you to develop a plan tailored to your particular needs. Typically, however, the first goal is to start expressing your milk via a breast pump, as frequent pumping helps build a woman's milk supply. (The pump can "fool" the breast into acting as if there's a hungry baby who needs more milk. What's more, a well-drained breast actually makes milk faster, while a breast that's less full makes milk more slowly.)

A lactation consultant will also come up with a personalized pumping plan for you and your baby. For example, notes Burger, "If a baby is very inefficient at feeding, it's usually better to practice nursing for brief, enjoyable periods rather than exhausting yourself with long, frustrating breastfeeding sessions. These shorter sessions allow a mom and baby to bond and learn new skills while enabling the mom to have enough time to pump."

Many lactation consultants also recommend galactagogues, herbs and prescription medications that can help increase milk production. (See "Milk Boosters" below) Before using any of these remedies, however, be sure to consult with an expert to make sure you receive a customized protocol and the proper dosage.

Of course, there's one more hurdle to overcome for women who experience low milk supply: the emotional one. It can be disappointing to give up the dream of breastfeeding exclusively if it turns out you need to supplement. But it's important to make peace with that—for you and your baby.

"You've got to change your attitude from mourning what you can't do to celebrating the amazing value of what you are able to give," says Diana West, I.B.C.L.C., a lactation consultant in private practice in Long Valley, N.J., and author of Defining Your Own Success: Breastfeeding After Breast Reduction Surgery (La Leche League International). "There's tremendous value in even just a drop of milk each day."

Milk Boosters The following herbs and medications, called galactagogues, have been found to be helpful for increasing milk production:

Blessed thistle This herb is widely considered beneficial for boosting milk supply, although some experts question its effectiveness.

Domperidone This prescription medication has an excellent reputation and is widely used in Canada and other countries. However, it's not commercially available in the United States;it can only be purchased from outside the country or from a pharmacy that will compound it.

Fennel This herb promotes milkletdown and increases supply.

Fenugreek This herbal favorite is available in tincture and tea forms. Some experts question the effectiveness of the tea form, however.

Goat's rue This herb is reputed to stimulate mammary gland growth, particularly helpful for women who've had breast surgery.

Metoclopramide This prescription medication has been linked to depression, a particular concern for women in the postpartum period. What's more, it can only be taken for three weeks; when it's discontinued, milk production returns to its previous level. For these reasons, many lactation experts hesitate to recommend it.

Shatavari This root shows a lot of potential. It has been used for centuries in India and China but only recently here.