The best way to establish a healthy supply of breast milk is to start early, breastfeed frequently and make sure your baby is latching on correctly.

Some women have low supply, particularly during the early weeks of breastfeeding. This is the main reason some mothers start weaning or move to formula feeding. However, it's rare for a mother to produce less milk than her baby needs.

What are some reasons for a low supply?

There are many different reasons why some women have low supply including:

• delays in breastfeeding after delivery or separations of mother and baby such as if the baby needs to be admitted to the special care nursery or if the mother is unwell after delivery
• poor attachment to the breast, which can be caused by flat or inverted nipples, a tongue or lip tie, a sleepy baby because of jaundice, or a difficult or prolonged delivery
• if the mother is unwell due to problems like mastitis, retained placental tissue or large blood loss after the baby is born
• scheduled or timed feeding, rather than feeding baby on demand
• taking an oral contraceptive pill that contains oestrogen
• formula feeding as well as breastfeeding
• skipping breast feeds and offering a supplement formula feed but not expressing breast milk at that time to ensure that supply continues to meet baby's demand
• long-term use of dummies or nipple shields
• smoking

Breast milk supply can be low if the woman has medical problems such as polycystic ovarian syndrome, hypothyroidism, diabetes and pre-diabetes, or takes some blood pressure medications and cold and flu preparations, or has taken the contraceptive pill or has been infertile.

In some women, breast or nipple surgery makes breastfeeding difficult. In a few women, the breasts did not change during puberty and early pregnancy in a way that makes breastfeeding easier.

Typical baby behaviour

Some health professionals and mothers have an unrealistic expectation of how the baby will behave and might be concerned that what is normal baby behaviour could indicate low supply.

If your baby is having a good number of wet nappies each day, low supply is not a likely cause.

Some issues with breastfeeding include:

• wanting to be fed often — breast milk is digested in about 1.5 to 2 hours, whereas formula takes longer to digest
• being more fussy in the evening; you might produce less milk at this time and your baby will request fewer feeds or will 'cluster feed' (feed frequently at certain times of the day)
• liking to suck even if they have had a good breastfeed — sucking comforts them
• wanting lots of cuddles and skin to skin contact — this makes them feel secure and ensures that baby's needs are being met
• wanting to feed more frequently, which will happen when a baby is having a growth spurt — increased feeding will increase your supply
• reduced amount of sucking time at the breast — this often happens after 2 or 3 months as your baby becomes more efficient at the breast

What is normal for mum?

Although breastfeeding is different for every woman, the following do not mean that you have a low supply:

• your breasts suddenly seem softer — this is normal as your milk supply adjusts to your baby's needs
• your breasts do not leak milk, stop leaking or only leak a little
• you don’t feel a 'let-down' when milk pushes out of the breast
• you are unable to pump very much with an electric pump — remember the baby is much more efficient and will always get more than a pump
• how much you pump decreases over time

How do I know that baby is getting enough milk?

Always look at the whole picture to ensure that baby's growth and development is with normal limits. The baby is getting enough milk if they:

• go through 6 to 8 wet nappies in a 24-hour period including at least a few dirty nappies
• wake for feeds by themselves and feed vigorously at the breast
• have 8 to 12 breastfeeds in 24 hours
• pass a soft yellow stool
• settle and sleep fairly well after most feeds
• is back to birth weight in about 2 weeks
• gain on average 150g or more every week for the first 3 months

If your supply is low

Milk supply is considered to be low if you are not producing enough milk to meet your baby's normal growth and development needs.

Low milk supply is usually a temporary situation that will improve with appropriate breastfeeding support and management. Making more milk is all about supply and demand — the more milk is removed from the breast, the more milk is made. The less milk removed, the less made.

How to increase your supply

The following may help increase your breastmilk supply:

• ensure that baby is attaching well and removing milk efficiently from the breast
• be prepared to feed your baby more frequently — breastfeed on demand every 2-3 hours at least 8 times in 24 hours
• switch your baby from one breast to the other; offer each breast twice
• ensure your breasts are emptied well at each feed or pumping session; you can express after breastfeeds to make sure
• do not go longer than 5 hours without milk removal — your baby at the breast sucking is the most effective way to do this, but otherwise use a hand or electric pump
• when your baby is feeding, compress your breast to aid milk flow as this will also encourage more effective sucking
• make sure you are drinking a lot of water, eating a healthy balanced diet and not missing any meals
• also ensure you are resting as much as possible between feeds

Other options that can help with a low supply include:

• a supplemental nursing system or 'supply line'
• herbal and pharmacological remedies that are known to increase milk supply (galactogogues)

Some cultures use food or herbs to increase breast milk supply but many of these have not been formally studied. Domperidone is a prescription medicine that can increase the hormone prolactin, which can help stimulate breast milk production. Your doctor may discuss if this medicine is right for you. The main way to increase breast milk supply is through breastfeeding or expressing milk more than you currently do.

If you think you have low milk supply, talk to your doctor, lactation consultant, breastfeeding counsellor or child health nurse. You can call Pregnancy Birth and Baby on 1800 882 436 for advice and support.