How do my breasts make breastmilk?

Milk is produced in clusters of sacs within the glands of your breasts. The milk is then carried through ducts to your nipple where the milk flows out of tiny openings – this is called the let-down reflex.

There are many factors that influence how much breastmilk you produce, including:

• how often you breastfeed
• how well your baby removes milk from your breasts
• your general health and wellbeing

What can I do to establish healthy breastmilk supply?

The best way to establish a healthy supply of breastmilk is to start breastfeeding soon after your baby is born, breastfeed often and make sure your baby is latching on correctly. Usually, your body makes enough milk to meet your baby’s needs.

What are some causes of a low milk supply?

There are many reasons why you may have low milk supply.

Some possible medical causes for a low milk supply include:

• delays in breastfeeding after the birth of your baby — for example, if you and your baby were separated, because your baby needed to be admitted to the special care nursery or if you were unwell after the birth
• poor attachment to the breast — if you have flat or inverted nipples, your baby has a tongue or lip tie, is sleepy because of jaundice, or due to a difficult or prolonged birth
• if you are unwell — due to problems such as mastitis, retained placental tissue or large blood loss after your baby is born
• medical problems such as polycystic ovarian syndrome (PCOS), hypothyroidism, diabetes
• certain medicines
• previous breast or nipple surgery

Other factors may include:

• feeding your baby at scheduled feeding times, rather than feeding your baby on demand (when they want to)
• taking an oral contraceptive pill that contains oestrogen
• combining formula feeding with breastfeeding
• skipping breastfeeds, without expressing milk when your baby would otherwise breastfeed
• use dummies or nipple shields long term
• smoking

When is milk supply considered low?

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

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

What is normal behaviour for a breastfeeding baby?

Some health professionals and parents have an unrealistic expectation of how the baby will behave.

Knowing what is ‘normal’ can help you identify baby behaviours that may suggest your milk supply is low.

It is normal for breastfeeding babies to:

• want to be fed often — breastmilk is digested in about 1 1/2 to 2 hours, while formula generally takes longer to digest
• be more demanding in the evening — you might produce less milk at this time and your baby will request fewer feeds or will 'cluster feed', meaning that your baby feeds more often at certain times of the day
• like to suck even after finishing breastfeeding — sucking may comfort your baby
• want lots of cuddles and skin-to-skin contact — this makes them feel secure and ensures that your baby's needs are being met
• want to feed more often at times — this can happen when a baby is having a growth spurt
• reduce the amount of sucking time at the breast — this often happens after 2 to 3 months as your baby becomes better at breastfeeding

What is normal for me, if I am breastfeeding?

While breastfeeding is different for everyone, the following signs are normal and do not mean that you have a low supply:

• your breasts suddenly seem softer than in the first few weeks after birth — 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 breast pump — remember the baby is much more efficient and will always get more out than a breast pump
• you express less milk over time when using a breast pump

How do I know that my baby is getting enough milk?

Always look at the ‘whole’ picture to ensure that your baby's growth and development is with normal limits.

Your baby is getting enough breastmilk if they:

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

How can I increase my breastmilk supply?

The main way to increase breastmilk supply is through breastfeeding or expressing milk more than you currently do. The more you feed the more breastmilk your body will produce.

Here are some tips to increase your breastmilk supply:

• Ensure that your baby is attaching well and removing milk efficiently from the breast.
• Be prepared to feed your baby more often — breastfeed on demand every 2 to 3 hours and at least 8 times in 24 hours.
• Use both breasts at each feeding; if you can, offer each breast twice.
• Express for a few minutes after each breastfeed. This will provide extra stimulation to your breasts, to signal them to produce more milk.
• When your baby is feeding, compress your breast to aid milk flow; as this will also encourage more effective sucking.
• Look after yourself: make sure you are drinking enough water, eating a healthy balanced diet, not missing any meals and resting as much as possible between breastfeeds.

Other options to ask your doctor or lactation consultant about include:

• a supplemental nursing system or 'supply line'
• herbal treatments and/or medicines that are known to increase milk supply (galactagogues)

Some cultures use food or herbs to increase breastmilk supply, but many of these have not been formally studied to ensure their safety or effectiveness.

Domperidone is a prescription medicine that can increase the hormone prolactin, which stimulates breastmilk production. Your doctor may recommend this if this medicine is right for you.

Resources and support

If you think you have a low milk supply:

• Talk to your doctor, lactation consultant, breastfeeding counsellor or child health nurse.
• Call the Australian Breastfeeding Association’s National Breastfeeding Helpline on 1800 686 268.
• Contact a trained specialist support and advice through Karitane’s virtual breastfeeding clinic.
• Visit the Royal Women’s Hospital for more information on low milk supply and other breastfeeding problems.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.