"Am I Making Enough Milk?" Unpacking the Realities of Low Milk Supply

As a lactation medicine physician, one of the most persistent worries I see in new moms is whether their baby is getting enough milk. It's a question that can create a lot of anxiety during an already overwhelming time. If you're experiencing this worry, know that mothers everywhere share this feeling. It's encouraging to see that, according to the CDC, most infants in the U.S. (83.2% in 2019) begin their feeding with breast milk.

While challenges are common, these numbers show families are resilient. At six months, over half of infants (55.8%) are still receiving some breast milk. This is so important because it highlights a key truth: every drop counts. Even some breast milk is incredibly beneficial to your baby. My goal is to provide you with evidence-based information to help you understand the signs, explore potential causes, and find the right support for your unique breastfeeding journey.

Telltale Signs: How to Know if Your Baby Is Getting Enough

Before concluding that you have a low milk supply, it's essential to know the reliable indicators that your baby is well-fed and hydrated.

Look for these positive signs:

• Diaper Output: After the first few days following birth, stool should change from a sticky, dark meconium color to a soft, seedy, and yellow stool. Persistence of meconium-like stool can indicate low milk production or poor infant transfer of milk from the breast. 
  

• Steady Weight Gain: While it's normal for newborns to lose a little weight initially, they should return to their birth weight by about two weeks. After that, a gain of about 5.5 to 8.5 ounces per week for the first few months is a strong sign of adequate intake.
  

• Frequent, Flexible, and Effective Feedings: In the early weeks, most newborns require nursing about 8 to 12 times in a 24-hour period. These frequent feedings help establish your milk supply and ensure your baby is getting what they need.
  

• Contentment After Feedings: A satisfied baby will often show relaxation and contentment after eating and may even fall asleep at the breast.
  

• Active and Alert Periods: When your baby is awake, they should appear healthy, alert, and have good muscle tone.
  

It's also important to recognize what isn't a reliable sign of low milk supply. Many mothers worry when their breasts feel softer than they did in the early weeks, especially if their baby goes through a period of cluster feeding (wants to nurse frequently), or if they produce little milk when they pump. These are often standard parts of the breastfeeding experience and not necessarily a cause for alarm.

When to Suspect Low Milk Supply

If you're noticing some of the following signs, it may be time for a deeper evaluation:

• Insufficient Weight Gain: This is the most reliable indicator of a potential issue.
  

• Persistent Fussiness or Hunger After Feedings: If your baby consistently appears hungry or unsatisfied after nursing, it's worth investigating further.
  

• Sleepy babies who don’t wake up to feed: If your baby is not regularly cueing to feed at least every 3 hours, this could be a sign that they do not have enough milk.
  

Uncovering the "Why" Behind Low Milk Supply

Low milk supply can stem from a variety of factors, and sometimes it's a combination of issues. These can include:

• Infant-related factors: A poor latch, tongue-tie (ankyloglossia), or other oral anatomical issues can prevent your baby from effectively removing milk from the breast. Many breastfeeding challenges can be related to an ineffective latch. An infant-led latch with positional stability helps to optimize milk transfer. A full infant oral assessment that focuses on function is also part of the latch evaluation.
  

• Maternal health conditions: Issues such as polycystic ovarian syndrome (PCOS), thyroid problems, retained placental fragments, or previous breast surgery can impact milk production.
  

• Infrequent or ineffective milk removal: Your body makes milk on a supply-and-demand basis. If milk isn't removed frequently and effectively, your body will get the signal to produce less.
  

• Certain medications: Some medications, including those containing pseudoephedrine or certain hormonal contraceptives, can decrease milk supply.
  

How a Lactation Medicine Physician Can Help

This is where my specialized expertise as a Lactation Medicine physician becomes invaluable. While lactation consultants are fantastic resources for many breastfeeding challenges, as a physician, I can take the next step to diagnose and treat underlying medical conditions that may contribute to low milk supply.

As a board-certified pediatrician, neonatologist, and lactation medicine physician, I can:

• Conduct a comprehensive evaluation of both you and your baby.
  

• Order and interpret lab work to investigate potential hormonal or other medical issues.
  

• Perform a thorough assessment of your baby's latch and milk transfer.
  

• Diagnose and treat conditions such as mastitis or other breast infections.
  

• Prescribe medications to increase milk supply when medically appropriate.
  

• Develop a personalized, evidence-based care plan to help you achieve your feeding goals.

I believe in creating a supportive and conversational space where you feel heard and reassured. It is always the family's informed choice how they feed their children, and I am here to help you find the best path forward.

If you're worried about your milk supply, you don't have to navigate it alone. I invite you to schedule a consultation at Bloom and Grow Lactation Medicine!