Low supply

Worry about supply is one of the most common reasons people stop breastfeeding, and often supply is fine. Check your baby's signs first. If supply really is low, the main fix is removing milk more often and more fully. Ask for help early.

Is it low?

Signs your baby is getting enough:

• Long, rhythmic sucks and swallows during feeds.
• 6 or more pee diapers a day from day 5 on.
• Steady weight gain after the first few days. Breastfed babies are back to birth weight at about 8 days on average, and 97.5% are by day 21.
• Content after most feeds.

These often feel like low supply but usually aren't:

• Stretches of very frequent feeds, including the second or third night after birth.
• A change in poop pattern after 6 to 8 weeks.

Common causes

• Milk isn't removed often or well enough. A shallow latch, a sleepy baby, time apart, or a pump that isn't working well.
• Health factors. Breast surgery, polycystic ovary syndrome, thyroid problems, retained placenta, heavy bleeding after birth, a new pregnancy, heavy smoking or alcohol, and some medicines.
• Not enough glandular tissue. This affects fewer than 5% of people.
• Some medicines. Estrogen-containing birth control and some decongestants can lower supply.

What helps

• Remove milk more often. More frequent, fuller drainage raises supply, some right away and more over several days. An extra pumping session can help.
• Follow your baby's lead. Let your baby feed as often and as long as they want, and offer both breasts.
• Skin to skin helps build supply.
• Check the latch and the pump. Make sure your pump and technique work well. See the latch guide.
• Hands-on pumping. Breast massage or compressions while pumping may get more milk.
• If your baby needs more, your own expressed milk comes first, then donor milk, then formula.

Supplements and medicines

• The ABM can't recommend any specific herb or medicine to boost supply. The evidence is mixed, and all of them can have side effects.
• Herbal products aren't regulated, so strength and safety vary.
• None of them work if milk isn't being removed often.
• Talk to your doctor before taking anything. You can look up any medicine in LactMed.

When to get help

An IBCLC (lactation consultant) can watch a feed, check your pump and make a plan. Call your pediatrician and an IBCLC if:

• Your baby has fewer than 6 pee diapers a day after day 5.
• Your baby has lost more than 10% of birth weight, or isn't back to it by about 2 weeks.
• Your baby rarely seems content after feeds.
• Your pumped total drops and stays low for several days.
• Anything worries you. Talk to someone as soon as you can.

Get urgent help: call 911 (999 in the UK) or go to the emergency department if your baby is very sleepy or hard to wake, isn't feeding, or has had no pee for 12 hours.