You do not have a low milk supply because:

• your baby needs frequent feeds. A healthy baby may be feeding frequently or cluster feeding or going off a growth spurt.
• your breasts are no longer leaking breast milk. It is normal for leaking to reduce as your breasts and your baby become more efficient at feeding.
• Your breasts feel softer again. The excessive fullness in early days is because your breasts haven’t yet worked out how much milk to produce in response to your baby’s needs. They start by over producing before eventually settling down to a real supply and demand cycle
• breastfeeds have got shorter – again your baby is stronger and more efficient at draining your breast and your milk supply is in sync with your baby
• you have small breasts. Large breasts are a combination of fatty tissue and glandular tissue. You cannot tell much about someone’s milk production by the size of the breasts.
• your baby wakes up a lot. Plenty of young babies feed with similar intervals day and night. Plenty continue waking every 2-3 hours during the night.
• your baby won’t ‘go down’ after a feed. So you feed your baby and they drop off to sleep on the breast. You move them to the Moses basket and they wake up as if you just placed them on a sheet of molten lead. And they seem to be rooting again. This happens because being next to you skin-to-skin was nice and cosy and relaxing and warm and it smelt good. The Moses basket is not as soothing and comfortable. You probably startled your baby when you moved them. You probably moved them about 15-30 minutes after a feed when the hormone cholecystokinin had dropped in their blood stream causing them to be more wakeful. Your baby finds the breast a lovely place to be. They like to suck to relax themselves. Babies like second helpings. This does not mean you are not making enough milk.
• your baby will take a bottle after a breastfeed. Put a teat against a newborn’s palate and you trigger their sucking reflex. Babies will usually continue to take milk beyond the point that they need it. This is one of the reasons we see links between bottle feeding and obesity as the ability to recognize fullness is reduced.
• you cannot feel your ‘letdown’ reflex (milk ejection reflex). Some women feel an electrical tingle at the point the milk lets down. Some don’t. It is common for the strong let down reflex to fade.
• you don’t pump very much milk. Pumping and breastfeeding are surprisingly unrelated. Your baby removes milk in a completely different way. Plenty of women with healthy milk supplies fail to pump much at all. Their bodies can’t be tricked into eliciting the milk ejection reflex (or ‘letdown’). Plus pumps don’t always work. Suction goes as valves get old.

However, here are some real signs that a breastfeeding mum might have low milk supply:

Your midwife and health visitor should carry out full feeding assessments during the first 2-3 weeks. They will ask you questions about how your baby is feeding, how many wet and dirty nappies they have and whether your breasts and nipples feel comfortable.

• Weight gain problems. A newborn is born and then loses weight. They regain birth weight at around two weeks. They then put on about 150-200g a week after that. That slows down after around four months. If your newborn loses more than 10% of their body weight, we might pay attention. If you were on a drip during labour, your baby may be born with high levels of fluid and hydration which can be lost after birth. This kind of water loss has nothing to do with feeding problems or low milk supply. However, we wouldn’t want your baby to lose weight after about day five or lose weight a second time. It might take some babies three weeks to get back up to birth weight. Have a look at your baby’s growth charts. Notice how we have birth weight line and then a space where the curvy lines don’t go and they start again at week two – this is to take into account the weight changes after birth. Just because your baby was born on the 75th percentile, that doesn’t mean we would expect them to definitely re-start on the 75th after that two week gap. That’s why the lines don’t continue. That’s why we have that space. We start again at two weeks. Your baby might be on the 50th then. They then ideally will roughly stick in the same vicinity. But babies wobble around a bit. They might dip below. They might get close to the 25th. And then they might bob back up again. We don’t expect all babies to hug a line exactly. This chart is a guide. It’s about averages. Ideally, a baby doesn’t cross more than two lines on their centile chart but some wiggling is normal.

• In the early days (first four to six weeks), we look at poo and pee. After your milk has come in (around day two to five), we’d expect to see six wet nappies in 24 hours and at least two (often more) poos the size of a £2 coin or bigger. After week four to six, some babies’ poo rate can slow right down. This doesn’t mean anything is wrong. Some babies can skip several days between poos and this isn’t anything to do with milk transfer or supply. However, if it’s not OK for a four day old or ten day old baby not to poo for a few days. Talk to your midwife or health visitor if you are worried or take your baby to their family doctor.

Weight gain and nappies. That’s it. Those are the only things that tell us about milk supply. You may hear people say that ‘babies should be settled after a feed’ but some babies get wind or need to poo or have reflux or wake up and want second helpings. Let’s be careful about even saying that. Equally very sleepy and ‘settled’ babies may not be feeding enough. Let’s look at weight gain and nappies for everyone.

If you do have a low milk supply here are some actions you can take. Get support from a certified breastfeeding expert or a local breastfeeding clinic.

Here you will be able to have a breastfeeding assessment which will look at all aspects of your breastfeeding. Including:

• your baby’s attachment, any pain in breastfeeding. Often just a little adjustment can mean that there is no pain and your baby can attach properly and drain your breast efficiently (this also stimulates your breasts to produce more milk during and after the feed)
• assess if your baby has any problems with their tongue or jaw such as a tongue tie that mean that they cannot attach effectively and drain and stimulate your breasts efficiently. They may be able to refer you to get e.g., a tongue tie divided quickly so your baby can breastfeed properly.
• Assess the length and timing of feeds. Are you feeding enough? Maybe your baby doesn’t show strong hunger cues and you need to offer feeds more often. Maybe someone told you to wait for them and you’re sometimes going four hours between feeds? Maybe you need to feed more frequently? When are you changing sides? Too quickly? (and baby is missing the fatty milk) or are you feeding on one side for too long (perhaps over 45 mins) whilst your baby isn’t swallowing. Maybe you need to change sides at 20-30 minutes instead and get baby a greater volume of milk overall and fatty milk overall. Both of these habits can cause weight gain problems. Get someone to help you recognise what swallowing and efficient feeding looks like so you’ll know when to change sides and when good feeding has finished.
• Google ‘breast compressions’. You’ll get to a video and handout from Dr Jack Newman. You can finish a feed with breast compressions and get an extra dose of fatty milk into baby.
• Try a version of ‘switch nursing’. Try and go back to the first side after your baby has taken as much as they want from breasts one and two. There will be milk there. The more breastfeeding you do, the more milk you will make. The second time you return to that breast, the milk will be fattier and richer and you’ll send signals to your body to make more milk.
• Give yourself time to get the help and self-help you need. Low milk supply is urgent so you need to focus on getting the help you need and then giving yourself the time you need to feed and build your supply up. This means enlisting help around the house and with other children so that you can give you and your baby the best chance of establishing breastfeeding and milk supply in the early days.
• Although breastfeeding is every breastfeeding mum’s first choice, many mums have found that pumps can be useful. You can pump on an emptier breast to send even more signals to your milk supply. Be gentle to your breasts when you are pumping and work round your baby’s feeds. Don’t think, “I don’t want to pump because I will empty my breasts and baby will have less milk.” Certainly, they might be less appreciative if you pump just before a feed is due and you leave them with an emptier breast full of thicker fattier milk but pumping overall will increase milk supply and stimulate milk production. You are not ‘taking their milk away’.
• Rarer problems. Some women who have had breast surgery or unusual breasts or PCOS or other hormonal issues may face milk supply problems. Speak to an International Board Certified Lactation Consultant or experienced infant feeding midwife to discuss your individual case. Have you had breast surgery? Or, are your breasts are very widely-spaced or asymmetrical, or very tubular with a bulging areola? Did they not really change much in pregnancy (or puberty)? This might indicate (in a minority of women) problems with the glandular tissue in the breast. Also, some women with PCOS (not all) have a reduced milk supply. Some doctors will do hormonal testing for you. There are also medications that can help develop breast tissue especially in pregnancy. It is also worth getting your thyroid function tested? This is something relevant for more people than you might realise. If you are trying everything and low milk supply continues to be a problem, ask your doctor to check your thyroid levels. There are sometimes medical reasons mothers have a low milk supply and doctors and lactation consultants may be able to help you.

Remember though that these are rare problems and the vast majority of breastfeeding mums will benefit from the tips outlined earlier. Most mums who genuinely have low milk supply got into problems and habits that have convinced their breasts that the demand for milk is lower than it is. The good news is that most low milk supply can, almost always, be reversed with the right help.

When there are problems with weight gain and nappies, a baby may need additional supplementation. This can be an upsetting time for parents who were hoping to exclusively breastfeed but it need not mean the end of breastfeeding. Ideally, supplementation is a mum’s expressed breastmilk and hiring a double hospital grade pump can be helpful. If it is felt that formula is needed, a pump can also help protect and develop mum’s supply to give her an opportunity to work on her breastfeeding issues and maximize her amount of breastmilk her baby gets in the future.