Category Archives: Causes of Low Milk Supply

The Causes of Low Milk Production

What is Nipple Confusion?

Definition of Nipple Confusion

Nipple Confusion means a baby is having difficulty latching correctly to the breast after being exposed to artificial nipples, such as those found on baby bottles or pacifiers.

What Age Is Nipple Confusion Most Common?

Nipple Confusion is most common in breastfed babies that are given artificial nipples in the first 6 weeks, but can occur in babies 3 months old or older. The older a baby is and the more he has figured out breastfeeding, meaning the baby (and the mother) know what a good latch feels like, less likely baby will become confused by the introduction of an artificial nipple.

Why Does Nipple Confusion Occur?

Nipple Confusion occurs because human nipples and artificial nipples are fundamentally different.

  • They have a different feel
  • They are shaped differently
  • They release milk (from the breast), formula (from a bottle) or nothing (from a pacifier) in different ways
  • They require different tongue placement

So when a newborn or young baby who isn’t yet a breastfeeding pro is introduced to a either a bottle nipple or a pacifier or both, the baby must learn a new way to hold the nipple in the mouth and new tongue placement. The more frequently the nipples are switched, the longer it takes for baby to get used to any of them and the more “confused” and frustrated baby will become.

The Effects of Nipple Confusion

Nipple confusion is caused by introducing baby to artificial nipplesBreastfeeding can be a real challenge with getting the right hold, supporting baby in the right way, getting a perfect latch, and encouraging baby to trigger let downs. When a baby is introduced to artificial nipples too early, and begins to suffer Nipple Confusion the baby may forget how to latch correctly or may have become too lazy (from the easy flow of a bottle) or too tired (from hours of sucking on a pacifier) to breastfeed effectively.

When this happens baby often begins to reject the breast by refusing to latch correctly or maintain the latch or by being very fussy at the breast. When this begins to happen many parents reintroduce the pacifier to calm the baby or give the baby a bottle for nutrition. This leads to poor milk removal from the breast which begins the breast shut down process. Once on this path most babies become exclusively formula fed.

How to Avoid Nipple Confusion

The simplest way to avoid Nipple Confusion is to not introduce any kind of artificial nipple to the baby until breastfeeding is very well established:

  • Baby has a perfect latch
  • No nipple soreness or pain
  • Good milk supply
  • Good weight gain by baby and following a growth curve
  • Baby is at least 6 weeks old, preferably 3 months old

After these are all met it is generally considered safe to introduce an artificial nipple. If introducing a bottle nipple to give breast milk or formula, it’s best to select a size zero or newborn size so that baby doesn’t not develop flow preference. A baby with flow preference will begin to reject the breast because it doesn’t flow as fast or as easy as milk from a bottle.

How to Correct Nipple Confusion

If your baby is exhibiting signs of Nipple Confusion you are at significant risk of losing your milk supply and needing to exclusively formula feed your baby. Here’s the steps to correct nipple confusion:

  1. Stop giving all artificial nipples – if this is not possible, for instance if you are away from baby for extended periods and a bottle must be given, choose a size zero or newborn size nipple that is shaped as close to your nipple as possible and have the caregiver latch baby to the bottle in much the same way you would latch to the breast.
  2. Insist on perfect latches when you breastfeed. Be prepared that it may take up to 10 minutes of trying to get the latch right before you get a perfect latch. Just keep in mind that baby is having to relearn this skill because of the nipple confusion.
  3. Breastfeed as often as possible. Practice makes perfect.
  4. If your milk supply has begun to suffer as a result of the nipple confusion, be sure to add one to two additional breastfeeding session and one to two additional pumping sessions. Consider taking a supplement that boosts breast milk supply, such as Lactiful Supply Max.

It is possible to re-establish a good breastfeeding relationship with a baby who has nipple confusion, however it will take a lot of work and dedication. Click for more articles about how to increase milk supply

Decreased Breast Milk

This article is for women with decreased breast milk, meaning they started out with an adequate breast milk supply but something has caused it to decrease recently. We’ll look at the causes for decreased breast milk and steps you can take to return breast milk production to it’s former levels.

The Causes of Decreased Breast Milk

Growth spurt – In this case there hasn’t been a decrease in breast milk supply, but because baby is trying to get as many calories as possible and breastfeeding all the time (or drinking more bottles, if you are an exclusive pumper) is can seem like you’re suffering from decreased breast milk. Growth spurts typically last 3 to 7 days and you may find that your baby returns to a typical amount of breastfeeding afterwards.

The return of your monthly cycle – The return of your monthly cycle is a sign that your hormone profile has shifted from lactation to fertility. When this happens, the lactation hormone (prolactin) is pushed to the side by the fertility hormone (estrogen). This often is often accompanied by decreased breast milk.

Giving bottles or pacifiers – Giving bottles or pacifiers can lead to decreased breast milk. If some of baby’s sucking is satisfied by a pacifier or a bottle, baby will be less likely to comfort suck after breastfeeding. Comfort sucking continues to stimulate the breast and helps maintain an adequate breast milk supply. If you’ve recently started giving your baby a pacifier, stop and see if your breast milk supply rebounds.

Aggressive dieting –  If you have recently cut a large amount of calories out of your diet, it may cause decreased breast milk production. In general it takes about 500 calories to produce a day’s worth of breast milk. If your body doesn’t haven enough calories available to make the milk, less milk will be made. Begin dieting gradually to avoid a decrease in breast milk production.

Supplementing – If you are giving your baby a supplement (either formula or previously frozen breast milk) it can lead to decreased breast milk supply. Your body doesn’t know you’re giving a supplement, so it will cut production to meet baby’s lower milk demands. Be sure you are pumping or using an SNS System whenever giving a supplement.

Overexertion & Aggressive Exercise – Have you started training for that marathon and noticed a decrease in breast milk production? Any kind of overexertion or aggressive exercise routine can cause a backlash in your milk supply. Even when medically cleared to do so, gradually return to exercise.

Stress – Has a new stressful event recently happened? If so that can cause decreased breast milk production. Returning to work or school is a classic example of decreased breast milk production due to stress (and challenges with pumping frequently.) Try to minimize stress: ask for help when needed and find time to do some relaxing every day.

Pregnancy – Just like with the return of your monthly cycle, pregnancy causes a shift in your hormones away from lactation and can result in decreased breast milk. There isn’t much that can be done with this cause of decreased breast milk production and nipple soreness typically makes breastfeeding too uncomfortable for most moms to continue.

Solid Foods – If your baby has begun eating solid foods, your baby will begin to require less and less calories from breast milk. When this happens your body naturally responds by decreasing breast milk production.

These are some of the more typical causes of decreased breast milk production. Correct (if possible) the cause, then see our 11 ways to increase milk supply to get your supply back to where you want it to be. Click for more articles about how to increase milk supply

27 Causes of Low Milk Supply

There are two types of causes of low milk supply. Either a woman had a good milk supply that has dropped or she never had good supply to begin with. Lactiful has written a series of articles covering each type. First let’s start the first group of causes of low milk supply (good supply that dropped). Feel free to skip or skim this section if it doesn’t apply to you.

Causes of low milk supply: When a good supply drops.

If you’re a mom who had a good supply that has been tapering off gradually or took a dramatic turn for the worse this section is for you. The good news is that there is probably something that caused the drop in milk supply and once that something is discovered it should be fairly straight forward to get your supply back up!

What follows is a potpourri of common problems that derail milk supply. It’s likely that one of these will have affected you and if so, you’ll have that, “Ah-Ha” moment, where you realize, “That’s what happened!” However if none of these common problems strikes a cord with you, all is not lost. You can use your newfound understanding of the kinds of things that derail milk supply to diagnose what happened around the time when your supply dropped.

Causes of low milk supply: Never started with a good supply.

The previous section covered moms who had a good milk supply that suddenly dropped. This section covers moms who never started with a good supply.

Mom’s like me.

I hemorrhaged badly with the birth of my first child and the resulting blood loss set me up for low milk supply right from the beginning. It was a tough uphill climb but I eventually got my supply where it needed to be and successfully nursed my little boy until he was 2 years old.

Milk supply that starts off low is often difficult to correct and sometimes impossible to correct. In those cases where supply issues can’t be corrected, take heart, you can still have a good nursing relationship. See our article for coping with chronic low milk supply [LINK COMING SOON].

If your milk supply issue is correctable, it may be a long and difficult road and it’ll require equal measures of courage and patience. I’m sure you’ll agree that the rewards of giving your baby the best start in life are worth the effort! Let’s get started.

What Else?

If your milk supply had been good but has recently dropped and none of the above scenarios seem to fit, try to think what was occurring around the time when your supply dropped. Sometimes the answer is as simple as a growth spurt. A baby that is breastfeeding all the time and complaining that he’s not getting enough milk can make any mother feel like she has low milk supply, but in reality, baby wants as many calories as he can get.

If you can’t think of any reason for your recent drop in milk supply, the best thing is to treat the low milk supply directly. See our article on the 11 ways to increase milk supply.

PCOS and Breastfeeding

Polycystic Ovary Syndrome

Commonly just called PCOS, this syndrome affects 1 out of 10 women. Symptoms include deepening of the voice, facial and body hair growth, male pattern balding, irregular periods, fertility problems, miscarriage, depression, weight problems and low milk production. PCOS is the most common endocrine problem of breastfeeding women.

If you have already been diagnosed with polycystic ovary syndrome, see your doctor and have her perform the blood tests described in our article on thyroid function and hormone imbalance. If you can correct the underlying imbalances and deficiencies, it’ll go a long way toward improving your milk production and breastfeeding. Additionally, consider requesting a prescription of metoclopramide (however please be investigate the important and significant side-effects of this drug) and follow the suggestions in our article on the 11 ways to increase milk production.

If you have not been diagnosed with polycystic ovary syndrome (PCOS), but think you might have it, visit the Polycystic Ovarian Syndrome Association at as a starting point for research. If you feel like you may be affected, visit your doctor who can check for markers of the syndrome. If those turn out negative, have her complete the blood tests in the article referenced in the previous paragraph on thyroid function and hormone imbalance. heart-logo

Thyroid and Breastfeeding

The Sneaky Destroyers of Milk Production : Thyroid Function, Hormone Imbalance Or Nutrient Deficiency

We have written many articles on the causes of low milk production in breastfeeding mothers. If none of the other causes we have written about seem to fit your situation, consider having your blood checked for one of these sneaky destroyers of milk production. Particularly have your doctor check for the following:

Hypothyroidism – This happens when your thyroid gland is functioning below normal levels. Symptoms include weight gain, depression and low milk supply. Medication can be given to increase thyroid function.

Anemia – This is a low red blood cell count. The first symptom is fatigue which is difficult for a new mom to know if it’s a symptom of anemia or if she’s just tired from those middle-of-the-night feedings. Like an under-functioning thyroid, Anemia can affect breastfeeding and lactation and should be corrected with supplementing with iron, eating iron rich foods, and vitamin C, which helps with the absorption of iron. Look for an Iron / Vitamin C blend and take 30 Mg of iron and 200 Mg of Vitamin C per day with a meal.

High Testosterone – A certain kind of cyst (Gestational Ovarian Theca Lutein Cyst, to be precise) on one of your ovaries during pregnancy can cause it to produce up to 150 times the normal amount of testosterone. Symptoms include deepening of the voice, facial and body hair growth, male pattern balding, low milk production and difficulties breastfeeding. The reason is that high testosterone interferes with prolactin’s (the milk-making hormone) job of making milk.

If your blood test shows abnormally high levels of testosterone and the cause is a gestational ovarian theca lutein cyst, the simple fix is to simply wait 2 to 4 weeks after birth and continue breastfeeding and follow the advice for increasing milk production in our article on the 11 ways to increase milk supply. After that time, testosterone levels simply return to normal on their own without treatment.

Nutrient Deficiency – Being deficient in any nutrient can have a domino effect that reduces milk production. Correct any “low” or “low normal” with supplements. Be sure to have at least the following nutrients checked: vitamins C, D, B12, iron, zinc, folic acid, calcium and protein.

If the thyroid and other blood tests don’t reveal any problems, it’s not the end of the road. Sometimes the cause of low milk production remains a mystery, but it can still be treated and overcome in many situations. I’ve found that doctors frequently take this approach. One time I went in to see a doctor for a skin problem – sort of like a boil on my arm that wouldn’t go away. The doctor told me he didn’t know what caused it or even what it was but gave me a prescription anyway. He said, “If that doesn’t clear it up, come back in.” His solution worked, even though he didn’t know the cause.

Sometimes the cause of low milk production can be found out with a simple thyroid blood test, and a simple medication can restore your breastfeeding relationship. But other times   you just have to treat breastfeeding problems even though you do not fully understand the underlying cause. See our article index for a complete list of helpful articles. heart-logo

Obesity and Breastfeeding: A Cause of Low Milk Production

The Link Between Obesity and Troubles Breastfeeding

Obesity map 2005

Obesity map 2005 (Photo credit: Wikipedia)

If you were obese before becoming pregnant, there’s a possibility that your prolactin (the milk-making hormone) levels weren’t high enough to adequately prepare your breasts for breastfeeding. Additionally, lower prolactin levels after birth can be a leading factor in lower milk production.

Even if you have very large breasts that seem like they should be able to produce plenty of milk, you can still have a problem breastfeeding successfully. Often, very large breasts are mostly made up of fat tissue and other not glandular, milk-producing tissue.

If you believe obesity might be affecting your breastfeeding relationship, see your doctor and have your prolactin levels checked and follow the advice of your health care professional. In the meantime, there is some good news: you can safely diet while breastfeeding.

You may have heard that you have to increase your calorie intake by 300 to 500 while breastfeeding, however that only applies if you want to maintain your body weight. When faced with obesity, it is safe to diet and lose a pound or two a week through exercise as long as you are getting at least 1800 calories throughout the day. This is the minimum amount of calories believed necessary to maintain a healthy milk supply.

Your body has no problem with burning fat to make milk. But remember, fat may contain toxins that are released into the bloodstream when the fat is converted to energy. Too many toxins can overwork your liver and kidneys so keep weight loss to 1 to 2 pounds a week. Don’t worry though, research has shown that these toxins are not present in breast milk.

I personally have had success with “The Abs Diet for Women.” This widely available book isn’t really a diet, but a lifestyle change that increases the number of times you eat (3 meals and 3 snacks per day) and favors higher protein and healthier food over high carb food. However it is not a low carb diet. You can find it at or possibly from your local library.

Eating six times a day kept me from feeling hungry and is great for obesity-battling, breastfeeding mothers. Furthermore the meals and snacks are often quick and easy to prepare – something a mother of small children can really appreciates!

Another option is the Milk Up! Meal Plan detailed in chapter 8 of the Milk Up! book. An electronic copy of this book is included as a free gift with an order of Lactiful Supply Max. This nutritious meal plan is specifically for mothers who want to increase milk production and can be the basis of a healthy diet.

And finally, my sister lost a lot of weight with Weight Watchers and is now a lifetime member so if you haven’t found a diet that works with your lifestyle, keep looking! Obesity and breastfeeding are not best friends, but working on weight loss can lead to more milk production, more energy and better overall health. To help boost milk supply see the 11 ways to increase milk productionheart-logo

Gastric Bypass and Breastfeeding

If you’ve had gastric bypass surgery in the last 24 months, chances are very likely that you will have challenges breastfeeding. What’s going on is that you and your baby are probably not getting enough vitamins, minerals or protein. And just like with vegetarianism (see our article on vegetarianism and breastfeeding), if baby isn’t getting enough B12, he’ll be too sleepy to breastfeed effectively and leave milk in the breast. Leaving milk in the breast results in lower milk production because the body see it as a sign that it is overproducing.

What to do about Gastric Bypass and Breastfeeding

Even if your gastric bypass surgery was more than 24 months ago, be sure to see your doctor for a blood test to see if you are low on any essential nutrients. Especially look at B12, iron, zinc, folic acid, calcium and protein as these play important roles in breastfeeding. Supplement anything that comes back “low” or “low normal.”

Even if your protein level isn’t low, be sure to eat at least half a gram of protein for each pound of body weight per day. So if you weigh 160 pounds, eat 80 grams of protein. There are many high protein bars, protein smoothie powders or premixed shakes that can help make up the difference in what you eat. Just check the weight lifting section in your local vitamin store.

If you’re breastfeeding and have had gastric bypass surgery in the past, correcting any low nutrient level should bring your milk supply back up fairly quickly (as long as it has not be low for very long, because the longer breastfeeding problems persist the more difficult they are to correct).

If fixing the nutrient levels that are a common problem of gastric bypass does not help with breastfeeding or milk supply, see our article on the 11 ways to increase milk supply or check your daily milk productionheart-logo

Breastfeeding And Breast Reduction

What is Breast Reduction Surgery?

Reduction mammoplasty: The keyhole incision pl...

Breast Reduction Surgery: The keyhole incision plan for breast reduction. (Photo credit: Wikipedia)

Breast reduction surgery is a type of cosmetic surgery that removes breast tissue and relocates the nipple so that the breasts and body are in proportion. Breast reduction is done for many reasons including physical reasons such as back pain, shoulder discomfort from bra straps, and breathing troubles; emotional reasons such as self-confidence and body image as well as aesthetic reasons.

Breast Reduction and Breastfeeding Considerations

Fortunately, most doctors who perform breast reduction surgeries keep breastfeeding and lactation as a worthy objectives. They perform the breast reduction surgery in such a way that as many of the milk ducts and milk glands can be undisturbed as possible. So it certainly possible that  a woman will be able to successful with breastfeeding after breast reduction. Generally the more time that has passed between the breast reduction and the start of breastfeeding, the higher the chances of adequate milk supply and successful breastfeeding.

When to Undergo Breast Reduction

If a woman anticipates breastfeeding, breast reduction should be delayed until after her last child has weaned, if at all possible. (This same advice applies to breast augmentation as well.) If it is not possible to delay the breast reduction surgery until after the last child has weaned, the next best option is to have the surgery as far in advance of the beginning of breastfeeding as possible. This allows time for nerve regrowth and the returning of sensations. This is important because nerve sensations play and important part in breastfeeding – they signal the body to release prolactin, the milk-making hormone.

How Breast Reduction Affects Breastfeeding (and what to do about it)

Any breast reduction surgery will likely sever either nerves or ducts or both. Any ducts that are severed prevent the delivery of milk from the milk gland to the nipple. This effectively shuts down the affected parts of the breast. Milk will likely come in normally behind a severed duct but since it can’t be drawn out, it is eventually reabsorbed and production shut down. In a similar way, nerve damage prevents breastfeeding signals from reaching the pituitary gland and can cause lower prolactin hormone levels and thus lower milk supply.

The good news is that even though parts of each breast may be shut down, there may be enough parts still functioning that breastfeeding can be successful. Some women have very little with breastfeeding and milk production and however others have an extremely difficult time. You won’t really know how breast reduction affects breastfeeding for you until you try. If you are finding breastfeeding or milk production to be a challenge, understand that building your milk supply will not be easy and will require determination and active work on your part. If you already know that you are struggling with low milk supply, a good starting point is our article on the 11 ways to increase breast milk supply.

However if you are unsure of how your breast reduction is affecting breastfeeding a good starting point is to measure your milk supply and find out. heart-logo

Vegetarianism and Breastfeeding

A diet rich in soy and whey protein, found in ...

A vegetarian diet has many benefits, but also poses a challenge for breastfeeding. (Photo credit: Wikipedia)

If a steaming plate of fatty, barbecued baby back ribs makes you want to toss your cookies, you might be a vegetarian.  Did you know that vegetarians have a few extra breastfeeding challenges compared to meat-eating moms?

Vegetarians are at risk for a vitamin deficiency that can lead to low milk supply. Here’s how it works: vegetarian diets are typically low in vitamin B12. Babies who don’t get enough B12 are often sleepy and lethargic. They often don’t have enough energy to completely empty the breast and whenever milk is left in the breast it signals the body that it is over producing, therefore supply will decrease.

The fix is easy. The vegetarian mom needs to take vitamin B12, which will naturally pass through to the baby when he breastfeeds. Even if you’re still taking your prenatal vitamins (which you should be) you need to supplement with a much higher concentration of vitamin B12. Take 1000 mcg per day.

Another risk of vegetarian diets is insufficient calories for nursing. Your body needs 300-500 more calories per day to make an adequate milk supply. See the “Eat Well, Diet Later” article for more info.

Supplements provide a quick fix but shouldn’t be substituted for good nutrition. Check out “The Vegetarian Mother’s Cookbook” by Cathe Olson. Available on or possibly at your local library.

While the B12 takes effect follow the advice in the 11 ways to increase milk supply to move your milk production in the correct direction. heart-logo

Soft Breasts And Breastfeeding

Soft, Empty Breasts And Extra Skin Can Cause Breastfeeding Problems

Pregnancy and breastfeeding dramatically change the character of breasts. Perky, firm breasts get swapped out for grandma boobs. Unfortunately it’s not always a cosmetic problem. Sometimes breasts are so soft that baby has a difficult time getting a good latch – there’s too much extra skin in baby’s mouth, so baby is not effectively removing the milk.

Whenever breast milk isn’t being effectively and completely removed, milk supply will suffer. Not to mention baby will be fussier and may not gain weight like he should. All this can lead to even softer, emptier feeling breasts.

If this sounds familiar you’ll need to work to increase your milk supply. Follow the 11 ways to increase breast milk supply. And in the meantime, every time you breastfeed be sure to pull the loose skin back from the nipple toward the chest wall. Once all the skin is pull back, the skin around your nipple should be tight. Now, baby can get a good latch. This is one of those tasks that could require 3 or 4 hands so expect a bit of a learning curve.

But in this way you can overcome the inherent challenges with soft breasts and breastfeeding. heart-logo