Risk Factors for Low Milk Supply

Worrying about whether you'll make enough breast milk is really normal, and concerns about milk supply are one of the most common reasons mothers reach out for lactation support. If you've ever heard that something about your health, pregnancy, or breastfeeding history could increase your risk for low milk supply, it's understandable to have questions.

The reassuring part is that having one—or even more than one—risk factor does not mean you will have low milk supply. Many mothers with risk factors go on to make plenty of breast milk. Whether you're learning about risk factors during pregnancy or you're already concerned about your breast milk supply after birth, you're not alone. Understanding what can affect milk production can help you recognize concerns early and find the right support if you need it.

Milk production changes quickly during the first days after birth. Two terms you may hear when talking about breast milk production are delayed onset of lactation (DOL) and low milk supply. Although they describe different concerns, they can sometimes occur together.

• Delayed onset of lactation (DOL): The onset of copious milk production that occurs more than 72 hours after birth.

• Low milk supply: Milk production that is not sufficient to meet the baby's needs.

DOL can increase the risk of ongoing low milk supply, especially when a baby isn't feeding well and additional milk removal is delayed. But delayed onset does not necessarily mean a mother will have persistent low production.

Several factors related to your health, breast development, previous breastfeeding experiences, pregnancy, and birth may increase the likelihood of delayed onset of lactation or low milk supply. The important thing to remember is that a risk factor is not a prediction that you will have issues with low supply.

Understanding your risk factors simply gives you more information to work with. You can use that information to prepare during pregnancy, know what to watch for after birth, and reach out for support if concerns arise.

Some medical conditions can affect the hormones, metabolism, or other processes involved in breast milk production. These include pre-pregnancy BMI, insulin resistance, including  (PMOS, formerly known as PCOS), diabetes including gestational diabetes, and thyroid disorders. A history of irregular periods or infertility may also provide information about underlying factors that could affect milk production.

Breast development can provide clues about the amount of milk-making glandular tissue present. Limited breast development during puberty or marked breast asymmetry can sometimes be signs of insufficient glandular tissue. Little or no breast growth during pregnancy may also be worth discussing with a lactation professional, particularly when combined with other risk factors.

Previous breast surgery, injury, or radiation can affect the nerves, ducts, or glandular tissue involved in milk production and milk removal. A history of low milk production with a previous baby may provide useful information when assessing factors that could affect breastfeeding in subsequent pregnancies.

A prenatal Newborn Feeding Prep Appointment with a lactation consultant can help identify factors that may affect milk production, answer questions, and provide good information about what to expect during the early stages of breastfeeding. During this visit, you can:

• Review your risk factors for delayed onset of lactation (DOL) and low milk supply and discuss which may warrant closer monitoring.

• Learn what normal milk production and feedings typically look like during the first hours and days.

• Learn hand expression and how to begin early, effective milk removal, if needed.

• Talk through what to do if your baby doesn't latch or transfer milk effectively.

• Make a plan for lactation support, including who to contact after discharge.

Share known risk factors with your maternity care team and lactation providers so they can help monitor feeding and milk production after birth.

The early days after birth are an important window for establishing milk production. Frequent, effective milk removal provides the stimulation needed to establish and maintain milk production. If breastfeeding doesn't go as expected, having a plan for support can make it easier to get help early.

Some factors that may affect milk production are known during pregnancy, while others can arise during labor or birth. First birth, cesarean delivery, and a prolonged second stage of labor have been associated with an increased risk of delayed onset of lactation.

Significant blood loss, including a postpartum hemorrhage, or retained placental tissue can interfere with the hormonal changes involved in establishing milk production and may increase the risk of delayed onset of lactation and low milk supply.

If you experience one or more of these factors, let your healthcare and lactation team know. They can help monitor your baby's feeding and milk transfer and provide early support to help establish milk production.

Because milk production is being established during the early postpartum period, problems with milk removal are worth addressing promptly. If your baby is not feeding effectively or if milk is not being removed frequently, early lactation support can help identify the problem and determine what steps may help protect your growing supply.

• Offer frequent feedings. In the early weeks, newborns typically feed 8–12 times per day.

• Hold your baby skin-to-skin and respond to their early hunger cues.

• Assess latch and milk transfer early if there are supply concerns.

• Begin hand expression early, and when appropriate, offer expressed colostrum to your baby.

• Arrange ongoing follow-up when risk factors or feeding concerns are present.

If breastfeeding isn't going well, you don't have to wait several days to see if it improves on its own. When a baby is not removing milk effectively, addressing the underlying issue and increasing milk removal can help protect your supply. Early assessment can identify problems with latch, milk transfer, or milk removal while there is still an opportunity to address them.

Monitoring your baby's intake should happen at the same time as assessing milk production. Understanding how much milk your baby is receiving can help distinguish concerns about milk production from concerns about milk transfer. Your baby’s growth—including birth weight and expected weight loss—feeding effectiveness, diaper output, and alertness can all help show whether your baby is receiving enough milk.

How often your baby nurses can vary, and cluster feeding is common, particularly during growth spurts, but a baby who spends little time actively feeding may not be removing milk effectively, even if they are feeding frequently. If your baby seems regularly unsatisfied or you have concerns about feeding, reach out to your pediatrician or lactation consultant. Early support can make a meaningful difference.

If your baby is not having enough wet or dirty diapers, is not gaining weight as expected for their age, is increasingly sleepy or difficult to wake, has difficulty feeding effectively, or shows signs of dehydration, contact your baby's healthcare provider promptly. These concerns warrant evaluation of your baby's intake and overall health.

When supplementation is needed, milk removal may also need to be continued through breastfeeding, hand expression, the use of an electric breast pump, or a combination of these approaches.

Depending on the circumstances, supplementation may include expressed breast milk, donor milk, or infant formula. Some mothers may use a supplemental nursing system to provide extra milk while their baby feeds at the breast. The appropriate plan depends on the reason for supplementation, the amount of milk needed, and the mother's and baby's individual circumstances.

Working with your lactation consultant can help you develop a plan that supports your feeding goals while making sure your baby’s needs are being met.

You don't have to wait to get help. If you are concerned about low milk supply, early evaluation can help determine whether milk production is actually low and identify factors that may be affecting milk removal or production.

Concerns about milk supply can also affect how a mother feels about breastfeeding. Worry, disappointment, frustration, or feelings of guilt can be difficult when breastfeeding isn't going as expected. If you are experiencing low milk supply, remember that it is not a reflection of how much you care for your baby or how hard you are trying. Getting support can help you understand what may be contributing to low milk production and make informed decisions about how you feed your baby.

A lactation consultant is a great place to start if you have concerns about low milk supply. A lactation evaluation can assess feeding and milk transfer and help identify whether something other than milk production itself may be contributing to your concerns.

Your lactation consultant may assess your baby's latch and whether your baby has oral or anatomical factors that could be affecting milk transfer. They can help you understand what a good latch looks and feels like and identify factors that may be contributing to nipple pain. If a possible tongue-tie or other oral restriction is identified, your lactation consultant can help you understand what they are seeing and provide referrals for further evaluation.

They may also review:

• Your baby's weight gain and growth pattern

• Breastfeeding, pumping, and supplementation history

• How often milk is being removed and whether milk removal is effective

• Breast pump function, settings, and flange fit

• When the concern began and whether milk volume increased substantially during the first week after birth

Sometimes what feels like low milk supply is actually related to ineffective milk transfer or another issue affecting milk removal. In other cases, milk production may genuinely be low and have a medical contributor. A lactation evaluation can help sort through these possibilities and identify appropriate next steps.

If milk production remains low despite effective removal, or if your health history, pregnancy and birth history, symptoms, or medications could be contributing to low milk supply, talk with your healthcare provider about whether a medical evaluation is appropriate. Your OB/GYN, midwife, or primary care provider can evaluate medical factors that may affect milk production.

If you're not sure how to bring up your concerns, you might say:

“I'm concerned about my milk production. I've worked with a lactation consultant to evaluate feeding and milk transfer, but my supply remains low. Could we review my health history, pregnancy and birth history, symptoms, and medications to determine whether a medical evaluation is appropriate?”

It can also help to bring:

• Your baby's weight history

• Feeding and supplementation information

• Pumping information and output

• Relevant medical history

• Medications and supplements, including birth control

• Information from your lactation consultant

Your healthcare provider may consider laboratory testing based on your history and other clinical findings. When indicated, testing can help evaluate specific medical factors that may be affecting milk production. There is no single standard lab panel for low milk supply, so testing is individualized based on your circumstances.

If you're still having concerns, struggling to get answers to your questions, or you feel that you need more specialized support, a breastfeeding medicine physician may be another option. They can take a closer look at more complex breastfeeding cases and help determine whether additional evaluation or support may be helpful.

These physicians provide specialized medical care for breastfeeding problems and can evaluate them alongside medical conditions and other factors that may affect milk production. Physicians who are board-certified in breastfeeding and lactation medicine have met specific requirements for board certification in this field.

To find a breastfeeding medicine physician, you can search the Academy of Breastfeeding Medicine Find a Physician directory. If you're looking for a physician who is board-certified in breastfeeding and lactation medicine, you can search the North American Board of Breastfeeding and Lactation Medicine directory. If there are no specialists in your area, telehealth may be an option.