Five Factors That Decrease Breast Milk Supply

A decrease in breast milk supply definitely presents a stressful situation to mothers who are breastfeeding their babies.

Breast milk production is controlled entirely by your hormones for the first 10 days postpartum. Next, it switches to local control at the level of the breast. Mismanagement of early breastfeeding can lead to a decrease in a mother’s milk supply. Additionally, maternal health conditions can contribute to a waning milk supply as well.

In this article, we are going to focus on some of the problems that cause a decrease in breast milk supply. These issues are often simpler to resolve.

What factors can potentially decrease milk production?

Often new mothers don’t realize that there are several things that can cause a decrease in their breast milk production. Throughout your breastfeeding journey, there are certain things that you can control and other things that you cannot. The following factors are often things that you can manage on your own. If you have followed these recommendations and still feel like your milk supply is low, be sure to reach out to a lactation consultant or your healthcare provider. 

Before we look at things that cause a decrease in supply, we should first define what a normal supply of breast milk looks like. On average, your breast milk supply should be between 24-30 ounces of milk per day in order to keep up with your baby’s needs. On either end of the first year of life, this amount will be slightly lower or around 20 ounces per day. Before 1 month postpartum as well as when your baby approaches their first birthday, they will need less milk.

Giving formula without pumping

Before your baby regains their birth weight, you may need to supplement with donor breast milk or infant formula in the first few days after birth.  Additionally, some babies may require supplements for longer than the first few days.

For the first 10 days postpartum, your breast milk production is entirely under the control of your hormones. This means that no matter how much you breastfeed, your body will still make breast milk. However, this is a critical time for your breastfeeding experience as the more often you put the baby to breast during this time, the better your milk supply is for the duration of breastfeeding. Through a complex interplay of hormones, your prolactin receptors increase inside of your milk ducts as you are breastfeeding during this important time.

When you supplement your baby, you need to feed physiological amounts of milk. This means that your 2 day old baby should be supplemented with 10 ml of formula or breast milk instead of 2 ounces. In addition to giving appropriate volumes, you need to use an electric pump to stimulate your breasts. In the early days of breastfeeding, your breasts need to be stimulated at least 8-12 times per day. This means either the baby is effectively feeding at the breast or you are pumping. By giving a formula supplement without pumping, you are signaling to your body that it does not need to make milk.      

Once breastfeeding moves into the supply and demand phase after 10 days postpartum, it is equally as essential to stimulate your breasts frequently. Your breast milk supply will decrease if you are supplementing your baby without pumping. 

Not Caring for Your Body

Your postpartum body is very sensitive to your stress levels. If you are stressed about caring for your baby, this can lead to a decrease in milk supply. Additionally, your mental health can play a role in milk supply. If you are depressed or anxious, it is much more difficult to keep up with the demands of breastfeeding. You will notice a decrease in milk production if you are unable to manage your stress, postpartum depression and mental health well. 

In addition, in the months after birth, you need to make sure that you are focusing on your own physical health as well. Adequate hydration as well as nutritious foods help your body to produce enough breast milk for your baby’s frequent feeding at the breast. Most breastfeeding mothers need between 300-500 calories above their baseline calorie needs while they are nursing. 

Maternal Illness

While you may have an adequate milk supply for your baby at baseline, you may notice a decrease in your supply if you come down with an illness. Frequent nursing puts many metabolic demands on your body and when you are sick with a viral infection, those demands increase. This is especially true if you have a vomiting illness. Dehydration from illness contributes to low milk supply. 

Thankfully, with the guidance of your healthcare professional, your milk supply should rebound once you are feeling better. Additionally, it is important to replenish your lost fluids and nutrients as soon as you are able to tolerate it. 

Medication

Most of the time, medications are compatible with breastfeeding. However, there are certain over the counter and prescription medications that you should avoid while you are breastfeeding. This is because these medications are known to decrease your milk supply.

Common cold medications have been known to have an effect on breast milk supply.  Pseudoephedrine is the most notorious for causing a decrease in milk supply. These are the little red tablets that you have to ask the pharmacist for. They are over the counter medications, but moved behind the pharmacy counter many years ago. Pseudoephedrine (or Sudafed) is a medication that I use frequently to help mothers decrease their milk supply when they are wanting to wean or to treat an oversupply. Talk with your health care provider about safer alternatives for when you have cough or congestion.

Additionally, certain mood stabilizers or anti-epileptic drugs are known to decrease milk supply in breastfeeding mothers. Some moms also notice a decrease in their supply when they start on birth control pills. This is especially true for combination OCPs that contain estrogen. I have also seen some mothers suffer from decreased milk supply with progesterone only pills as well.

Failing to have adequate milk removal

In order to have an abundant milk supply, breastfeeding mothers need to remove milk from their breasts frequently. Early on, this means 8-12 feedings per day. As time goes on, each mother has a different amount of milk removals per day in order to maintain her supply. On average, women need 7 removals per day in order to continue to produce enough milk for successful breastfeeding.

The amount of milk removals is different for each woman. You can calculate something called your “magic number” by seeing how much you pump first thing in the morning.

If you click below, you can find out how much milk your body should be producing and how to calculate your magic number.

What are Ways to Increase Your Breast Milk Supply?

If you are experiencing a decrease in milk production, you need to first identify the cause of the decrease. As we looked at in this article, there are some reversible causes of decreased milk flow that can be changed with some effort.

However, we did not address some of the other causes of low milk supply including previous breast surgery, introducing solid foods, high blood pressure, hormonal imbalances such as polycystic ovarian syndrome and poor milk transfer at the breast. If you suspect any of these causes, please reach out to a breastfeeding expert to help you manage these causes of insufficient milk production.

Supplement appropriate volumes and use a breast pump

When you supplement your baby, you need to feed physiological amounts of milk. This means that your 2 day old baby should be supplemented with 10 ml of formula or breast milk instead of 2 ounces. In addition to giving appropriate volumes, you need to use an electric pump to stimulate your breasts.

In the early days of breastfeeding, your breasts need to be stimulated at least 8-12 times per day. This means either the baby is effectively feeding at the breast or you are pumping. By giving a formula supplement without pumping, you are signaling to your body that it does not need to make milk.

Once breastfeeding moves into the supply and demand phase after 10 days postpartum, it is equally as essential to stimulate your breasts frequently. Your breast milk supply will decrease if you are supplementing your baby without pumping. Additionally, your breast milk supply will decrease if you are overfeeding your baby with infant formula supplements.

Choose Alternative Treatment for your cold

Instead of choosing a cold medication that has the potential to decrease your supply, pick an alternative treatment instead. In general, cold medicines are not usually very helpful anyway. In their place, I recommend supportive care with stuff like warm liquids, a spoonful of honey to calm your cough, humidifiers and nasal saline rinses.

These alternatives to medical treatments will help your symptoms to improve while protecting your milk supply as a nursing mother.

How can 127 Pediatric help you?

At 127 Pediatrics, we offer concierge level pediatric and breastfeeding care. If you are near Colleyville, Texas and would like to know more about our in person services, fill out a contact form on our website for a free meet and greet. If you are not close to our practice, but would like breastfeeding support, we offer an array of services.

First thing you can do is to subscribe to our YouTube channel and then get on our email list so that you can stay up to date on our breastfeeding offerings.

© 127 Pediatrics, February 2024