ASK THE DOC: Troubleshooting Low Milk Supply

ASK THE DOC: Troubleshooting Low Milk Supply

It’s fair to say that I spend most of my clinical days regulating maternal milk supply. The number one complaint is “I don’t have enough milk,” Sometimes, I’m in agreement but other times, I find maternal expectations, for how much milk one is supposed to produce is pretty unrealistic. Although we don’t want to be living paycheck to paycheck (milk-wise), we also don’t want to open a Dairy Queen. I’ve discovered slow gaining babies with what we call “inadequate weight gain,” can be a result of moms who are “feeding the freezer.” They need a stash.

 There are many factors that come into play when helping women regulate supply such as:

  • Storage capacity of the breasts (meaning amount of glandular tissue an milk-making alveoli within the breast itself)
  • Adequate nipple stimulation to help moms produce prolactin (a hormone that promotes milk production)
  • Suckling ability of the baby (big strong baby or small jaundiced baby with a low birth weight)
  • Frequency of stimulation by either baby or breastpump (moms with less storage capacity (smaller breasts) will most likely be feeding more frequently and sometimes for longer sessions. 

Trouble usually starts when moms either start on any type of hormonal contraception or return to work outside the home. Keep in mind that empty breasts make milk, so if you don’t have any significant reason for a decreased supply, you basically need to keep emptying the breasts. 

Here’s the 12 point checklist that I give my consultants to work with moms with this complaint.

  • Are you bleeding for a prolonged period or passing clots in addition to not making enough breast milk? You could have retained placenta.
  • Did your breasts increase with size during pregnancy? You should have gone up approximately one cup size.
  • Do you have adequate breast tissue, in other words, do you have very small or conical shaped (meaning tubular-shaped) breasts that are also widely spaced? You may have Mammary Hypoplasia also known as Insufficient Glandular Tissue (IGT).
  • Do you have thyroid problems, low iron or insulin-resistance? These can all cause low milk supply.
  • Are you drinking more than what you’re thirsty for? More water than you need works against you and you’ll end up peeing more and making less milk.
  • Have you tried herbal supplements of fenugreek (can cause gas, ugh) or moringa (my clinical choice)? Supplements can come in the form of a liquid capsule, tincture, cookie, protein powder, drink mix or herbal tea and may also contain other herbs such as blessed thistle, fennel, stinging nettle, goat's rue, alfalfa, milk thistle, anise, marshmallow root, red raspberry leaf, coriander, caraway, verbena and food source galactogogues such as brewers yeast and flax seed. A few brands we love are MotherLove, if you prefer liquid capsules or tinctures, Majka, if you want your supplementation in the form of lactation cookies, protein powders or drink mixes or LOVE Tea’s Breastfeeding Tea
  • Have you had a low supply since baby’s birth? Maybe you’re dealing with a tongue tie or lip tie or both. Is baby a good feeder, meaning is he/she gaining at least an ounce a day?
  • Is your baby sleeping through the night? If they are in bed by 7 or 8, you should pump before going to bed at 10 or 11. If you go to bed when baby does, you should optimally not go longer than 6 hours without stimulation to the breasts.
  • Are you on ANY type of hormonal contraception? OBs and midwives sometimes aren’t aware that even progesterone only (mini-pill) or hormonal IUDs can really negatively impact milk supply.
  • Are the flanges in your breast pump the correct size? The flanges are the funnels that cover your breasts and nipples. I can’t tell you how many women have JUMBO flanges that are totally unnecessary. You want some stimulation for the nipples. You can size your flanges properly by looking at the nipple when you pump. You want clearance enough around the entire perimeter of the nipple (mid base to tip) and should not have a large part of the breast itself being sucked in. You also don’t want them too small or you could cause damage (read soreness) from pumping. This can be tricky, so again, find a local lactation consultant to help you determine the best size for you.
  • I always recommend double pumping (both breasts at once) for 20-30 minutes when back at work or for pumping to substitute for being with baby. Fifteen minutes rarely cuts it unless you have an oversupply but again, if that’s your problem you’re not my reader. Yes, I know the milk stops coming but if you can hang in there a few minutes longer and dry pump, you’ll get another letdown, meaning the milk will start to squirt out again. It’s great to have at least two or three letdowns. Just to close the loop, by the time you’re getting a fourth letdown, you’re expressing more milk than you had when you first sat down and hooked yourself up to the pump. This means you’re expressing newly made milk. Of course, I always recommend using a hands-free pumping bra to make the process of double pumping easier. I love Simple Wishes SuperMom Collection for traditional flange pumps and their Undercover styles for wearable pumps.


  • Are you using a personal use pump to express milk more than 3-5 times per day? The pumps you usually obtain from your insurance company is rarely adequate when moms need to pump IF separated from their babies for extended periods. This means when you’re back at work, leaving the house at 8 and returning at 6, you may need a stronger hospital grade pump.

Keep in mind that some moms will fall outside the bell-curve and do just fine with their insurance pumps but, since this article is about low milk supply, those moms aren’t even reading this blog. Insurance pumps that you own are sometimes called “hospital grade” but in the world of lactation consultants, we mean pumps that you rent from your lactation consultant or hospital. My favorite is the Medela Symphony because it’s only seven pounds and has a soft stimulation phase that helps moms produce prolactin. Again, you will need to trial different pumps to see what works best for you.

If you’ve ticked through this entire list and are still unable to increase your milk supply, visit your local IBCLC or schedule a telehealth consult at Metropolitan Breastfeeding. Our website is and there’s no doubt we can help you.