Many women worry they don’t have enough milk for their babies, but it is rare to have an actual problem with making milk.

What to expect

Here are some guidelines for what to expect:

• During the first few days after birth it is normal to produce small amounts of colostrum
• By the end of the first 10-14 days, you will be producing around 500-1,000 ml (or 16-32 ounces) of milk per day
• Babies should breastfeed 7-19 times per day, if you count each breast as one feeding
• Babies may feed from one or both breasts depending on how hungry or how awake they are
• Feed the baby immediately when he or she shows signs of hunger, no matter what time the baby ate last
• If you are separated from your baby and are pump-dependent, pump eight times per 24-hour period

Enough milk?

To make sure the baby is getting enough milk, look for these things:

• Baby breastfeeds well at least eight times per day for at least 10 minutes
• Your breasts feel softer after feedings
• Baby has several yellow seedy stools each day by day 5
• Breastfeeding babies have varying stooling patterns as they grow (as often as every feeding to as infrequently as every few days)
• Baby urinates at least 6-8 times per day
• Baby regains his/her birth weight by 2 weeks of age
• Baby continues to gain weight according to the World Health Organization breastfeeding growth charts

Medical issues

Sometimes, mothers have medical issues that can cause low milk supply including:

• Severe postpartum bleeding or hemorrhage (more than 1,000 ml). You can ask your healthcare provider about blood loss during labor and delivery
• Treatment with magnesium sulfate before birth for high blood pressure or preterm labor
• Placenta pieces still remaining in your uterus (usually you will have severe cramps and heavy bleeding)
• No breast growth during pregnancy and after birth
• Breast surgery
• Untreated hypothyroidism
• Polycystic ovarian syndrome (PCOS)
• Obesity
• Diabetes
• Smoking
• High blood pressure

Your milk supply could also be effected if you received steroids during your pregnancy to help your baby’s lungs mature faster. This is often the case when clinicians know a baby will likely be born prematurely.

Other causes of low milk supply

• Poor latch — with or without sore nipples
• Flat nipples that make it difficult for the baby to latch
• Not breastfeeding or pumping often enough
• Change in feeding pattern (mom returns to work or baby sleeps through the night)
• Supplementing the baby with formula instead of breastfeeding
• Baby has a weak suck or poor endurance
• Baby has untreated tongue-tie
• If you have any of these issues, you should contact a lactation consultant or healthcare provider

Treatment for low milk supply

• Breastfeed or pump more often
• Massage your breasts before, during and after feedings
• Relax during breastfeeding or pumping
• Hand-express and/or pump after feedings
• Hold the baby skin-to-skin as much as possible (diaper-only baby on your naked chest)
• Improve latch with the help of a lactation consultant
• Medications such as Reglan® (metoclopramide) or Motilium® (domperidone)
• An herb called fenugreek has some research saying it may increase milk supply