E112: Low Milk Supply

The first days of feeding can feel like a maze: a sleepy newborn, an empty‑looking pump bottle, and a mind full of what‑ifs. We pull the fog back with clear ways to spot true low milk supply, from weight trends and diaper counts to weighted feeds and hunger cues, then map out what to do next without judgment or panic.

We walk through the twin pillars of milk production—effective milk removal and consistent stimulation—and show how small shifts add up: deepening latch and positioning, feeding 9–10 times in 24 hours, adding short post‑feed pumps, and leaning into skin‑to‑skin. We also tackle the big medical and situational factors that can shape your journey: thyroid issues, PCOS, insulin resistance, prior breast surgery, IGT, early hormonal birth control, long labors, cesareans, heavy IV fluids, and delays to the first feed. If you’ve been told to “just relax,” we explain why stress, severe sleep loss, and under‑fueling matter biologically and how to protect your basics.

Real stories ground the guidance. You’ll hear about parents doing everything “right” and still facing partial supply, what triple feeding looks like in practice, and how to transition to combo feeding with intention. We unpack the emotional weight of comparison culture—freezer stashes on social media—and offer a kinder metric for success: a fed baby, a supported parent, and a sustainable plan. Whether you’re troubleshooting a dip or navigating long‑term low supply, you’ll leave with practical steps, language for advocating with your care team, and permission to define success on your terms.

If this conversation helps you or someone you love, share it with a new parent, subscribe for more grounded birth and feeding guidance, and leave a review to help others find the show. Your support keeps these evidence‑based, compassionate chats coming.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Transcript

Setting The Stage: Milk Supply

SPEAKER_00 0:10

Welcome to the Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

How To Know Baby Gets Enough

Baby Factors And Latch Essentials

Parent Health And Medical Causes

Birth Events That Delay Milk

Stress, Sleep, And Nutrition Effects

Detective Work And Multi‑Pronged Fixes

Night Feeds And Timing Matters

IGT And Surgical Histories

Supplementing And Redefining Goals

Triple Feeding And Combo Feeding

The Relationship And Emotions

Comparison Culture And Grief

SPEAKER_01 1:02

And this is something that can be common. I know people have lots of um concerns and worries going into breastfeeding. Some people do, some people don't. Some people are very worried about things, some people are not worried at all. And probably neither of those is the best place to be. Like it's not great to worry about everything. It's also not great to absolutely worry about nothing and think that it's all gonna be fine. It might be. But in my experience, uh people need some pretty good support. Um, so I want to talk about milk supply and specifically low milk supply and kind of what is going on there. Um, that is a concern that some people have going into it. And one of the difficult things about breastfeeding, um, well, it's not that difficult, but we think it's difficult is how do we know baby's getting enough, right? And so if people are nervous going in about producing enough. Um, so this can be a stressful and an emotional experience for our breastfeeding parents. So um let's kind of talk about that a little bit. The reasons, the true legit reasons for low milk supply. Um, that's kind of what I want to dive into today because low milk supply can be real. Um, it also can be created. We can create low milk supply situations by, and I see it all the time, um, especially in hospital settings, by not doing enough um breast stimulation in the beginning. So sometimes if we have, you know, the hospital offers to take your baby overnight, they're gonna give bottles. So we've gone six, eight, ten hours without any breast stimulation, right there, that's setting us up for low milk supply based on behavior. But I want to talk about the type of low milk supply that is more frustrating, really, where the mom is doing everything she possibly can, she's doing all the right things, um, she's being diligent about pumping and latching and skin to skin and hand expression and all of the things, and still is faced with low milk supply. So let's talk about what that how do we know there's a low supply? One of the biggest factors is looking at the baby. So baby weight gains. So babies are gonna gain weight according to what they take in, obviously. We want babies to gain about one ounce a day for the first after the milk is established, anyway, for about the first four months of life. That's kind of the pattern we're gonna look for. Um, other ways to know babies are getting enough or not getting enough is wet and um poopy and wet diapers. So they're dirty diapers. If they're not getting um enough of those, what we expect expect to them to get, that might be an indication of low supply. Or it might be we have a fussy baby. We have uh not just fussy, but like a hungry baby that persistent hunger cues even after what looks like effective feeds. And I have seen hungry babies before, they kind of whimper a lot. There's uh like truly hungry babies are kind of gonna whimper a lot. Um, also checking a weight feed. If we don't have adequate milk transfer from a weighted feed, um, then that can help too. So milk removal, of course, breast stimulation drives up production is the goal. But here's the part I want to dive into. Sometimes that is not the case. And we look at other things. So um if we're doing all the right things and we're still not confident in or we're pretty sure the baby's not getting enough, um, we look at some of the most common causes, like how, you know, there's baby stuff, there's mom stuff. Those are our two players here. Um, some of them are like, okay, how's the latch? How's the um oral anatomy of the baby's mouth? Um, what's, you know, are we are we scheduling things in? Is that kind of being a problem if we're overscheduling things or not feeding enough? We sometimes we get super tired babies are kind of lethargic and they don't eat enough. They don't eat frequently enough, they don't get enough every time they eat, and they just kind of live on this low level. But um, usually they're kind of um whimpery about that. Um, or it could be ineffective removal methods based on a pump or pump fitting or flange fitting. So that's another thing we want to look at. Um, so with those, we would pretty simple fixes adjust the latch, deepen the latch, get that baby nice and close to the mom to help with supply. Um, other things we would look at, things with the mom, um, that might be hormonal or medical causes. It could be any thyroid disorders, um, prior breast surgeries, um, it could be PCOS, um, some insulin resistance, might be retained placenta fragments, it might be a high blood loss at birth that takes a while for the milk to come fully in. It might be IgT, something's called um insufficient glandular tissue, which there's not enough mammary glands to build make a full supply. Um, it could be hormonal birth control that started very early on in postpartum when the the hormones that make and push milk are trying to regulate and um and do their thing. Other other factors can come in in the early days. That might be the type of labor. Um, like if we had a really long labor, cesarean births also. A cesarean birth can delay onset of milk. Sometimes getting a lot of IV fluids during um labor can delay milk. We've got a lot of fluids in the body and they're kind of compressing those glands that are trying to make milk. Sometimes, if we have, for whatever reason, the mom and baby were separated, maybe baby's in NICU or something, um, and mom was not pumping, or we delay that first feed for a number of hours, that can kind of delay milk too. Um, so those are some factors that go back to the birth. And then some could be um just extreme worry about it, which is interesting when moms have high cortisol and they're when they're like experiencing stress about that and worry, and this is not a blaming kind of way, it's just philosophically, this can impact milk supply. Um, if moms aren't getting enough calorie intake after having a baby or um or hydration, um if they're incredibly sleep deprived, I mean, sleep deprivation is part of newborn period. Um, if maybe their anxiety is about it, that can impact supply too. Um so, so addressing all these possible issues, this is like detective work. And I'm thinking of a couple cases I've had over the last couple of months that have really stretched me um and made me kind of uh look in nooks and crannies and find every little thing, like, why is this, you know, we're doing all the right stuff. And we've got willing players, right? Um, some of the clients I work with as a lactation consultant would um, you know, certain challenges present themselves, um, legit challenges, and people like, okay, awesome, let's back way off of that goal and and shift goals. Other people are gonna hang on pretty tight to their goal of of breastfeeding or exclusively breastfeeding. And there's no right or wrong. Again, not a judgment call, or just some people are um their drive, their dedication for it is runs a little deeper than others, and that's so fine. Um and but if it's difficult though to have that kind of that kind of dedication, it can be challenging. Um so some sometimes we think of cluster feeding as a low supply, right? We think of fussiness as a low supply, and it might not be. Um, but the those true signs are babies wakings, peas and poops, um baby being satiated, hopefully at some point. So ways to increase supply again, as we're a detective, and a lot of times the solutions to things are not a one switch that fixes everything, but it might be several approaches from different angles that might um help that. So some of the moms I've been working with lately with this particular challenge in mind is to increase the number of feedings. So we might go from um, you know, one of those doing like seven or eight a day, so we move it to like nine or ten a day. Um, working on an effective latch, a deep latch that's gonna be able to be back on the ducts and pump the milk where the baby's gonna be able to keep sucking, right? Um, adding pumps after feeds will help. Um doing skin to skin time nighttime feeds too. Nighttime feeds are important. The early prime time for milk production is from about midnight to 6 a.m. So sometimes we have a well-meaning partner or um we have a postpartum doula or a family member in town, like, oh, I got the night for you. I will take care of the night for you, which can be awesome on sleep and recovery. Um, but if we go a whole night without breast stimulation, that could be challenging to the supply as well. Um, so a couple cases I'm thinking of lately. One of them, the mom um has IgT, so that's insufficient glandular tissue, and so dedicated to breastfeeding um that sometimes, quite often, moms with IGT, and IgT kind of has a specific look to the breast to it, um, kind of more conical, and the areola is uh a little bit of a different shape. Sometimes the breasts are not the same shape, and that's very common actually for a lot of people, might be a little more pronounced with IGT. Um, and maybe one breast changes during pregnancy and the other one doesn't, or maybe neither of them do. So IgT is is a legit thing that can cause lower milk supply or only a partial milk supply. Um and so what we'd look at here is perhaps supplementing. This is the same thing with moms who have had a breast reduction or some kind of breast surgery, sometimes even like something as simple as a biopsy can go in and disrupt those tissues and impact the supply, um, even if it's years after it has happened. So we may look at realistically supplementing in those cases. Now, to some moms, that's devastating. To other moms, that's a breath of real, you know, a breath of relief like awesome, I don't have to do all this work. Um, but any kind of feeding the baby is a success, right? One time, uh gosh, years ago, somebody said to me, and I've loved this, it's always stuck with me. If the only um breast milk that a baby gets is that first latch after delivery, um where we have 20, 30 minutes of a latch and that baby gets a few drops of colostrum, that is an incredible gift that can never be replaced. So, you know, if a baby gets one day, one week, one month of breastfeeding, that is an incredible gift that nobody else can provide for that baby. So some people are very apt to supplement, some people are not. Another thing to do would be triple feeding. This is not sustainable long term. Another mom I have been working with, I'm thinking of, has been doing triple feeding for gosh, probably about three weeks now. Um, it's a very curious case because it's her, um, she's had multiple babies before, never had a problem with breastfeeding, never had a problem with um babies latching and getting enough and being really chunky. And um, and this particular baby is just really giving her some challenges that way in that he was losing weight. Um, and it's been very difficult to get her supply up in any way with all the things that she's tried, and she's tried a lot of things, and it it's a journey to get to the place where you're like, okay, supplementing is not a failure. Um, feeding the baby in any way is awesome. That's where the success comes in. So she's kind of settling into like, okay, it's looking like I'm gonna be a partial producer. Um, but it's also important to protect that milk supply if we want to be a partial producer, right? So triple feeding, triple feeding includes latching the baby at the breast. That's feeding type number one. Um, pumping that's number two effort to increase supply if the latching at the breast isn't effective where we need more breast stimulation. And the third part of triple feeding is feeding the baby with a bottle after you've breastfed them, pumped. And that bottle might be pumped milk, it might be um supplement in another way, whether that's formula or donated milk or something like that. Um, that is a lot of work. So if you can imagine doing that every time the baby feeds, um, some people do it a few times a day, some people do it all the time. Pumping to replace bottles. So if baby gets a bottle, mom needs to pump in that um in that arena, if we were to say that. And then combo feeding, combo feeding is breast and bottle, right? So some people with their awesome dedication to breastfeeding, that's a really hard um reality to accept. But combo feeding and being able to feed the baby some bottles, some pumps. So some of the babies I've been seeing um I can think of in the last several weeks, that's kind of where we've gotten to, where we're doing a little bit of both. And donor milk is definitely something that can be um considered for that, as well as um formula. Um, that is also an option that people can use. So this is uh as we look at breastfeeding as a relationship, right? We have a relationship involving several components here. We have um the breastfeeding person, we have the baby who's eating, we have the support team around that. Um, we have the how the person who's breastfeeding feels about breastfeeding, we have how the baby who's eating the food feels about breastfeeding. It's kind of a complex um relationship. We've got a lot of factors that can go into a legitimately low milk supply. There's also an emotional component to this. I think that like is one of the hardest things because some people put their identity in or their success, they measure their success as a parent in how well they're able to breastfeed, or if they're able to solely breastfeed. So they put a lot of pressure on themselves. And maybe that pressure comes from other places, other family members, other friends, or partners. Also, there's a comparison culture. Just um this week I was visiting a mom with low supply and um she's cried several times, and I don't blame her. Like she's she's uh emotionally distraught about this, but she said, gosh, like I'm so I feel so misled. There's all these freezer moms online on Instagram, on TikTok, who have just freezers full of milk. She's like, I want to be a freezer mom. Um, so we're comparing, right? We're comparing, and that oversupply can be a problem too, not as common. Um, some people are gonna have some grief and mourn that they are not able to feed the baby the way they want to or feel guilty, guilty that they're not, that the baby's hungry, that the baby's not gaining enough. Like it is a lot of pressure to keep this tiny baby going every day, right? To if we put this pressure on us to keep them alive, right? Um, so kind of feeling also like your body failed or you did something wrong, which is not the case. Um, and so so many times it's um several different things. So if this is the case, using compassion, feeling, letting yourself feel compassion. Um, I know I feel it for clients when I work with them, and it kind of does just break my heart. There's some really tough, really tough situations when we're working so hard. And for um, you know, we're we're going down all the rabbit holes, we're turning no stone left unturned as we're trying to increase milk supply. So giving some compassion to self as well, um, and reaching out to support networks. There are others out there who have had similar experiences, right? Um so so I I guess like what I want to encourage here, I want to give a huge shout out of compassion because I'm thinking of three or four clients I've had lately who have had this challenge when they are doing seriously every single thing that they can do. And um and time, time is another thing, and a couple of them are waiting on time. Um, so so give some compassion, reaching out for support, whether that's professional lactation support, um, whether that's uh just emotional support, sometimes taking a break and doing something that's not bright baby or breastfinging related can be very helpful as well. Um, so I guess with this episode, really being gentle to those who have a lower supply side. Because I'm feeling it right now. I'm feeling it with my clients and um and understand how heartbreaking that can be. And there's so many things, right? So many things that can add to that. Um so if you know someone who's had a low supply, reach out and give them a hug in some kind of way. Um maybe donate them some milk if you have some extra. If people are open to that, I think that can be a really great way to help as well. Um, I'll be delivering a little bit of donated milk to someone this weekend, I think. So um that is a pretty awesome showing of love and support as well. So, those of you with low supply, be good to yourself. Um, be gentle to yourself. You know, you're doing all the things, and any any feeding of your baby is an incredible gift. That baby um loves you, and um, you can't go wrong really buy that baby. They they haven't read the books, they haven't uh, you know, they they uh are pretty easy, they're pretty forgiving to us. And then because we are not perfect parents and babies are pretty, pretty resilient about that. So hold that baby, love that baby, um, and find the ways that you can to uh be able to feed your baby. Lots of love to you. Um hopefully as we wrap up this episode, I I uh I just want you to be gentle to yourself and if you're working with low supply, and as always, please go out, make a connection with someone today, reach out and make a difference in their life. It's important. We need each other. See you next time.

SPEAKER_00 18:42

Episode credits will be in the show notes. Tune in next time as we continue to explore the many aspects of giving birth.