Postpartum With a Newborn and Low Milk Supply: A Gentle, Evidence‑Based Guide
You are not failing. Low milk supply is common, often fixable, and you and your baby can still thrive. This guide offers practical steps you can start today, plus when to seek extra help. Every feeding—breast, expressed milk, or formula—is an act of caring for your baby and yourself.
How milk supply works (and why it sometimes dips)
Milk production runs on supply and demand: the more thoroughly and frequently milk is removed, the more your body is signaled to make. Early and frequent milk removal in the first 2 weeks is especially important for establishing your long‑term supply (AAP 2022; WHO 2018). Birth factors (cesarean, significant blood loss, retained placenta), certain health conditions (thyroid disease, anemia, PCOS, insulin resistance, insufficient glandular tissue), medications (combined estrogen birth control, pseudoephedrine), ineffective latch, or infrequent feeds can contribute to low supply (ABM 2017; ACOG 2021; CDC 2024).
How to tell if your baby is getting enough
Watch the baby, not just the clock. Signs of adequate intake include hearing/seeing swallowing at the breast, relaxed hands and body after feeds, and appropriate diapers and weight gain. Typical diaper patterns: day 1–4 of life, roughly one more wet diaper each day (1 on day 1, 2 on day 2, etc.); after day 5, at least 6 wet diapers and 3–4 yellow stools per day. Many breastfed babies stool less often after the first month; weight gain becomes the key marker (AAP 2022). Most babies lose up to 7% of birthweight in the first 3–4 days and regain birthweight by 10–14 days. If there’s >7–10% loss, few stools, dark urine, marked jaundice, lethargy, or poor feeding, contact your pediatrician promptly (ABM Protocol #3; AAP 2022).
A step‑by‑step plan to protect and build your supply
Step 1: Prioritize frequent, comfortable latching
Offer the breast at least 8–12 times in 24 hours. Aim for a deep latch: baby’s tummy to yours, nose level with nipple, chin touching breast, wide mouth with more areola seen above than below, and no pinching pain. Use breast compressions—gently squeeze the breast when sucking slows to help milk flow—then switch sides when swallowing decreases (“switch nursing”) (ABM 2017).
Step 2: Add skin‑to‑skin contact
Hold your baby skin‑to‑skin on your bare chest as much as you can, especially before feeds. This increases feeding cues, stabilizes baby, and boosts milk‑making hormones (WHO 2018; AAP 2022).
Step 3: Remove milk effectively—by baby, by hand, and by pump
If your baby isn’t transferring well yet, protect supply by expressing milk early and often. In the first days, hand expression can yield more colostrum than a pump and helps milk “come in” (ABM 2017; AAP 2022).
Practical plan: - After most feeds, hand express or pump for 10–15 minutes. If baby isn’t latching or is very sleepy, aim for 8–10 expressions per 24 hours (including at least one overnight). - Use a hospital‑grade double pump if possible. Ensure proper flange fit: your nipple should move freely without rubbing; most people need 1–3 mm clearance around the nipple. Pain or blanching means the size may be off. - Try hands‑on pumping: massage, pump, pause to compress and “shake” the breast gently, then resume pumping to increase yield. - Consider “power pumping” once daily for a few days to mimic cluster feeding: 20 minutes pump, 10 minutes rest, 10 minutes pump, 10 minutes rest, 10 minutes pump.
Step 4: Supplement strategically when needed
Sometimes supplementation is medically necessary while you work on supply and latch. Use your expressed milk first, then pasteurized donor milk if available, then formula (ABM Protocol #3). Whenever possible, supplement in a way that supports breastfeeding—paced bottle feeding, cup, syringe, or an at‑breast supplementer—so baby still practices at the breast. Keep supplements to the amount baby needs to stay safe and satisfied, and reassess frequently with your pediatrician and an IBCLC.
Approximate intake by day of life (each feed): day 1: 2–10 mL; day 2: 5–15 mL; day 3: 15–30 mL; day 4: 30–60 mL; by 1–2 weeks: 60–90+ mL per feed, totaling ~450–800 mL/day for most term infants (ABM Protocol #3). Your team can tailor volumes based on weight, bilirubin, and transfer.
Step 5: Track and troubleshoot with data
Keep a simple log of feeds, pumping sessions, diaper counts, and baby’s behavior. If possible, do a “weighted feed” with a precise scale (before/after weight difference) with an IBCLC to measure milk transfer. If transfer is low, address latch, positioning, tongue‑tie/oral anatomy, and consider temporary tools like a nipple shield under guidance—pump after shield use to protect supply (ABM 2016; ABM 2021).
Check for reversible causes in you and your baby
Baby factors: tongue‑tie or oral motor issues, prematurity or late preterm sleepiness, jaundice, or ineffective suck. Maternal factors: significant postpartum blood loss or retained placenta (can delay milk), thyroid dysfunction, anemia, PCOS/insulin resistance, insufficient glandular tissue, prior breast surgery, pain or stress, and certain medications (ABM 2017; ACOG 2021). Discuss symptoms such as fatigue, hair changes, cold intolerance, heavy bleeding, or breast changes with your clinician; targeted treatment can improve supply and your overall health.
Medications, herbs, and foods: what we know
Galactagogues (substances that may increase milk) work best only when effective milk removal is in place. The Academy of Breastfeeding Medicine recommends first optimizing latch and expression; medications or herbs are considered case‑by‑case (ABM Protocol #9).
Prescription options: Metoclopramide may temporarily increase supply but often causes side effects like fatigue or mood changes; it is generally used short‑term, if at all. Domperidone is used in some countries but is not FDA‑approved in the U.S. due to concerns about heart rhythm effects; any use requires medical supervision and screening for cardiac risks (ABM Protocol #9).
Herbal options: Evidence is limited or mixed. Moringa (malunggay) shows modest increases in small trials; fenugreek is widely used but can cause GI upset, maple‑syrup body odor, and interacts with some medications and conditions (e.g., diabetes, thyroid disease). Goat’s rue and shatavari lack robust safety/efficacy data. Discuss supplements with your clinician and monitor your and baby’s reactions (ABM Protocol #9; Cochrane reviews).
Nutrition and fluids: Eat to appetite, including protein, whole grains, fruits/vegetables, and healthy fats. Most breastfeeding people need about 330–400 extra calories per day. Drink to thirst; forcing excessive fluids doesn’t increase supply (CDC 2024; AAP 2022).
When to seek urgent care
Call your pediatrician promptly for signs of dehydration (fewer than expected wet diapers, very sleepy baby, sunken fontanelle), worsening jaundice, fever, or ongoing weight loss. Seek maternal care for heavy bleeding, fever, severe breast pain with redness (possible mastitis), chest pain, or mood changes with thoughts of self‑harm (AAP 2022; ABM 2014).
Protect your mental health
Low supply can feel heartbreaking. You deserve support. Postpartum mood changes are common; if sadness, anxiety, or intrusive thoughts persist beyond two weeks or interfere with daily life, reach out. Tools like the Edinburgh Postnatal Depression Scale can help screen, and effective treatments are available and compatible with breastfeeding (ACOG 2021). Remember: combination feeding is breastfeeding, and your bond with your baby is built on responsiveness, not ounces alone.
Practical everyday tips
Set a gentle rhythm: feed at early cues (stirring, rooting, hands to mouth), not just crying. If baby is sleepy, try diaper change, skin‑to‑skin, or a few drops of expressed milk on the nipple to entice latching.
Use warmth and massage before feeds or pumping; cool compress after if breasts feel swollen. If nipples are sore, start on the less sore side, ensure a deeper latch, and apply a bit of expressed milk after feeds; seek help for persistent pain (ABM 2016).
Night strategy: try one longer 4–5 hour stretch of sleep if baby is growing well, otherwise aim to remove milk at least once between 1–5 a.m. when prolactin is highest.
Consider your meds: avoid estrogen‑containing birth control until breastfeeding is established; progestin‑only options are generally compatible. Decongestants with pseudoephedrine can lower supply; choose alternatives after discussing with your clinician (ACOG 2021; ABM 2017).
Build your support team
Partner or family can help with diaper changes, burping, preparing snacks, washing pump parts, and paced bottle feeds while you rest or pump. Connect early with an International Board Certified Lactation Consultant (IBCLC), your pediatrician, and peer support (La Leche League, WIC). If supplementation is needed, ask about pasteurized donor human milk from accredited milk banks when available (HMBANA; ABM 2017).
Your plan, your success
Low supply is rarely a dead end. Most families see improvement with frequent effective milk removal, targeted troubleshooting, and the right support. Even if exclusive breastfeeding isn’t possible, any amount of your milk is valuable, and your responsiveness and love are what matter most. You are doing a wonderful job.
References (selected)
American Academy of Pediatrics (AAP). Breastfeeding and the Use of Human Milk. Pediatrics. 2022. https://publications.aap.org/pediatrics/article/150/6/e2022057988/189442
Academy of Breastfeeding Medicine (ABM). Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate. 2017 (reaffirmed/updated). https://www.bfmed.org/clinical-protocols
ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production. 2018 update. https://www.bfmed.org/clinical-protocols
ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. 2016. https://www.bfmed.org/clinical-protocols
Centers for Disease Control and Prevention (CDC). How to Keep Your Milk Supply. 2024. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maintain-supply.html
World Health Organization (WHO). Implementation guidance: protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services (Ten Steps). 2018. https://www.who.int/publications/i/item/9789241513807
American College of Obstetricians and Gynecologists (ACOG). Optimizing Support for Breastfeeding as Part of Obstetric Practice. 2021. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
Human Milk Banking Association of North America (HMBANA). Find a Milk Bank. https://www.hmbana.org/