Breastfeeding Basics: Monitoring Your Milk Supply

I've breastfed four babies and I believed my supply was failing with every one of them. It was failing with none of them.

That goes at the top because low supply is one of the most common worries in the first months and one of the least common actual problems. Most of what convinces a mother her milk is going is normal, and knowing which is which is the difference between a difficult fortnight and stopping something you didn't want to stop.

The three things that tell you

Output, weight and behavior, with everything else being noise. Diapers first, because they're the measurement you have at home. From about day five, six or more heavily wet diapers in twenty-four hours, with pale, near-odorless urine, and at least two yellow stools a day in the early weeks. Stools become less frequent after about six weeks in breastfed babies, which is normal and alarms everybody. Weight second. Up to about ten percent loss in the first days, birth weight regained by around two weeks, and then steady gain along her own line on the chart. The line she's following counts far more than which line it is.

Behavior third. She's alert when awake, has periods of contentment, and comes off the breast relaxed. A baby who's underfed isn't a baby who fusses in the evening. She's a baby who's sleepy, difficult to rouse, and hard to wake for feeds.

What a good feed looks and sounds like

You can tell a great deal from watching one, once you know what you're looking at.

A deep latch takes in a good portion of the areola, and her chin is pressed in with her nose clear. The rhythm changes as the feed goes on: quick shallow sucks at the start to trigger let-down, then slower, deeper drawing with a pause at the bottom of each suck, which is the swallow. You can often hear it as a soft swallowing sound, quite unlike a click.

Clicking, smacking, dimpled cheeks or pain are all signs the latch needs adjusting, and pain in particular is information. Breastfeeding shouldn't hurt beyond the first few seconds.

If any of that is uncertain, have somebody watch an entire feed in person. This is the highest-value thing available in the early weeks and it's the one most often skipped. I skipped it with my first, I think out of pride.

Five normal things mistaken for low supply

I've been caught by every one of these.

• Softer breasts after the first few weeks. Supply regulates to demand at around six to twelve weeks and the engorged feeling goes. This means it's working.
• Cluster feeding in the evening. Frequent, on-and-off, apparently dissatisfied feeding from late afternoon is normal behavior and it's what drives supply up.
• Shorter feeds. A newborn takes forty minutes; a practiced three-month-old takes eight. Efficiency isn't decline.
• Getting very little when pumping. A pump is far less effective than a baby at triggering let-down, and pump output is a poor proxy for what she's removing.
• A baby who wants feeding again an hour later. Breast milk digests quickly, and growth spurts at around three weeks, six weeks and three months produce a few days of near-continuous feeding that then resolves.

Signs that deserve acting on today

These are the ones that aren't on the reassurance list.

• Fewer than six wet diapers a day after day five, or dark, strong-smelling urine.
• No weight gain, weight still below birth weight at two weeks, or crossing downward through centiles.
• A baby who's sleepy, floppy, hard to rouse, or has to be woken for most feeds after the first week.
• Persistent brick-dust or orange crystals in the diaper after day three.
• Dry mouth, no tears, or a sunken soft spot, which needs same-day assessment.
• Feeding that has become constant and frantic with no contented periods at all.

Any of those means a call today.

If supply is low

The mechanism is almost always removal, so that's where the work goes.

Feed more often, from both sides, and let her finish the first before switching. Fix the latch with in-person help, since an inefficient latch is the most common underlying cause. Add pumping after feeds to increase demand. Skin-to-skin helps, and so does taking the baby to bed for a couple of days and doing very little else.

Look at the reversible causes too: certain hormonal contraceptives, some medications, retained placenta, thyroid problems, significant blood loss at delivery, and previous breast surgery all affect supply and all want a doctor, whatever the herbal remedy promises. Galactagogues, prescribed or otherwise, are a distant second to effective and frequent removal.

If supplementing is needed

Then supplement, and there's something to say about that.

A fed baby is the requirement and everything else is preference. Combination feeding is a completely legitimate outcome, and a mother who supplements hasn't failed at something. I've watched friends damage themselves badly over this, and no baby has ever benefited from an exhausted parent chasing an ounce.

Do it with support if you can, so that supply is protected where you want to keep it. Offer the breast first, supplement after, pump to maintain demand, and use paced bottle feeding so the bottle doesn't become the easier option by default. Take advice on how much and how often from somebody who has seen your baby.

What the research says

• Huang et al. (2022), Maternal & Child Nutrition 18: The rates and factors of perceived insufficient milk supply: A systematic review
• NHS. Breastfeeding: is my baby getting enough milk?
• UNICEF UK Baby Friendly Initiative: Responsive feeding

This guide is general information, written to help you understand a topic and ask better questions. It is not medical advice and does not replace your own doctor, midwife or paediatrician. Anything that worries you about your baby belongs with them.

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