Tuesday, December 17, 2013

Common breastfeeding concerns early postpartum: I don’t have enough breast milk!

A recent study examined first-time mothers’ breastfeeding concerns in the first weeks postpartum.  What they found from these interviews is that many mothers, about 40%, believed that they did not have enough breast milk.  So, why do so many women think that they don’t produce enough breast milk? While we don’t know the specific reasons these mothers were concerned about their milk supply, we do know from our own work that infant crying and waking in the first few days postpartum were commonly seen as hunger cues by new parents. Parents expected their babies would sleep and be content (not cry) if they were satisfied and full. So, if their newborns were crying a lot and not sleeping, they assumed the infants were not getting enough breast milk to satisfy them. While an extremely small number of women produce an insufficient amount of breast milk, for the majority of mothers, it is the perception that they don’t have enough milk that leads them to supplement with formula. That perception is often associated with the baby's behavior.

There is hope! When you know that it’s normal for your newborn to cry a lot and not sleep much in the early days, then you will be less likely to associate those behaviors with your baby being hungry  because you think you don't have enough breast milk to satisfy him. If you know that your baby needs to feed frequently and practice breastfeeding as much as possible then you won’t be surprised if your baby never seems to sleep! Having this information before you have your baby is the key!
It’s also important to be prepared for the reality of breastfeeding. For example, breast milk can take a while to “come in.” You may not feel any changes in your breasts for several days or even until after you leave the hospital. However, there is always breast milk present, even if you don’t feel it. In the beginning there is a small amount of colostrum, this is ALL your baby needs.  Soon, your breast milk will change (color and nutrient content) and increase in volume. This is when mothers think that their breast milk has officially “come in”, but it has actually been there the entire time, just in smaller amounts. This increase occurs anywhere between 24-72+ hours (15% of mothers' milk comes in after 72 hours postpartum) after delivery and depends on several factors. It’s also important to know that the amount of milk produced varies from woman to woman and even  from pregnancy to pregnancy.  You can see why many women think that they don’t have enough breast milk after their baby is born! It can be very confusing when a mom doesn’t feel the milk in her breasts and her  baby seems to be constantly crying and wanting to eat all the time. It’s a perfect storm that often leads to the perception that the baby isn’t getting enough milk.
Whether you or someone you know has had concerns about producing enough breast milk, know that you are not alone!  Here are a few other resources to help. The more you know about normal newborn behavior the more prepared and confident you will feel.

Answers to Mothers’ Common Questions about the First 3 Days Postpartum

Breastfeeding comes naturally, right? One story of a not-so-perfect start to breastfeeding

Life with a Newborn: Day 1

Life with a Newborn: Days 2 & 3


Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013;132(4):e865-75.




  1. I think it's important to note, though, that sometimes some women really don't have enough milk. It had never occurred to me that I wouldn't -until we took our five day old into the pediatrician after a day of nonstop screaming and discovered he'd lost a pound and a half. Weighed feedings with a lactation consultant revealed that, even with a good latch, he was only transferring 0.25 oz per feeding. We're lucky we had the appointment scheduled when we did- because I'd been told that not enough milk was a myth, I likely wouldn't have thought to question whether he was getting enough, and my child was already on the road to dehydration. After a month of desperate attempts to up my supply -supplements, pumping, everything- the lactation consultant suggested I had insufficient glandular tissue. Articles like this -suggesting that insufficient milk is a myth- are dangerous: I understand most women's worries are unfounded, but some of us really don't make enough.

  2. Articles like this, though well intended, can be detrimental to chronic low supply moms, those whom you describe as "... [the] extremely small number of women [who] produce an insufficient amount of breast milk."

    I am an admin of a support group for chronic low supply moms. Time and time again, I read accounts from our members who read articles such as this, and misinterpreted their baby's behavior as being normal when they were in fact severely dehydrated. Some don't know to seek help until several weeks later than they should.

    Instead of just listing normal baby behavior, you should also include a list of warning signs of when a mom should seek help from an experienced IBCLC, e.g., (1) insufficient wet & dirty diapers (2) baby not regaining birth weight by two weeks (3) baby not gaining 5-7oz/week in months 0-4 (per Kellymom) (4) baby sleeping all the time and not showing periods of wakeful alertness

  3. Thank you for both of the above comments on this post. Of course, we recognize that there is a proportion of mothers who do not produce enough milk, and while biological or metabolic issues are fortunately quite rare, there are other reasons (misinformation or mismanagement of early challenges) that result in low milk supply and these reasons are often out of mothers' control. We have posted in the past about behaviors that need to be well-known warning signs.


    We invite you to review this and other posts and you will see that we seek to describe the range of newborn behaviors and circumstances and are not dismissive of mothers' very real concerns. Clearly, this post needed some reference to other posts that were more informative about the "red flags" that can come up. Thank you for this important reminder.