breast feeding (insufficient milk supply)

Last reviewed 07/2023

"Insufficient milk supply" is the most common cause discontinuation of breastfeeding throughout the world

• in UK it was the cause in 66% of women who discontinued breastfeeding in the first two weeks after birth (1)
• concerns about insufficient milk supply can be perceived as insufficiency or low milk intake (2).

The most common cause of insufficient milk supply is the low intake by the baby (which leads to a decrease in production of milk). A low milk intake can be due to:

• breastfeeding factors
  • poor attachment
  • delayed initiation of breastfeeding
  • infrequent feeds, feeds at fixed times or no night feeds
  • short feeds
  • using bottles or pacifiers
  • use of a nipple shield
  • giving other foods or drinks
    
    
• psychological factors of the mother - depression, lack of confidence, worry, stress, dislike of breastfeeding
  
  
• baby's condition - illness, prematurity or congenital abnormality (palate defect, heart condition or kidney abnormality) (2)

True milk insufficiency is rare and can be caused by:

• prolactin deficiency
  • pituitary necrosis (Sheehan syndrome) and other causes of anterior pituitary dysfunction
  • medications - dopamine, ergot preparations and pyridoxine
  • nicotine, alcohol
• bulimia
• retained placental fragments
• breast surgery
• obesity
• postpartum haemorrhage (3,4)

Reference:

• 1. National Institute for Health and Clinical Excellence (NICE) 2005. The effectiveness of public health interventions to promote the duration of breastfeeding.
• 2. World Health Organization (WHO) 2009. Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals
• 3. UK Medicines Information (UKMi) 2010. Drug treatment of inadequate lactation
• 4. UK Medicines Information (UKMi) 2010. Which drugs can inhibit lactation?