If you have recently become a parent, you may want to provide your baby with all the necessary nutrients through your breast milk. Breast milk is the perfect food for a newborn baby, and therefore, if possible and if you wish, breastfeeding your baby is a great option.

Although lactation is a natural process, in reality, it can be complex, challenging, and sometimes painful, especially at the beginning. For many mothers, the first days or weeks are filled with not only pleasant moments but also doubt, fatigue, and even frustration. Holding your baby correctly to breastfeed can be a difficult task without causing pain. If you feel intense pain, are experiencing cracks, or if your baby is constantly coming off and re-latching, it is likely that the hold is not appropriate.

In these situations, it is very important to ask for help: consult your doctor, midwife, pediatrician, or a lactation consultant (IBCLC advisor, support group, etc.). A small adjustment in the holding position, how you present the breast, or the sucking technique can change everything. The change can be very positive and help you enjoy breastfeeding more.

In addition to providing a good hold and a comfortable position, you should also keep in mind another important point: there are many factors that affect breast milk production. Knowing these can help you develop a better understanding of what is happening and make more confident decisions without feeling guilty.

Establishing, maintaining, and even increasing breast milk production is only part of the success of breastfeeding, but it is a very important aspect that is often misunderstood by both mothers and some professionals. Especially at the beginning, it is completely natural to have many questions such as whether you are producing enough milk, whether your baby is going hungry, whether the breast is emptying, and whether your baby wants to suck frequently.

Evidence shows that most mothers can produce enough milk through frequent and on-demand breastfeeding, and maintaining skin-to-skin contact with their babies also supports this process. However, in some cases, medical issues, birth conditions, or problems related to breastfeeding management can reduce milk production. These conditions are known as hypogalactia (low milk production) and can be temporary or permanent.

Knowing the factors that affect milk production allows you to take action in a timely manner. Below you will see the main factors that can reduce breast milk production; these can be of medical origin or related to breastfeeding management and the environment.

Factors Reducing Milk Production Related to Breastfeeding Management

Before considering illnesses or complex reasons, it is important to review how breastfeeding is managed. The baby's frequent and effective sucking and the emptying of the breast are the main stimuli for the body to produce milk. If this stimulation is not sufficient or appropriate, milk production may decrease even if the mother is healthy.

Insufficient Hold or Improper Position

A shallow hold, where the baby only takes the nipple and not a large part of the areola, can cause sucking to be painful and ineffective. This has two consequences: The baby receives less milk than they could, and therefore the breast receives the signal to produce less milk; additionally, the mother may develop cracks, intense pain, and reluctance to breastfeed, which reduces the frequency of breastfeeding.

Signs of insufficient hold may include: constant pain, deformed nipples after sucking, making noises during sucking, the baby falling asleep too early, frequently coming off and re-latching, or appearing angry towards the breast. Improving the hold and position often provides a quick reversal of hypogalactia caused by poor management.

Not Offering the Breast Frequently or Limiting Sucking Time

Milk production follows a simple rule: as the amount of milk coming from the breast increases, more milk is produced. If feedings are done at very long intervals, strict time frames (for example, every 3 hours) are applied, or if the baby is taken off the breast after a few minutes, the breast is less emptied, and the body thinks it needs to produce less milk.

The current recommendation is to breastfeed on demand: offer the breast every time the baby wants it, without looking at the clock and without restricting the duration. It is common for a newborn to breastfeed 8-12 times a day; it can even be more during certain growth spurts. Frequent breastfeeding does not usually indicate low milk production; most of the time, it is a normal part of the baby's and breast's adaptation.

Those Using Pacifiers, Bottles, and Nipple Shields

Using pacifiers and bottles in the first weeks can lead to nipple confusion, meaning the baby learns a different sucking pattern, which can make a deep latch more difficult. This can lead to less effective breastfeeding and therefore less milk production.

Many guidelines recommend avoiding the use of pacifiers and bottles until breastfeeding is well established; this is usually after the first 4-6 weeks, unless there is a medical condition or advice from a breastfeeding specialist. Nipple shields should also only be used in very specific situations, evaluated by a professional, as they can make it harder for the baby to get the richer milk at the end of breastfeeding.

Use of Ineffective Breast Pumps

When the baby is in the hospital, has difficulty sucking, or when the mother needs to express breast milk, the type of breast pump used and how it is used can make a significant difference. A weak, improperly adjusted, or incorrectly sized breast pump may not empty the breast well and can send signals to the body to produce less milk.

To ensure and maintain good milk production, a hospital-grade electric double breast pump is generally recommended, and expressing milk at least 8 times within 24 hours should take about 100 minutes a day. Massaging the breast and manually expressing at the beginning and end of each session helps to empty the breast better.

Medications for Cold or Allergy

Some medications can affect milk production. Pseudoephedrine is a compound found in many medications commonly used for colds and allergies, and can reduce breast milk production. This is not good news for mothers with severe seasonal allergies, but there are important nuances.

In general, a single dose of pseudoephedrine is unlikely to significantly affect milk production when breastfeeding is well established. The problem arises when these medications are taken repeatedly or when taken during the first days and weeks after birth; during this period, breastfeeding is still being regulated.

Therefore, it is always recommended to avoid these medications during the early period and it is important to look for alternatives that are compatible with breastfeeding. When you need to take medication, it is important to consult your doctor, pediatrician, or review expert resources about the compatibility of medications with breastfeeding. In most cases, there is a safe alternative that does not jeopardize milk production.

Postpartum Hemorrhage, Puerperium, and Difficult Birth

Postpartum hemorrhage is a condition that every woman experiences to a greater or lesser extent, but when blood loss is excessive or the birth is very traumatic, hormonal function can be affected, which can impact breastfeeding.

Significant bleeding can affect milk production, especially if accompanied by low blood pressure, severe anemia, or the need for a blood transfusion. In very rare and severe cases, excessive bleeding can damage the pituitary gland; this gland is responsible for the production of prolactin and oxytocin; this condition is called Sheehan's syndrome and can lead to very low or no milk production.

Additionally, if the mother is hospitalized due to bleeding and is separated from her baby in the first hours or days, this may also negatively affect the initiation of breastfeeding. Skin-to-skin contact and frequent sucking are very strong signals to initiate milk production.

However, if the milk comes in late (sometimes up to 7-14 days), this does not mean that there will be insufficient milk production in the future. When the mother recovers, frequent breastfeeding or pumping milk, applying skin-to-skin contact, and seeking professional support can help normalize production. In some cases, it may be necessary to carefully monitor the baby's weight and provide temporary supplementation if there is excessive weight loss.

Thyroid Problems and Other Hormonal Disorders

Both hyperthyroidism and hypothyroidism can affect breast milk production. The thyroid gland helps regulate key hormones for breastfeeding, such as prolactin, which is responsible for milk production, and oxytocin, which affects milk flow.

Postpartum thyroiditis is a condition where the thyroid gland becomes inflamed after childbirth and can occur within the first year; this can affect both the mother's overall health and milk production. This condition affects approximately 9% of women in the first year after childbirth and can manifest with symptoms such as extreme fatigue, intolerance to cold or heat, sudden weight changes, palpitations, anxiety, or hair loss.

If you notice that your baby is not gaining enough weight, breastfeeding sessions are taking too long, and the baby still seems unsatisfied, or if you observe a drop in your milk production for no apparent reason, one of the first things to do is to evaluate thyroid function through analysis. If you notice that your baby is not getting enough breast milk, one of the first steps is to check your thyroid and discuss it with your healthcare professional. The good news is that most treatments for thyroid disorders are compatible with breastfeeding, and by managing the underlying issue, many mothers can return to an appropriate level of production.

Other hormonal disorders that may affect breastfeeding include conditions such as polycystic ovary syndrome (PCOS) or a history of long-term amenorrhea during adolescence. In some of these cases, the breast may have developed less milk-producing tissue, which can limit maximum production capacity. Still, with special support, many women with this history can breastfeed; sometimes through mixed feeding or other personalized strategies.

Some Herbs, Spices, and Phytotherapy Products

While some herbs and spices are said to increase milk production (galactagogues), others are reported to decrease it. Those said to potentially reduce milk production include saffron, mint, oregano, lemon balm, parsley, or thyme; however, scientific evidence on this is limited.

There's no need to worry: moderate consumption in your normal diet (in light infusions, as spices in meals, etc.) generally does not pose a problem. Cooking with these herbs or using them occasionally should not significantly affect your milk production.

However, caution should be exercised particularly with the consumption of concentrated oils, supplements, or phytotherapy products derived from these plants. The concentration of active ingredients in these products is much higher than what is obtained through a normal diet, and some substances may affect breastfeeding or may not be safe for the baby.

If you have any doubts about the use of any herbal medicine, supplement, or "natural" product, it is best to always consult your doctor, midwife, or a qualified professional. Similarly, it is recommended to avoid alcohol and tobacco consumption and to limit caffeine, as these can negatively affect both the baby and breastfeeding.

Birth Control Pills and Other Hormonal Methods

Returning to fertility after childbirth and the choice of birth control methods can also affect breastfeeding. Most hormonal birth control methods can somewhat affect milk production.

Options that contain only progestin (synthetic progesterone), such as some progestin-only pills, implants, or certain injections, are generally more compatible with breastfeeding and are less frequently associated with a reduction in milk production compared to combined methods (estrogen + progestin).

However, some mothers report a decrease in milk production even with progestin-only birth control methods when initiated immediately after childbirth. Therefore, if you have concerns about hormones and breastfeeding, it is important to clearly discuss with your doctor or healthcare provider and express that maintaining milk production is a priority for you. Together, you can evaluate the best option and may consider non-hormonal methods if necessary.

Previous Breast Conditions and Breast Surgeries

Some women may have breast characteristics that could limit milk production. For example, breast hypoplasia (breasts with insufficient glandular tissue) can lead to conditions such as breasts that are very separate, tubular, significantly different sizes from one another, or show little change during pregnancy.

Another common condition is having undergone breast reduction surgery or having had interventions on the areola and nipples. These surgeries can cut milk ducts, nerves, and some of the milk-producing tissue; this often results in insufficient milk production to maintain exclusive breastfeeding, especially with the first child.

In these cases, the goal may be to provide the best possible breastfeeding (sometimes mixed) and a specialized team may need to provide support with a breast pump, relactators, and other tools. Hypogalactia may not always be fully reversible; however, with appropriate support, many mothers succeed in breastfeeding, provide supplementation when needed, and maintain the bond and comfort that breastfeeding offers.

Obesity, Diabetes, Cesarean Section, and Other Maternal Factors

Some maternal health conditions can also be associated with delayed milk production or temporary hypogalactia:

  • Obesity and diabetes (including gestational diabetes) can delay lactogenesis, that is, the transition from colostrum to mature milk beyond 72 hours.
  • Emergency or planned cesareans, especially if the mother has not initiated labor, can be associated with more fear, stress, and an environment that negatively affects early breastfeeding. Fear and intense pain can temporarily inhibit milk production.
  • Retention of placental remnants in the uterus can prevent the body from receiving the precise hormonal signal for milk production and may cause colostrum to remain longer than expected.

In all these situations, the key measures are quite similar: frequent skin-to-skin contact (as soon as medical conditions allow), offering the breast on demand, using a strong breast pump when the baby cannot latch well, monitoring the baby's weight, and providing supplementation if necessary; always aiming to ensure that breastfeeding is reinforced as production improves.

Stress, Fatigue, Pain, and Negative Environment

The postpartum period is a phase of profound changes both physically and emotionally. Intense stress, lack of rest, poorly controlled pain, or an environment that does not respect breastfeeding can affect oxytocin, which is the hormone that helps milk flow from the breast.

Stress typically does not permanently "cut off" milk production, but it can lead to delays in milk flow or a less effective let-down reflex; this can create a feeling of having less milk. Creating a calm environment, asking for help with household chores, delegating when possible, and seeking emotional and professional support can make a significant difference.

Mastitis, Breast Engorgement, and Other Breast Complications

After a mastitis (infection or inflammation of the breast gland), many mothers notice a decrease in milk production in the affected breast for a while. When the inflammation decreases and balance is restored, production usually returns. It is generally recommended to continue breastfeeding from the affected breast (unless there is a medical counter-indication), to empty the breast well, and to continue the prescribed treatment.

Breast engorgement (very hard, full, and painful breasts) can also affect the baby's latch and production at the beginning of breastfeeding. To prevent and treat this, it is important to offer the breast frequently, use gentle warmth and massage before latching, apply cold after feeding to reduce inflammation, and if the baby cannot empty the breast, to express milk manually or with a pump.

What Should You Do If You Have Concerns About Your Milk Production?

If you still have concerns about your milk production despite all this, you should first not stop breastfeeding on your own. Continue to offer the breast to your baby frequently and seek professional help as soon as possible: a midwife, pediatrician, lactation consultant, or a specialized support group.

Some common strategies to increase milk production include:

  • Ensuring a good latch and position, reviewed by someone experienced in breastfeeding.
  • Increasing the frequency of breastfeeding or pumping, 9-12 times a day in cases of hypogalactia, including nighttime feedings.
  • Engaging in prolonged skin-to-skin contact, as this stimulates breastfeeding hormones.
  • Switching breasts and offering both breasts twice at each feeding if possible.
  • Expressing milk after feedings to empty the breast further and stimulate the milk glands more.
  • Paying attention to your nutrition, fluid intake, and rest, as much as possible during the postpartum period.

In some specific cases, your doctor may consider the use of galactagogue medications to support milk production; always evaluating the risks and benefits and keeping in mind that the key element is the stimulation of breastfeeding or pumping.

Milk production is usually sufficient in most mothers, and when challenges arise, it can often be restored with appropriate information, support, and management adjustments. And if your milk production remains low despite everything, you are neither less of a mother nor do you love your baby any less: excellent formula milks and donated milk banks ensure your child’s healthy and strong growth; during this process, you can continue to enjoy the breastfeeding experience, which is also an important part of bonding, contact, and love, even if this process is not entirely breastfeeding.