The Low Supply Talk

You know that conversation. It’s probably not your favorite to have. Maybe you’ve been working with someone for a while and their milk supply is just not going up like you’d expect. It’s time to have the low supply talk. 

This can be especially nerve-racking for new practitioners who aren’t sure what approach works best, but more experienced ones also know that parents don’t always react well to this information. And for good reason; it’s really hard to hear, and the breastfeeding and perinatal establishment has led many of us to believe that everyone can make enough milk if they just do things right. So it follows that learning that milk supply will probably not go up can lead to a spiral of self-blame, regret, anxiety and depression. It’s something we often discuss in our low supply support group.

Given that, lactation consultants and other perinatal-focused clinicians are well-positioned to prepare clients and patients for this news. And other professionals, such as doulas, can help support our population too. 

You’ll have the best chance of being successful if you are thoughtful about the mental health of at-risk patients well before their low supply is established.

What to do before you get to the low supply talk

Plant seeds early but with delicacy

As we mentioned, many of your patients go into this process believing the insidious myth that everyone can breastfeed, and a common lament in the low supply community is  “No one told me….”  If you notice risk factors for primary low milk supply, it is appropriate and important to present a view that a full supply is not a guarantee. At the same time, since many people who start out with low supply will go on to exclusively breast/chestfeed despite risk factors, it is also vital to approach this earliest stage carefully. Here are some examples that people in our group like:

“We never know what the body and your baby will do, but these are all the best practices, so let’s start with that and see what happens.”

“If we do these things, for most people we would expect to see x result, but every body is different and we never know. Let’s check in soon to see how your body is reacting and reevaluate the plan.”

Another suggestion from a member of our group is to be objective and explicit when the output from a weighted feed is low, explaining what you’d normally expect to see. Most lactation consultants are probably doing this, but it is really helpful to follow such information with guidance that implies a wait-and-see approach, rather than making patients feel as though their supply will certainly go up if they adhere to the best practices.

Screen for risk factors

If you are a family medicine provider, OB or midwife, please familiarize yourself with risk factors for low milk supply and screen patients for them. (For a concise summary of these risk factors and recommendations for management, see the Academy of Breastfeeding Medicine’s 2024 position statement, Recommendation for Exclusive Breastfeeding: Avoidance of Underfeeding and Overfeeding.) This knowledge is actionable during pregnancy, and when possible, vulnerable patients can and should be offered a prenatal consultation with a lactation consultant or breastfeeding medicine physician. One of the members of our group put it so well: “During my pregnancy, I kept telling my doctor that my breasts were sore. She said that it meant that I was going to produce a lot of milk! What she didn’t tell me is that my gestational diabetes and hypothyroidism were risk factors for lactation issues. After I was discharged, the first time I did a weighted feed, my baby got literally no milk from me.” She was lucky enough to find the right support and was able to eventually make a full supply. But it was not a given for this mom; it took a lot of work, and she also suffered emotionally and physically in her attempt to increase supply. She could have been set up for a different postpartum experience if she had been helped in the prenatal period to prepare for breastfeeding challenges that sometimes accompany her medical conditions.  

Early follow-up is key

This should go without saying, but please provide especially early follow-up if you suspect there could be primary low supply. Interventions to increase supply, such as triple feeding, are costly. One of the primary low supply moms in our group said, “Triple feeding is not supposed to be long-term. That’s something I finally heard after three months and I wish they had told me sooner. It was all consuming, all I did all day and night, and I don’t think it really helped at all.”  This mom had a toddler as well, and her husband ended up having to take more paternity leave than he’d planned; there was no other way they felt like they could do what they were being told was important for their baby.

Caring for a newborn around the clock is already incredibly difficult, even when lactogenesis II (the onset of copious milk production) has occurred like it should and direct, responsive breastfeeding is possible. When someone feels that they must do all that, and also pump after each feed, and maybe also give a bottle if there is not someone else to do it, the cost to that family is significant. There is a physical cost to the mother or lactating parent, who often can’t fathom how they will possibly sleep, who may have sore or bleeding nipples that are given so little time to rest, and who is recovering from what might have been a long, painful or traumatic labor or c-section. And there is a heavy emotional cost when we recommend an intervention that will take someone away from their baby in those early days and weeks. We did not evolve for this. 

It is worth emphasizing that we don’t use the word must lightly in saying that low supply parents feel they must do all this and heed the advice they are given by lactation consultants and other clinicians. Many people with low supply feel pressured to do everything they can to increase their supply, partly because we are socialized to trust what medical authorities are telling us, partly because we’ve been made to believe that doing so is what’s best for our babies (and who doesn’t want to do what’s best for their baby?), and partly because we desperately want things to work. 

We owe our patients this much

We have an ethical responsibility to these patients to make sure they will not bear that cost a moment after it’s clear that the strategy will not be effective. Even if you work at a busy clinic and are limited in when you can follow up, it’s critical to check in soon, at least in writing, to evaluate and adjust the plan. As most lactation consultants know, there are many people like the mom we quoted above who end up triple feeding for way too long because they are not told just how temporary the intervention should be, or they are too overwhelmed or sleep deprived to process it during their appointment. (Please see our article To Triple Feed or Not to Triple Feed for more thoughts on the subject from a low supply perspective.)

So let’s say you’ve been mindful about a low-supply-friendly approach from the beginning, and now it really is time to sit down and let your patient know that things might not improve.

Our tips for the low supply talk

Explain what is and is not within your scope, and where they can go next

It is absolutely appropriate for someone you suspect has primary low milk supply to see a breastfeeding medicine physician or a knowledgeable OB or family medicine practitioner. Many people in our support group have found this very helpful, even when their low supply has already been established and they are not trying to increase milk production. There are several reasons for this:

It gives them a sense of closure

That closure is important even if they are still breastfeeding, because it can answer questions about why it is happening, or let them know that the breastfeeding medicine community does not have an answer (and according to Dr. Rachel Yang, the latter happens a lot). 

It can help them plan for the future

Depending on the cause of the low supply, it may make sense for patients to consider using pharmaceutical or herbal galactagogues during or after future pregnancies, and it’s important for them to be able to work on this strategy ahead of time with a knowledgeable clinician. In our group we’ve also seen people who consider altering their plans to have another baby, purely because of the physical and emotional toll of their low supply experience—not only on the mom but also sometimes on their partners and other children. A breastfeeding medicine doctor can help them understand what might and might not change with their milk supply in the future, informing a possibly life-altering decision.

It could get emerging PMADs on the radar of a provider

Many breastfeeding medicine physicians are especially attuned to perinatal mood and anxiety disorders and how to help low supply patients who are suffering from them. We often hear from people in our group who have not sought out help, and the warning signs may not be caught if they have limited contact with their other doctors, NPs, etc. in the postpartum period. And people who experience difficulties with breastfeeding have a higher incidence of PMAD symptoms (Yuen et al., 2022). We’re not saying this is necessarily the one reason to see a breastfeeding medicine specialist, but it is a significant fringe benefit.

It is meaningful to get validation from a doctor

Families with low supply often feel as though they have been gaslit into believing that unresolvable low supply is not a thing, and in our group we have seen the emotions that come with the shock of then being told that you can’t make a full supply. It follows that in our society, it can be healing for someone’s low supply to be acknowledged by a physician. 

Finally, we have the right to have this medical information about our bodies

As lactation consultants, most of us are not licensed to diagnose, and when access is not an issue, we have a responsibility to direct patients to a provider who does have the scope and knowledge to do so. Some causes of low supply, such as Sheehan syndrome, have medical implications that go far beyond lactation (Laway & Baba, 2023). Parents deserve to work with a clinician who can evaluate the whole picture and help them decide what to do next.

Unfortunately, not all patients will have access to a breastfeeding medicine practitioner. For those in the US: if there isn’t one in your state who is nearby (or can do telehealth) and who accepts insurance or Medicaid, try to find other physicians who are knowledgeable about the causes of primary low supply. We can’t give this option to everyone, but there are so many people who could easily see such providers and don’t even know they exist. In our group, we have many moms who live in the San Francisco Bay Area, which has multiple skilled breastfeeding medicine doctors who accept many insurance plans, but most parents in our group have never heard of the specialty. A lot of them go on to make appointments, and are happy they did. (See our resources page for a directory of breastfeeding medicine physicians.) In cases where there are no breastfeeding-savvy clinicians to refer to, you can consider directing the patient’s doctor to the Low Milk Supply Foundation, which has information about the etiology of low milk supply. But we find that patients who can see a specialist benefit from the option to do so. 

Be prepared with resources and groups geared toward low supply

This can include our group, the PSI support group on breastfeeding grief, the IGT and Low Milk Supply Facebook Group, the Low Milk Supply Foundation and Low Supply Mom. Many patients with low supply also find it helpful to learn more about their condition, and the curated list of podcasts on our site is a great place to start. Your patients may not need individual support from a lactation consultant anymore, but they deserve to find a community that understands and can help them explore what is happening to their bodies. Many people with low supply feel isolated and alone, and they are told that this is extraordinarily uncommon, but the parents in our group crave knowing that there are others out there who experience the same thing. 

On that note, try not to focus on how uncommon you believe low supply is

We don’t have good research on the incidence of low milk supply (Whelan et al., 2025), and more importantly, it’s not helpful or productive to make us feel like a part of our bodies that can be so intrinsically tied to our identity as women and mothers is extremely abnormal. Doing so centers mammotypical parents, but in the low supply talk, our focus should be on the mammoatypical person in front of us. 

Recommend reading material

When appropriate you can also recommend books from our resources page, including Why Breastfeeding Grief and Trauma Matter by professor and psychologist Amy Brown.

And perhaps most important…

Make it clear that now they have a choice about how to proceed. Do not tell them that some people just can’t breastfeed. We should never default to assuming that they will do everything possible to maximize supply, or that it’s not worth continuing to feed their babies their own milk. Please see our blog post on Taking Back Our Power for more thoughts on this topic.

Thank you. Really.

Thank you for taking so much care with the members of our community. The fact that you are reading this says a lot about who you are as a lactation consultant, provider, or other perinatal professional. And please share the Low Supply Lactation Project with colleagues so we can help more people feel supported even when breastfeeding will never go as planned.

 

References

Yuen, M., Hall, O. J., Masters, G. A., Nephew, B. C., Carr, C., Leung, K., Griffen, A., McIntyre, L., Byatt, N., & Moore Simas, T. A. (2022). The effects of breastfeeding on maternal mental health: A systematic review. Journal of Women’s Health, 31(6), 787–807. https://doi.org/10.1089/jwh.2021.0504

Laway, B. A., & Baba, M. S. (2023). Sheehan syndrome: Cardiovascular and metabolic comorbidities. Frontiers in Endocrinology, 14, 1086731. https://doi.org/10.3389/fendo.2023.1086731

Whelan, C., O’Brien, D., & Hyde, A. (2025). Breastfeeding with primary low milk supply: A phenomenological exploration of mothers’ lived experiences of postnatal breastfeeding support. International Breastfeeding Journal, 20, Article 7. https://doi.org/10.1186/s13006-025-00699-4