What causes low milk production?

Occasionally, a delay in the time when milk "comes in" turns into an ongoing problem with low milk production. Sometimes, a mother has been producing sufficient amounts of milk, and then milk production slowly, or quite suddenly, decreases. Some of the conditions associated with a delay may also have an ongoing effect on milk production, including, but not limited to, the following:

•    severe postpartum hemorrhage (excessive bleeding)
•    retained placental fragments
•    thyroid conditions

Mothers with previous breast surgery that cut some of the nerves, milk-making tissue, or milk ducts, may have difficulty producing enough milk to fully feed a baby.
Other factors can also lead to insufficient milk production. Maternal smoking has been shown to result in less milk. Some medications and herbal preparations have a negative effect on the amount of milk produced. Hormonal forms of birth control, especially any containing estrogen, have been found to have a big impact on milk production. However, some mothers report a drop in milk production after receiving/taking a progestin-only contraceptive during the first four to eight weeks after delivery (postpartum). Milk production may also decrease if you become pregnant again.
If insufficient milk production seems to be a problem, yet the baby seems to be sucking effectively, your physician or certified lactation consultant (IBCLC) may recommend the following:

•    Increase the number of breastfeedings to 10 to 12 in 24 hours.
•    Increase the amount of skin-to-skin contact you have with your baby. Take off your shirt and baby's shirt and place your baby on your chest with a sheet or shirt over both of you.
•    A review of your health history with you to discover if there may be a health condition, treatment, or medication interfering with milk production.
You also may want to:
•    pump your breasts for several minutes after breastfeeding, using a hospital-grade electric breast pump.
•    ask your physician or a certified lactation consultant (IBCLC) about taking a galactogogue, which is a medication or an herbal preparation found to have a positive effect on milk production.
Think positive. Although insufficient milk production usually can be reversed, any amount of milk you produce is valuable for your baby. Try to remember that your baby is 25 to 90 percent breastfed rather than feel discouraged that he/she is also receiving a breast milk substitute.