Sample FAQ: Causes of low milk supply from birth (failure of lactation)
Why have I never had enough milk?
There are many reasons why a mother may have a low milk supply from birth. They fall into five groups: (1) problems related to labour or delivery; (2) hormonal problems; (3) breast problems such as surgery or lack of development; (4) illness in the mother around the time of delivery; and (5) genetic conditions. Some mothers with a low supply don’t have any of these conditions. Some mothers will always have a low milk supply, but others, particularly those whose problems are related to delivery, may have a full supply with the next baby. Some mothers worry that they have a low milk supply because they are not eating or drinking enough or are getting too little sleep. Those are rarely the cause of a low supply.
A) Reasons for never having had enough milk
Please work with your health-care providers if you feel that you do not have enough milk.
Possible reasons for a low milk supply fall into five groups.
1) Causes of low milk supply related to labour or delivery
- Lack of breast stimulation related to:
- Medication used to prevent early labour (Bjelakovic et al. 2016)
- A retained piece of placenta
- Excess blood loss or drop in blood pressure during labour
- Severe maternal illness
2) Causes of low milk supply related to hormonal problems
- Polycystic ovarian syndrome and infertility
- Type 2 diabetes
- Thyroid problems
- Infrequent periods
- A certain type of ovarian cyst
3) Causes of low milk supply related to breast problems
- Lack of breast development:
- Breast surgery:
- Trauma of the breast:
- Breast abscess as a baby
- Chest surgery as a child
- Severe trauma of the breast
- Irradiation of the chest for cancer
- Abscess with a previous baby
4) Causes of low milk supply related to illness in the mother around the time of delivery
- Extremely low weight (as from anorexia or starvation)
- Severe life-altering stress
- Major illness
- Breast cancer
5) Causes of low milk supply related to genetic conditions
B) Unknown reasons for not having enough milk
We have found that some mothers who have never had enough milk do not have any of the above conditions. There is a small amount of evidence that the mother’s genetics, diet, and environmental toxins may prevent the normal development of the breast. Research continues (Lee and Kelleher 2016).
C) Milk supply with the next baby
Some mothers, particularly those with insufficient glandular tissue or who have had extensive breast surgery, will have a low milk supply with each baby. Other mothers, particularly those who have had problems related to delivery, may have a full milk supply with the next baby.
D) Other concerns
Bjelakovic L, Trajkovic T, Kocic G, et al. The Association of Prenatal Tocolysis and Breastfeeding Duration. Breastfeed Med. 2016 Dec;11:561-563
Golan Y, Assaraf YG. Genetic and Physiological Factors Affecting Human Milk Production and Composition. Nutrients. 2020 May 21;12(5):E1500
Kelleher SL, Gagnon A, Rivera OC, et al. Milk-derived miRNA profiles elucidate molecular pathways that underlie breast dysfunction in women with common genetic variants in SLC30A2. Sci Rep. 2019 Sep 3;9(1):12686
Lee S, Kelleher SL. Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology. Am J Physiol Endocrinol Metab. 2016 Aug 1;311(2):E405-22
Lee S, Zhou Y, Gill DL, et al. A genetic variant in SLC30A2 causes breast dysfunction during lactation by inducing ER stress, oxidative stress and epithelial barrier defects. Sci Rep. 2018 Feb 23;8(1):3542
Rivera OC, Geddes DT, Barber-Zucker S, et al. A common genetic variant in ZnT2 (Thr288Ser) is present in women with low milk volume and alters lysosome function and cell energetics [published online ahead of print, 2020 Apr 22]. Am J Physiol Cell Physiol. 2020;10.1152/ajpcell.00383.2019