Low amounts of expressed milk

What can I do if I don’t express well?

Ineffective expressing can lead to a decreasing milk supply and other difficulties. Mothers who are not expressing the expected amount of milk or colostrum have several options. They can try to optimize the let-down by letting the baby feed on one breast and then the other while expressing the first one. Or try expressing both breasts at the same time. Mothers can try increasing their expressing speed for about a minute to obtain another let-down, or try breast compression and power expressing. Mothers can consider changing their expressing technique, switching between manual expression and pumping or using both. Any nipple or breast pain should be addressed as pain can reduce the amount of milk expressed. Expressing must be regular and frequent to prevent a decrease in the milk supply. If the expressed amounts remain low, mothers may have a full or a low milk supply.

B) Increasing the amounts of expressed milk at each session

Expressing is a skill. It may require some practice and the right tools. Here are some ideas to consider if:

  • You are not getting the expected amount of milk or colostrum while expressing.
  • Your breasts are not empty and soft after expressing.
  • Expressing takes more than 20 minutes on each breast.

1) Use breastfeeding to create a let-down and maintain or increase the milk supply

Expressing may not be as effective as breastfeeding at removing milk from the breast or at maintaining increasing the milk supply. Depending on the situation, mothers may be able to: 

  • Increase the number of times they breastfeed each day to stimulate more milk production. 
  • Create better let-downs by expressing on one side once the baby has moved to the second breast. 
  • Breastfeed a toddler to help get milk for a new baby.

Mothers who are breastfeeding a toddler and expressing for a premature baby at the same time often have fewer struggles maintaining their milk supply. If you have a toddler who has recently been weaned, the toddler may be interested in resuming breastfeeding and you can express before or while breastfeeding the toddler.

2) Optimize the let-down

Consider these options to stimulate let-downs and milk flow:

  • Increase your expressing speed for about one minute to obtain another let-down.
  • Use other techniques to get a let-down.
  • If you can breastfeed, let the baby feed on one breast, then on the other while expressing on the first.
  • Express both breasts together.
  • Try breast compression and power expressing.

3) Change your expressing technique

Consider the following:

  • Ensure your tools are effective:
    • Use the correct breast shield size. Proper shield size can change over time.
    • Your breast pump should work properly and create proper suction.
    • Use the maximum comfortable suction strength.
    • Use a pump kit that works with your electric pump.
    • Use proper technique with manual expression.
    • The cycle speed (how quickly suction is held and released) should not be too fast. The suction must be held long enough for milk to leave the breast.
  • Change from manual expression to pumping or vice versa and choose the most effective method.
  • Use manual expression after pumping to fully empty the breast (Morton 2009).

4) Expressing when in pain or stressed

Pain and stress can decrease the ability to have a let-down and result in a decreased milk supply. This effect is more likely when mothers are expressing compared to breastfeeding. Mothers need to address any pain from pumping or manual expression.

Some mothers turn to expressing because of nipple or breast pain. They also need to address the underlying problem.

C) Express frequently and regularly

Life can be busy and a mother’s milk supply and her expressed amounts may decrease because she is not removing milk often enough or regularly.

Mothers should ensure that they breastfeed or express at least 7 times in 24 hours. They should not go more than five hours without breastfeeding or expressing. If the expressed amounts have decreased, they may benefit from expressing 8 or 9 times in 24 hours. Power expressing for a few days may also be helpful.

D) When expressing still doesn’t work

1) When breastfeeding is going well

Some mothers with a full milk supply cannot express well. They may worry that it means they don’t have enough milk.

If your baby is breastfeeding effectively, growing well, and not receiving other regular milk supplements, you probably have a full milk supply.

In this case, try expressing one breast after the baby has fed on it and while the baby is breastfeeding on the second. It may requires a little co-ordination. There is generally a little more milk in the breast after the baby’s first morning feed and this may be a good time to express.  

Some mothers have trouble expressing colostrum using a breast pump. If you have that problem, try manual expression before pumping; this is recommended when establishing the milk supply. 

Milk supply naturally declines as a child enters the second year of life and the expressed amounts will also decrease.

2) A low milk supply

A few mothers have a low milk supply and will have express correspondingly low amounts. They should consider ways to increase milk supply, with increasing the baby's time at the breast usually being the most effective. In this situation, babies will need to be supplemented with milk and their growth should be monitored.