Causes. Anxiety and tension as well as contrary hormonal influences can inhibit the let down reflex so that the baby only gets the foremilk which is low in fat and protein and so does not gain mass.

Insufficient stimulation by not feeding often enough is one of the main causes of inadequate production of milk. Remember, the more you feed, the more is made to meet the demand. Never miss a feed in the belief that you will store up milk for later.

A low fluid intake can affect the milk supply. You require between one and two litres a day while you are breast feeding. Rest as much as possible during the day, and if you have older children get a friend to look after them if possible so that you can sleep when the baby sleeps.

As I have already said, faulty feeding technique can result in incorrect or no stimulation of the nipple and milk-producing glands.

In very rare instances there may be true agalactia (no production of milk) due to damage to the pituitary gland, or to a deficiency in the production of prolactin by the pituitary.

The combined (dual) contraceptive Pill reduces the milk supply after a few weeks, although the contraceptive injection and the mini-Pill do not appear to do so. You can become pregnant while breast feeding so you need some form of contraception. (See p. 134 for other means of contraception.) Although your periods may not return at all while you are breast feeding, you could become pregnant because you could be ovulating – but you may not realise this because it happens before you start menstruating.

Your periods could return six weeks after delivery even if you are breast feeding and your milk supply may be lower when you are menstruating. Some babies are reluctant to breast feed at this time due to the diminished output and the frustration they experience as a result. If your milk supply is lower you should feed more frequently and possibly give a complementary feed from a bottle after the ten oclock feed at night if she is restless. (See complementary feeds p. 97.)


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