‘Physically and emotionally draining’ – why some breastfeeding mothers worry about low milk supply

Mothers are encouraged to exclusively breastfeed for the first six months of their baby’s life. Yet, for many women in Singapore, making it that far can be challenging.

First-time mother Abigail Tan remembers the early weeks after giving birth as a constant struggle to produce enough milk for her newborn, who never seemed satisfied.

“At the start, I thought I would breastfeed for six months to a year to boost my baby’s immunity. I didn’t expect it to be so physically and emotionally draining,” said the 29-year-old preschool teacher, who delivered her baby in December 2025.

Her struggles are not unique. The 2021/2022 National Breastfeeding and Child Feeding Survey found that about 46 per cent of mothers exclusively breastfed for up to three months, but the figure dropped to about 35 per cent among those with infants aged four to five months. By six months, only 3.3 per cent of babies were exclusively breastfed.

This is not for lack of trying. Nearly all mums (94 per cent) who wanted to breastfeed knew breast milk was healthier, but more than half (53 per cent) felt they didn’t produce enough.

While true physiological low milk supply does occur, perceived low milk supply is far more common, especially in the early postpartum period, around the first 10 days after childbirth, said Nurhanesah A Rahman, senior staff nurse at Tengah Polyclinic and an International Board-certified lactation consultant.

This mistaken perception often leads mothers to supplement with formula or stop breastfeeding, even when their babies are getting enough milk and growing normally, she added.

MISCONCEPTIONS AND MEDICAL FACTORS SABOTAGING MILK SUPPLY

A common misunderstanding is assuming that a newborn who feeds frequently is not getting enough milk. In reality, feeding eight to 12 times in 24 hours is “very normal” newborn behaviour, said senior lactation consultant Chen Liqin, head of Thomson Parentcraft Centre.

“Newborns have very small stomachs and are unable to hold a large volume of milk at one time. Therefore, feeding based on the baby’s hunger cues, rather than strictly following the clock, is generally recommended,” Chen explained.

Another behaviour that often worries new parents is cluster feeding, when babies feed more frequently over a short period. It is common in the early weeks, often in the late afternoon or evening, she added.

“This pattern is thought to be partly related to natural hormonal fluctuations in milk production, as levels of prolactin (the hormone responsible for milk production) tend to be lower later in the day. Cluster feeding helps stimulate the breasts and signal the body to increase milk production,” Chen said.

Long-held beliefs can also influence feeding practices in ways that reduce breast stimulation – a key factor in maintaining milk supply. One example is the perception that formula-fed babies sleep longer and are more satisfied.

“For instance, offering formula feeds at night, sometimes encouraged so the mother can rest, reduces breast stimulation during a crucial period for establishing milk supply. This may unintentionally affect milk production and undermine a mother’s confidence in her ability to breastfeed,” said Chen.

In some cases, physical or medical factors may also affect milk supply.

Situations that reduce effective milk removal, such as a poor latch, a sleepy or jaundiced baby, or babies born slightly pre-term, can slow milk production over time. Babies with restricted tongue movement, such as those with a tongue-tie, may struggle to latch and suck ineffectively, said Nurhanesah.

Birth complications, such as a Caesarean birth, retained placenta or significant postpartum bleeding, may delay the hormonal shift needed to establish milk production in the early days, Nurhanesah added.

Medical conditions including thyroid disorders, diabetes, hormonal imbalances, or rare pituitary problems can also contribute to low milk supply. Additionally, it is normal for breast milk supply to temporarily drop during an illness or mastitis, which is inflammation of breast tissue due to blocked milk ducts or bacterial infection.

HOW TO TELL IF YOUR BABY IS FEEDING WELL

According to Nurhanesah, a baby who is feeding well shows several signs. Parents may hear swallowing and the mother’s breasts feel softer afterwards, suggesting good milk transfer.

“The baby will appear satiated after feedings, has steady weight gain and an adequate number of diaper changes,” she said.

On the other hand, some signs may indicate that baby is not getting enough milk. For example, there is minimal to no change to the mother’s breast fullness after feeds, or if the baby appears persistently unsettled despite very frequent feeding.

For example, the baby may feed almost every hour but still seem unsatisfied, or fall asleep quickly during feeds and show hunger cues again soon after, Chen added.

Other signs suggesting poor milk intake include fewer wet diapers than expected, infrequent bowel movements or poor weight gain over time.

In such situations, a lactation consultant or a healthcare professional can help. “An early assessment can help determine whether the baby is latching well and transferring milk effectively, and whether additional support or adjustments to breastfeeding techniques are needed,” said Chen.

VICIOUS CIRCLE OF STRESS AND LOW MILK SUPPLY

Many mothers who struggle with low milk supply experience guilt, anxiety, or grief, said Nurhanesah, who has guided many mothers through breastfeeding, including Tan.

For Tan, the experience was emotionally taxing from the start. Her breast milk only came in about five days after her baby was born, and she initially relied on mixed feeding with formula and breast milk.

The mismatch between her baby’s needs and her supply became a cycle of self-doubt and stress.

“It was very stressful,” said Tan. “Breastfeeding is tied to hormones, so when I feel stressed, that curtails milk production. It’s only when I'm very relaxed that I find myself being able to produce more.”

The experts explained that a mother’s overall well-being plays an important role in milk production.

“High levels of stress, inadequate hydration and significant sleep deprivation may affect milk production, as these factors can interfere with the body’s hormonal balance and a mother’s ability to breastfeed or express milk regularly,” said Chen.

To protect milk supply during the demanding early postpartum period, Chen encourages mothers to learn about breastfeeding and newborn care during pregnancy, establish a feeding plan early and ensure adequate support after birth.

Chen said: “Some mothers may choose to exclusively breastfeed through direct latching, while others may combine breastfeeding with pumping or opt for exclusive pumping.

“Feeding plans may also be adjusted. If a newborn is re-admitted for jaundice, for instance, the mother may need to pump regularly during that time.”

Support from family members, friends and healthcare professionals can make a significant difference in a mother’s breastfeeding journey, allowing her to rest, stay well hydrated and focus on feeding her baby, Chen said.

Nurhanesah added that support needs to be gentle, affirming and realistic. “Know that breastfeeding is a learning process for both mother and baby. Focus on what a mother is able to give, rather than what she is unable to,” she said.

WAYS TO BOOST MILK SUPPLY 

Every woman can produce milk after pregnancy and childbirth, although milk production can vary widely, said Chen. What’s important to understand is that breast milk production operates on the principle of “supply equals demand”, she added.

Ideally, feeding involves a well-latched baby who feeds eight to 12 times a day, both day and night, said Nurhanesah. During feeds, the baby may nurse from one or both breasts, with the mother applying intermittent breast compression to help increase milk flow.

Night feeds are important, especially in the early weeks. Prolactin is naturally at its highest levels between midnight and 6am. Feeding during this time helps establish and maintain an adequate milk supply, Chen explained.

Although some mothers pump after every latch to boost supply, Chen noted that this is not necessary for all mothers. It can be physically exhausting for mothers who are already coping with recovery and sleep deprivation.

“If the baby is latching well and feeding effectively at the breast, it is usually best for the mother to focus on direct breastfeeding rather than adding routine pumping,” she said.

Pumping may be helpful if the baby cannot latch effectively or is separated from the mother for medical reasons, said Chen.

In such cases, Nurhanesah advised following a pumping schedule that mimics a baby’s natural feeding pattern. Each session should last about 20 minutes with intermittent breast compressions during pumping to increase milk flow, she added.

WHEN SUPPLEMENTING WITH FORMULA MAY BE REQUIRED

In some cases, temporarily supplementing with infant formula may be medically necessary. For example, for premature infants or babies weighing less than 1.5kg at birth, excessive weight loss after birth (more than 10 per cent of birth weight), or severe neonatal jaundice, said Chen.

Even so, this does not mean that milk supply cannot be rebuilt or improved later on.

“If supplementation is required, always offer to feed the baby at the breast first, followed by topping up with formula to ensure continued breast stimulation,” said Nurhanesah.

Using a cup or syringe reduces the risk of nipple confusion and overfeeding, as babies control the pace and stop when full.

“Using a cup or syringe also prevents overfeeding as baby stays active during the feeds – they need to lap or sip with coordinated suck-swallow-breathe rhythm – and naturally stops feeding when showing signs of satiety,” explained Nurhanesah.

If bottles are used, paced bottle feeding is recommended, Nurhanesah added.

This mimics breastfeeding by slowing milk flow and allowing the baby to control feeding pace, reducing the risk of breast refusal or overfeeding, which is important when baby is still learning to latch effectively.

Tan sought help five days after delivery, when she brought her baby for a check-up at a National University Polyclinic, and arranged for a lactation consultation.

With guidance on feeding frequency, latching and pumping techniques, and adjustments to her diet and supplements, Tan increased her supply. After two to three weeks, she was able to produce enough milk to match her baby’s intake.

She hopes to continue breastfeeding for its nutritional and immune benefits, as well as the cost savings.

“I’ve learnt a lot from my lactation consultant and hope to breastfeed my daughter until she is two,” said Tan.