In Part 1, I explored the definitions, causes, and diagnostic signs of low milk supply. Now I’ll turn to what lactation professionals can do to support parents—clinically and emotionally—when faced with either primary or secondary low milk supply. I’ll also cover promising emerging treatments and emphasize how to create individualized care plans.

Non-Pharmacological Strategies: Foundations First

For any low milk supply case, the first step is to maximize milk removal through frequent, effective breastfeeding or pumping:

Latch and Positioning
Ensuring a deep, comfortable latch is essential. Poor latch can lead to incomplete milk removal, limiting supply (Riddle & Nommsen-Rivers, 2016). Lactation consultants can provide hands-on support and observation, adjusting positions for better milk transfer.

Feeding Frequency and Milk Removal
Milk production is demand-driven. Frequent and thorough emptying of the breast—whether via baby or pump—signals the body to maintain or increase supply (Toronto Public Health, 2013). Early postpartum weeks are crucial for establishing prolactin receptor sites; missed feeds can have lasting effects (Hale & Hartmann, 2017).

Switch Nursing and Breast Compressions
Switching sides multiple times per feed and using gentle compressions can help maximize milk removal (Toronto Public Health, 2013). This is particularly helpful for sleepy or disorganized feeders.

Pumping and Hand Expression
Pumping after feeds or during breaks can boost supply. “Power pumping” (10 minutes on, 10 minutes off, repeated for 1 hour) mimics cluster feeding and can stimulate a supply increase (Toronto Public Health, 2013).

Skin-to-Skin Contact and Relaxation
Skin-to-skin helps with milk ejection reflex and supports the breastfeeding relationship (Haase et al., 2016). Stress reduction techniques—like breathing exercises or partner support—also play a role in improving letdown and milk flow (Baker et al., 2021).

Pharmacological and Herbal Options

For some parents, non-pharmacological strategies alone may not be enough—especially in cases of primary low milk supply. In these cases, lactation professionals may consider or discuss pharmacological or herbal galactagogues.

Domperidone and Metoclopramide

Both drugs act by increasing prolactin, the hormone critical for milk production. Domperidone (not FDA-approved in the U.S.) is widely used in other countries. Studies show it can boost milk volume by 30–75% (Grzeskowiak et al., 2014; Haase et al., 2016). Metoclopramide is an alternative in the U.S. but carries more risk of mood-related side effects (Haase et al., 2016).

These medications should always be prescribed and monitored by a knowledgeable clinician and only after breastfeeding management has been fully optimized (Grzeskowiak et al., 2014).

Metformin for Metabolic Causes

Insulin resistance (often seen in PCOS) has been linked to low milk supply (Verd et al., 2022). A pilot trial found that metformin modestly increased milk volume in some mothers with metabolic concerns (Nommsen-Rivers et al., 2019). While not a universal solution, it may offer a targeted option in carefully selected cases.

Herbal Galactagogues

Parents often inquire about herbs like fenugreek, blessed thistle, and moringa. Evidence is limited and variable—some mothers see benefits, others don’t (Baker et al., 2021). Side effects (like GI upset with fenugreek) and lack of regulation mean caution is needed. Any herbal supplement should be discussed openly, weighing cultural relevance and scientific data.

Emerging Treatments and Future Directions

Research is exploring newer strategies to support milk production, including:

Recombinant Prolactin Therapy – Experimental trials suggest that prolactin replacement could help mothers with true prolactin deficiency (Khan et al., 2019).

Insulin Pathway Modulation – New studies on insulin’s role in lactation hint at future therapies to address metabolic causes (Verd et al., 2022).

Human Growth Hormone (hGH) – Small trials show possible benefits in mothers with hypopituitarism, though not yet standard practice (Haase et al., 2016).

Individualizing Care: Partial Breastfeeding as a Valid Goal

It’s critical to recognize that any amount of breast milk is beneficial—whether fully exclusive or partial. Combination feeding with expressed milk, donor milk, or formula can still offer health and emotional benefits for both baby and parent (Baker et al., 2021).

Support plans should be individualized:

For Secondary Low Milk Supply: Focus on breastfeeding management, remove barriers, and provide education to rebuild supply.

For Primary Low Milk Supply: Recognize that full exclusive breastfeeding may not be possible and focus on maximizing supply while embracing combination feeding if needed.

Equally important is emotional validation. Studies show that empathetic lactation care—acknowledging grief and offering realistic plans—improves maternal wellbeing (Whelan et al., 2025).

Key Takeaways for Lactation Professionals

Identify whether low milk supply is primary or secondary—this guides treatment.

Address modifiable factors first: latch, frequency, milk removal, maternal health.

Use galactagogues carefully and only as part of a comprehensive care plan.

Individualize support—some parents will breastfeed partially, and that’s okay.

Offer empathy and emotional support as much as clinical advice.

Conclusion

For lactation professionals, supporting families through low milk supply requires both clinical expertise and deep compassion. While evidence-based practices are essential for addressing secondary causes, primary low supply often calls for a broader approach that includes psychological support, realistic goal-setting, and culturally sensitive care. As research evolves, so too will our ability to help parents reach their breastfeeding goals—whatever form those take.

References

Baker, H., Shere, H., & colleagues. (2021). Chronic lactation insufficiency is a public health issue: Commentary on “We need patient-centered research in breastfeeding medicine.” Breastfeeding Medicine, 16(6), 349–350.

Grzeskowiak, L. E., Lim, S. W., Thomas, A. E., & Angley, M. T. (2014). Pharmacological management of low milk supply with domperidone: Separating fact from fiction. Medical Journal of Australia, 201(5), 257-258.

Haase, B., Brennan, E., Wagner, E. A., & Parker, L. A. (2016). Domperidone for treatment of low milk supply in breast pump–dependent mothers of hospitalized infants: A clinical review. Journal of Human Lactation, 32(2), 327-335.

Khan, D. N., et al. (2019). Recombinant human prolactin in the treatment of lactation insufficiency. Journal of Clinical Endocrinology & Metabolism, 104(7), 2450–2460.

Nommsen-Rivers, L. A., et al. (2019). Feasibility and acceptability of metformin to augment low milk supply: A pilot randomized controlled trial. Journal of Human Lactation, 35(2), 371–381.

Riddle, S. W., & Nommsen-Rivers, L. A. (2016). A case-control study of diabetes during pregnancy and low milk supply. Breastfeeding Medicine, 11(1), 14–19.

Toronto Public Health. (2013). Breastfeeding Protocol #12: Insufficient Breast Milk Supply. Toronto, ON: Toronto Public Health.

Verd, S., Perapoch, J., & Nommsen-Rivers, L. A. (2022). Measures of maternal metabolic health as predictors of severely low milk production. Breastfeeding Medicine, 17(7), 566–576.

Whelan, C., O’Brien, D., & Hyde, A. (2024). Mother’s emotional experiences of breastfeeding with primary low milk supply in the first four months postpartum: An interpretative phenomenological analysis. Breastfeeding Medicine, 19(3), 197–207.

Whelan, C., O’Brien, D., & Hyde, A. (2025). Breastfeeding with primary low milk supply: A phenomenological exploration of mothers’ lived experiences of postnatal breastfeeding support. International Breastfeeding Journal, 20(7). https://doi.org/10.1186/s13006-025-00699-4