---
title: "Low milk supply"
url: "https://acuiq.com/wiki/evidence/low-milk-supply"
updated: 2026-10-20
last_verified: 2026-10-20
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-20"
reading_minutes: 11
sources: 23
---

# Low milk supply

_What three Cochrane reviews, seven reviews of acupuncture and acupressure, controlled trials and three guidelines report on point stimulation for insufficient breast milk._

Low milk supply, also called insufficient lactation or hypogalactia, is a frequent worry of breastfeeding mothers: the [2020 Cochrane review of oral galactagogues](https://doi.org/10.1002/14651858.CD011505.pub2) by Foong and colleagues notes that many women express concern about their ability to produce enough milk, and that insufficient milk is frequently cited as the reason for supplementing with formula and stopping breastfeeding early. Cochrane has no review of acupuncture or acupressure for it: that review covered only substances taken by mouth. Seven reviews published from 2017 to 2026 gathered the trials of acupuncture, electroacupuncture, acupressure and ear seeds, almost all run in China and almost all compared with routine care or Chinese herbs. They report more milk and higher prolactin, the hormone that drives milk production, and two reviews from 2024 and 2025 rated the certainty of that evidence low or critically low with GRADE.

## What Cochrane has reviewed

Foong's review searched to November 2019 and included 41 randomised trials with 3,005 mothers of healthy term babies, testing drugs such as domperidone and metoclopramide and foods and herbs such as fenugreek and moringa against placebo, no treatment or each other. The authors rated the evidence low to very low certainty overall, found low-certainty evidence that the drugs may increase milk volume, and could not say whether any galactagogue keeps mothers breastfeeding at 3 to 6 months. Acupuncture and acupressure fall outside its question.

Two other Cochrane reviews include point stimulation for related breastfeeding problems. The [2020 review of treatments for breast engorgement](https://doi.org/10.1002/14651858.CD006946.pub4) by Zakarija-Grkovic and Stewart, 21 trials with 2,170 women, included two Swedish trials of acupuncture against usual care and one Iranian trial of acupressure against hot and cold compresses; it found the evidence on acupuncture and acupressure for engorgement of very low certainty. The [2020 review of interventions for preventing mastitis](https://doi.org/10.1002/14651858.CD007239.pub4) by Crepinsek and colleagues, 10 trials with 3,034 women, found from one trial of 400 women that acupoint massage probably reduces mastitis and breast pain compared with routine care (moderate-certainty evidence); adverse events were not reported. [Breast pain](/wiki/evidence/breast-pain) covers pain while breastfeeding.

## Reviews of acupuncture and acupressure for low supply

| Review | Methods and comparison | Studies and people | What the authors report |
| --- | --- | --- | --- |
| [Chen 2017](https://doi.org/10.1016/j.ctcp.2017.09.006) | Ear therapy, in 25 of the studies seeds taped to ear points, against control groups | 23 randomised and 3 non-randomised studies | Earlier onset of lactation, less risk of low milk production, prolactin generally higher than with routine care; narrative synthesis, with a call for more stringent designs |
| [Rosetti 2022](https://doi.org/10.1097/nmc.0000000000000866) | Acupressure, English-language studies only | 5 studies and 1 case report | Preliminary evidence that acupressure helps milk come in after caesarean and vaginal birth |
| [Bautista-Hernández 2024](https://doi.org/10.1016/j.enfcle.2024.01.002) | Any point stimulation, trials and observational studies | 14 studies | Manual point stimulation increased milk quantity (standardised mean difference 1.63); study quality judged moderate |
| [Fang 2024](https://doi.org/10.1016/j.heliyon.2024.e27154), searched to October 2022 | Acupuncture, acupressure, scraping, cupping, moxibustion and others, against control groups | 20 studies | Higher overall efficacy, prolactin and milk volume, less engorgement |
| [Bao 2024](https://doi.org/10.1371/journal.pone.0303948), searched to October 2023 | Needle acupuncture or electroacupuncture against Chinese herbs, conventional care or sham | 19 trials, 2,400 women | Higher prolactin, milk volume and exclusive breastfeeding; GRADE critically low for every outcome |
| [Chang 2025](https://doi.org/10.1186/s13643-025-02773-8), searched to September 2023 | Acupuncture, acupressure, electroacupuncture, laser, catgut embedding and ear therapy, mostly against routine nursing | 24 trials, 3,214 women | 81 mL more milk and higher prolactin; GRADE low, and very low for the time until milk came in |
| [Chu 2026](https://doi.org/10.1186/s13006-026-00829-6), searched to June 2025 | Network meta-analysis of massage, acupressure, acupuncture, ear seeds and other methods, against conventional care or sham | 33 trials, 5,710 people | Massage with acupressure ranked first for exclusive breastfeeding; acupuncture with ear seeds ranked first for milk volume |

Bao and colleagues, at Chengdu University of Traditional Chinese Medicine, found that 17 of their 19 trials came from China, the others from Italy and Thailand, and that no trial had registered its protocol in advance. Ten trials added acupuncture to herbs or conventional care and compared the result with herbs or care alone. One three-arm trial of 135 women after caesarean section compared acupuncture with sham acupuncture and with conventional care over 48 hours, and reported most milk with acupuncture, then sham, then conventional care. Four trials looked for harms, and three recorded minor ones, such as itch, dizziness and fear of needles, which resolved after treatment. The authors put the critically low certainty down to risk of bias, inconsistent results and suspected publication bias.

Chang and colleagues, at Chang Gung Memorial Hospital in Taiwan, found that all but 4 of their 24 trials were run in China; the others were in Iran, Egypt, Thailand and Italy. The points used most often were [`ST18`](/points/st18) (Rugen), [`ST36`](/points/st36) (Zusanli), [`CV17`](/points/cv17) (Danzhong) and [`SI01`](/points/si01) (Shaoze). The trials differed so much that the statistic for inconsistency between them, I², reached 99% for milk volume, and one trial reported a case of low blood pressure. Chu and colleagues, at Shandong University of Traditional Chinese Medicine, drew 29 of their 33 trials from China, 3 from Iran and 1 from Italy, and did not grade the certainty of their rankings; they note that blinding was not feasible in most trials. [Acupressure](/wiki/techniques/acupressure) and [Ear acupuncture](/wiki/techniques/ear-acupuncture) describe the methods.

## Trials with a comparison group

Two Chinese trials compared electroacupuncture at SI01 with electroacupuncture at [`LI01`](/points/li01) (Shangyang), so both groups were needled. A [2008 trial](https://doi.org/10.1016/s0254-6272(08)60038-2) of 92 women by Wei and colleagues reported a total effective rate, the share of women reaching the trial's own grade of response, of 100% at SI01 against 69.6% at LI01. A [2020 trial](https://doi.org/10.13703/j.0255-2930.20190107-0001) of 62 women by Su and colleagues reported more milk, with more lactose and protein in it, after electroacupuncture at SI01. [Electroacupuncture](/wiki/techniques/electroacupuncture) describes the method.

A [2011 trial](https://doi.org/10.1089/acm.2009.0714) in Italy by Neri and colleagues randomised 90 women to six sessions of acupuncture over 3 weeks or to observation with routine care. At 3 weeks every woman in the acupuncture group was breastfeeding exclusively, against 60% in the observation group; at 3 months 35% and 15% were still breastfeeding. A [2009 trial](https://doi.org/10.1007/s11655-009-0117-9) in China by Zhou and colleagues gave 116 women with low supply after caesarean section ear seeds pressed four times a day, or feeding on demand alone, for 5 days, and reported 89.7% reaching its top two response grades against 27.6%. A [2015 trial](https://pubmed.ncbi.nlm.nih.gov/25709684/) in Tehran by Esfahani and colleagues added 12 days of acupressure at SI01, [`LI04`](/points/li04) (Hegu) and [`GB21`](/points/gb21) (Jianjing) to routine education for 60 mothers with low supply, and measured a larger pumped volume at 2 and 4 weeks than with education alone.

A [2020 trial](https://doi.org/10.1055/s-0039-1693428) in Egypt by Maged and colleagues gave all of 60 first-time mothers domperidone and lactation advice, and randomised them to nothing more, to laser on the breasts, or to electrical stimulation at [`SP06`](/points/sp06) (Sanyinjiao), [`LV03`](/points/lv03) (Taichong) and SI01; prolactin and infant weight rose most in the electrical stimulation group. A [2026 trial](https://doi.org/10.4103/ijnmr.ijnmr_378_23) in Mashhad, Iran, by Pouresmaeili and colleagues used a double-dummy design in 54 mothers of premature babies: one group pressed real points with placebo drops, the other took milk-booster drops with sham point pressure. On day 14 the acupressure group expressed a mean of 38 mL in the morning, against 32 mL. A [2024 study](https://doi.org/10.1089/bfm.2023.0278) by Baker-Fox and colleagues in a neonatal intensive care unit enrolled 66 mothers who were expressing milk for their babies in two non-parallel, non-randomised groups, and associated acupuncture with larger pumped volumes from day 10 to day 30.

## Has acupuncture been tested for engorgement?

Yes, in two Swedish trials that the Cochrane engorgement review included. The larger, a [2007 trial](https://doi.org/10.1016/j.midw.2006.02.003) by Kvist and colleagues at a midwife-led breastfeeding clinic, randomised 205 mothers with inflamed breasts to care alone, which could include oxytocin nasal spray, or to care with acupuncture by midwives, with or without SP06. Mean severity scores differed between the acupuncture groups and the group without acupuncture on days 3 and 4, but the number of mothers with the lowest severity score on days 3, 4 or 5, the days of contact needed and the number given antibiotics did not differ, and no one was blinded. The Cochrane review found little or no difference in engorgement between acupuncture and usual care in that trial (risk ratio 0.72, 95% confidence interval 0.47 to 1.10).

## What guidelines say

The Academy of Breastfeeding Medicine's [Clinical Protocol #9](https://doi.org/10.1089/bfm.2018.29092.wjb), on galactogogues, by Brodribb, is the 2018 second revision, and the Academy's [protocol list](https://www.bfmed.org/protocols) still gives 2018 as its current version in October 2026. It advises evaluating the mother for medical causes of low supply, such as hypothyroidism, polycystic ovary syndrome or retained placenta, and increasing how often and how well milk is removed, and states that the Academy cannot recommend any specific galactogogue. It does not mention acupuncture or acupressure. The Academy's [Clinical Protocol #36](https://doi.org/10.1089/bfm.2022.29207.kbm), The Mastitis Spectrum, revised in 2022 by Mitchell and colleagues, replaced its protocols on mastitis and engorgement; it cites the 2007 Swedish trial only for its finding that warm showers and antipyretics did not improve outcomes, and makes no recommendation on acupuncture. NICE guideline NG194, [Postnatal care](https://www.nice.org.uk/guidance/ng194/chapter/Recommendations), published on 20 April 2021 and last updated on 9 June 2026, recommends face-to-face breastfeeding support and assessment by a practitioner skilled in it, and does not mention acupuncture. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares positions across conditions.

## What the reviews could not settle

Almost every trial compared point stimulation with routine care, herbs or a drug, and Bao's review found one sham-controlled trial of needling, lasting 48 hours, so no review could separate the effect of the points from the extra attention a treated mother receives. Treatment lasted from 2 days to a month in Chang's trials, and the outcome reported most often in Bao's was the effective rate rather than a measured volume. Most trials came from China and none of those in the 2024 review was registered in advance; [Where the trials come from](/wiki/research/where-the-trials-come-from) and [Sham acupuncture](/wiki/research/sham-acupuncture) discuss what each means for a reader. Chu and colleagues add that enthusiastic providers may have given more breastfeeding guidance than the protocols set. Bao's review could pool exclusive breastfeeding from only 2 trials with 164 women. Bao and colleagues call for more high-quality trials with standardised protocols.

AcuiQ's [lactation insufficiency](/symptoms/lactation-insufficiency), [insufficient lactation](/symptoms/insufficient-lactation), [lactation postpartum](/symptoms/lactation-postpartum) and [breastfeeding postpartum](/symptoms/breastfeeding-postpartum) pages list the protocols clinical texts and individual studies prescribed, each with its citation.

### Sources

1. Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH, Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants, Cochrane Database of Systematic Reviews 2020 — https://doi.org/10.1002/14651858.CD011505.pub2
2. Zakarija-Grkovic I, Stewart F, Treatments for breast engorgement during lactation, Cochrane Database of Systematic Reviews 2020 — https://doi.org/10.1002/14651858.CD006946.pub4
3. Crepinsek MA, Taylor EA, Michener K, Stewart F, Interventions for preventing mastitis after childbirth, Cochrane Database of Systematic Reviews 2020 — https://doi.org/10.1002/14651858.CD007239.pub4
4. Chen ML, Tan JY, Suen LK, Auricular therapy for lactation: a systematic review, Complementary Therapies in Clinical Practice 2017 — https://doi.org/10.1016/j.ctcp.2017.09.006
5. Rosetti MA, Spatz DL, Effects of acupressure on lactation: an integrated review, MCN: The American Journal of Maternal/Child Nursing 2022 — https://doi.org/10.1097/nmc.0000000000000866
6. Bautista-Hernández MA, Argueta-Figueroa L, Gómez-Jiménez DC, Torres-Rosas R, Evidence of the acupuncture points stimulation for the treatment of hypogalactia: a systematic review and meta-analysis, Enfermería Clínica 2024 — https://doi.org/10.1016/j.enfcle.2024.01.002
7. Fang YW, Chen SF, Wang ML, Wang MH, Effects of traditional Chinese medicine-assisted intervention on improving postpartum lactation: a systematic review and meta-analysis, Heliyon 2024 — https://doi.org/10.1016/j.heliyon.2024.e27154
8. Bao QN, Yin ZH, Zhou YF, et al, Efficacy and safety of acupuncture for postpartum hypogalactia: a systematic review and meta-analysis of randomized controlled trials, PLoS One 2024 — https://doi.org/10.1371/journal.pone.0303948
9. Chang YC, Wang YA, Chang ZY, Liao JA, Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis, Systematic Reviews 2025 — https://doi.org/10.1186/s13643-025-02773-8
10. Chu L, Liu Y, Xu C, Effectiveness of non-pharmacological traditional Chinese medicine therapies in promoting human milk feeding outcomes: a systematic review and network meta-analysis, International Breastfeeding Journal 2026 — https://doi.org/10.1186/s13006-026-00829-6
11. Wei L, Wang H, Han Y, Li C, Clinical observation on the effects of electroacupuncture at Shaoze (SI 1) in 46 cases of postpartum insufficient lactation, Journal of Traditional Chinese Medicine 2008 — https://doi.org/10.1016/s0254-6272(08)60038-2
12. Su WW, Gao XA, Tian JS, Effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and composition in postpartum hypogalactia, Zhongguo Zhen Jiu 2020 (in Chinese) — https://doi.org/10.13703/j.0255-2930.20190107-0001
13. Neri I, Allais G, Vaccaro V, et al, Acupuncture treatment as breastfeeding support: preliminary data, Journal of Alternative and Complementary Medicine 2011 — https://doi.org/10.1089/acm.2009.0714
14. Zhou HY, Li L, Li D, et al, Clinical observation on the treatment of post-cesarean hypogalactia by auricular points sticking-pressing, Chinese Journal of Integrative Medicine 2009 — https://doi.org/10.1007/s11655-009-0117-9
15. Esfahani MS, Berenji-Sooghe S, Valiani M, Ehsanpour S, Effect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in Tehran, Iranian Journal of Nursing and Midwifery Research 2015 — https://pubmed.ncbi.nlm.nih.gov/25709684/
16. Maged AM, Hassanin ME, Kamal WM, et al, Effect of low-level laser therapy versus electroacupuncture on postnatal scanty milk secretion: a randomized controlled trial, American Journal of Perinatology 2020 — https://doi.org/10.1055/s-0039-1693428
17. Pouresmaeili N, Shoorab NJ, Sezavar M, et al, Comparison of the effect of milk booster drops and acupressure on the milk volume of mothers with premature infants: a randomized clinical trial, Iranian Journal of Nursing and Midwifery Research 2026 — https://doi.org/10.4103/ijnmr.ijnmr_378_23
18. Baker-Fox C, Hayakawa J, McCarty R, et al, East meets West: effect of acupuncture on lactation and maternal quality of life, Breastfeeding Medicine 2024 — https://doi.org/10.1089/bfm.2023.0278
19. Kvist LJ, Hall-Lord ML, Rydhstroem H, Larsson BW, A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation, Midwifery 2007 — https://doi.org/10.1016/j.midw.2006.02.003
20. Brodribb W, Academy of Breastfeeding Medicine, ABM Clinical Protocol #9: use of galactogogues in initiating or augmenting maternal milk production, second revision 2018, Breastfeeding Medicine 2018 — https://doi.org/10.1089/bfm.2018.29092.wjb
21. Academy of Breastfeeding Medicine, Clinical protocols, accessed October 2026 — https://www.bfmed.org/protocols
22. Mitchell KB, Johnson HM, Rodríguez JM, et al, Academy of Breastfeeding Medicine Clinical Protocol #36: the mastitis spectrum, revised 2022, Breastfeeding Medicine 2022 — https://doi.org/10.1089/bfm.2022.29207.kbm
23. National Institute for Health and Care Excellence, Postnatal care (NG194), 2021, last updated 2026 — https://www.nice.org.uk/guidance/ng194/chapter/Recommendations