The most efficient axion production mechanism in a supernova (SN) core is the nucleon-nucleon bremsstrahlung. This process has been often modeled at the level of the vacuum one-pion exchange (OPE) approximation. Starting from this recipe, we revise the calculation including systematically different effects, namely a non-vanishing mass for the exchanged pion, the contribution from the two-pions exchange, effective in-medium nucleon masses and multiple nucleon scatterings. Moreover, we allow for an arbitrary degree of nucleon degeneracy. A self consistent treatment of the axion emission rate including all these effects is currently missing. The aim of this work is to provide such an analysis. We find that the axion emissivity is reduced by over an order of magnitude with respect to the basic OPE calculation, after all these effects are accounted for. The implications for the axion mass bound and the impact for the next generation experimental axion searches will be discussed.