Concern over low milk supply is a very real issue for many breastfeeding moms. While not having enough milk is the most common reason given by mothers for early weaning and supplementation, actual low milk production is very rare. 1 Whether it is real or perceived, understanding how your milk supply is established and knowing what to do to optimize your breast milk supply can relieve stress, worry, and ensure your body has the opportunity to make enough milk for your baby.
Strategies to increase breast milk supply
Once you realize there is a milk supply issue, diligence is extremely important to help build your supply.
- Ensure you are feeding your baby with a deep latch and effective milk transfer at his early feeding cues, without limiting access to the breast, at least 8-10 times (or more!) every 24 hours.
- Increase the amount of times your baby is nursing at the breast. Babies with an effective suck are usually more effective at milk removal than pumping or expression. Offer each breast more than once at a feeding and offer to nurse your baby often!
- Use breast massage/compression. Think of this as “pumping” into your baby. Breast compressions while breastfeeding (or pumping) help your breasts drain even more milk. And an empty breast makes more milk.
- If your baby doesn’t completely drain your breasts, you can express following a feeding to help build your supply. Alternatively, if your baby does empty your breasts, waiting 30 minutes (while your breasts are busy at work making milk) and then expressing will help increase your supply. Remember, an empty breast makes more milk, whereas milk stasis in your breasts slows milk production.
- Don’t allow more than 5 hours to go between a feed, and only allow this much time once every 24 hours. If your baby goes this long between a feed, make sure he is still nursing at least 8-10 times in a 24 hour period.
- Spend as much time skin-to-skin with your baby as possible.
- Consider safe bed sharing or co-sleeping with your baby.
- Avoid pacifiers (dummies) and anything else that would keep him from suckling at the breast.
- Consider taking a galactagogue. Herbal galactagogues include fenugreek and blessed thistle. There are also prescription medications that can help (though all galactagogues can have side effects and inherent risks) so other measures should be tried first. Also, a galactagogue will only be effective if you are frequently and effectively removing milk from your breasts.
- If a supplement must be given, consider giving it through an at-breast tube feeding device. This has the benefits of continued breastfeeding and breast stimulation while at the same time giving your baby a supplement (which could be formula or breast milk), skin-to-skin time holding your baby, and no chance of nipple confusion! But, be aware that formula takes nearly twice as long to digest as breast milk (78 minutes vs. 48 minutes) so if you give a supplement with formula (as opposed to expressed or donor breast milk) then your baby may sleep longer between feeds than he should. You may need to express twice during this time to actually mimic how your breastfeeding baby would have nursed.
- If any bottles are given, make sure you pump or hand express on both sides so your body knows that your baby just ate. If using a pump, make sure the flange is the correct size.
- Use caution with bottles. Babies must suck at the breast before there is a let-down of milk. This makes it easier to self-regulate how much milk he actually needs. With a bottle, some babies continue to eat even when they are full because it is an “effortless flow” and they can do nothing but gulp and swallow. Taking care in how you give a bottle can ensure this doesn’t happen.
Other things to consider:
- Make sure you are not using any hormonal medications (estrogen suppresses lactation and progesterone may also) or other known anti-galactagogues (such as decongestants).
- Is it possible you are pregnant? Hormonal changes in pregnancy can also decrease your milk supply.
- Have your doctor check your endocrine levels. Perhaps there is a thyroid issue or some other hormonal imbalance that could be corrected with medication.