Increasing Breast Milk Supply

One of the most common reasons nursing mothers give their baby bottle feeds is because they feel they are not producing enough milk for their baby. Fortunately there are many ways to increase milk supply.

Where to start?

Nearly every mother, at some stage, worries whether her baby is getting enough milk. When faced with difficult or irritable infant behavior, nursing mothers often worry that their milk supply has decreased. Where a breastfed baby is healthy and thriving, low supply is rarely the cause of difficulties.

Before attempting to increase your milk supply, the first thing to determine is whether your milk supply really is low or not. (See our article on How to tell when your baby is getting enough breast milk).

How to increase your milk supply

There are many things you can do to improve your milk supply. By following the steps below, most nursing mothers will notice an increase in milk supply within 24 - 72 hours.

1. Ensure correct latch-on

If your milk supply is low, there is a good chance you can increase it by stimulating and emptying your breasts more effectively. The best way this can be achieved is to make sure your baby is latched-on correctly. A baby who is well latched-on gets milk more easily than one who's not. Once your baby is properly positioned, well latched and sucking effectively, the longer she nurses at your breast the more milk will be produced. (See Breastfeeding basics for more about latch-on).

2. Increase the number of breastfeeds

Breastfeeding your baby more frequently may increase your milk supply. The principle of 'supply and demand' applies to breastfeeding. If your breasts remain full milk is produced more slowly. The more often your breasts are emptied the more milk is made.

Offer your baby a breastfeed every 1.5 to 2 hours during the day and at least every 3 hours during the night. Allow your baby to nurse on each side until she pulls off herself or goes to sleep. If your baby has been napping for more than 2 hours during the day, wake her up and offer her a breastfed.

3. Encourage a milk ejection reflex (let-down)

Successful breastfeeding requires an adequate milk ejection reflex (let-down). Many mothers feel a tingling, pins and needles sensation or a feeling of fullness at the time of a let-down. However, not all breastfeeding mothers are aware when a let-down occurs.

To encourage a let-down, apply a warm compress to your breast 5 minutes before breastfeeding or pumping. Try to feed in a quiet, relaxing environment. Use relaxation techniques such as deep breathing or visualization.

4. Offer both breasts each time you feed

One-sided breastfeeding is often not enough while you are attempting to increase your breast milk supply. The more frequently both breasts are emptied the better.

While your baby is feeding well allow her to nurse for as long as she chooses, when she has had enough, then offer your other breast. Babies sometimes fall asleep on the breast or pull away from the breast when the flow of milk is slow and not necessarily because they have had enough to eat. Before switching sides try breast compression.

5. Breast compression

Breast compression often stimulates a natural let-down reflex to occur. The purpose of breast compression is to continue the flow of milk to your baby once she no longer drinks on her own.

When your baby loses interest in feeding and slows down or begins to comfort suck, support your breast with your thumb above and fingers below, as far back from the nipple as possible, and gently compress your breast. Keep the pressure up until your baby no longer drinks. Wait a short while and compress again. (Breast compression is not necessary if your baby is feeding well). Once she's no longer interested in continuing to feed then try switch feeding.

6. Switch feeding

Switch feeding, where you alternate back and forth between breasts at the same feed, can encourage a sleepy baby to suck more vigorously for a longer period of time. (Try to encourage her to stay awake by burping her or changing her diaper between sides).

You will know when to change sides by observing your baby's feeding pattern. When the intensity of her suck and swallow decreases, first try breast compression, then switch her to your other breast and encourage her to nurse actively again. When her sucking once again slows, switch back again and so on, until you find she can no longer be encouraged to continue.

7. Top-up feeding

The more frequently your breasts are emptied the more milk will be produced. Wait for 20 or 30 minutes after breastfeeding and then offer another quick little 'top-up' breast feed.

8. Pumping

The principle behind pumping is to place a greater demand on your breasts to encourage them to produce more milk. A well latched-on baby is more effective at emptying and stimulating your breasts to produce more milk than any breast pump, so if your baby is willing to nurse, this is preferable to pumping.

As soon as possible after day time breastfeeds, pump for 5 to 10 minutes on each breast. Pumping after night time breastfeeds would also be beneficial but this needs to be weighed against the benefit of you getting as much sleep as possible, which will also positively improve your milk supply. Don't be concerned that "nothing is coming out" when you pump. Provided you can feel the suction from the pump it's stimulating your breast to produce more milk.

If you have a dual pump, pumping both breasts at the same time is often more effective at stimulating increased production than pumping from one breast at a time.

9. Hand expressing

Nursing mothers have been expressing breast milk by hand long before breast pumps were invented. (Unfortunately, hand expressing is a skill that is rarely taught in busy maternity hospitals these days). When done correctly, hand expressing can be even more effective than an electric or hand pump at extracting milk and stimulating milk production.

You can choose to either hand express or pump following breastfeeds to stimulate milk production. It is not necessary to do both.

10. Overnight feeding

Maternal prolactin (milk-making hormone) levels peak in the early hours of the morning. By nursing more frequently at night you can take advantage of the higher levels of prolactin to help stimulate your supply.

11. Fluids

Drinking sufficient fluids won't make you produce more milk, but it is important to replenish lost fluids. When you think about it, you may be producing anywhere from 20 to 40 ounces of breast milk per day. This fluid needs to be replaced along with the recommend 8 glasses of water that you would need even if you weren't lactating.

Don't rely on thirst as an indicator of when you need to drink. By the time you feel thirsty, you are already mildly dehydrated. Try to get into the habit of drinking a glass of water each time you breastfeed.

12. Diet

As a new mother, you will be so busy it can sometimes be difficult to find the time to eat. However, you need for a healthy diet provided by regular meals and snacks is even more important now your breastfeeding. Your milk supply will not be directly affected if your diet is inadequate, but your health may suffer as a result.

Nursing alone requires about an extra 500 calories each day on top of what you would normally need to eat. You need foods high in calcium, iron and protein. Eat 3 healthy meals per day and regular snack such as yogurt, cheese and fruit throughout the day. Avoid junk food.

13. Rest

Get plenty of rest. It's important that you are not trying to be a 'super mom'. This is the time to not only nurture your baby but to nurture yourself. Accept offers of help from friends and family. Where possible, take whatever steps you can to reduce household tasks and other responsibilities. When your baby sleeps, try to rest yourself.

14. Medications

Medications should never be use as the first or only method of increasing breast milk supply.

Domperidone (Motilium™) is a drug used to treat nausea and vomiting. A side effect of this drug is that it increases the production of prolactin (the milk-making hormone). Domperidone can be purchased over-the-counter in many countries; however, in the United States it is only available with a doctor's prescription.

Domperidone is most effective in doses of 10 mgs, 3 times a day. After starting Domperidone it may take 3 or 4 days before you notice any effect. (Although some mothers notice some effect within 24 hours.) It can take up to 2 or 3 weeks to get maximum effect. When using Domperidone in an attempt to increase breast milk production, most mothers continue to take it for 3 to 8 weeks.

Metoclopramide (Maxeran™, Reglan™, Maxalon™). Another related but older medication, Metoclopramide is also know to increase milk production, but it has frequent side effects (fatigue, irritability, depression) with extended use over 4 weeks, which make its use unacceptable for many mothers. Domperidone seems to have far fewer side effects than Metoclopramide.

Metoclopramide, which is most effective with doses of 10 - 15 mg 3 times a day, should not be used for any longer than 2 - 4 weeks.

IMPORTANT: We recommend that you consult with your doctor for medical advice before using Domperidone or Metoclopramide.

15. Herbal Therapies

There are no scientific studies that show that certain herbs will make you produce more milk. However, some mothers and lactation consultants believe that certain herbs can increase the production of breast milk. Some herbal suggestions include...

Fenugreek
Blessed Thistle
Alfalfa
Fennel
Brewers Yeast
Raspberry Leaf

These come in various forms, as tinctures (the strongest preparation), tablets (next strongest preparation) and teas (mildest preparation).

IMPORTANT: As there can be considerable variations in quality and strength of herbal remedies, we recommend that you speak to a qualified herbalist personally before using any herbal remedies.

When supplement feeding is needed

If your baby is not gaining weight, then supplement feeding may be necessary. Pumped breast milk is preferable to formula. However, if enough pumped breast milk is not available then formula supplements may be necessary to ensure your baby's nutritional needs are met. (At least short term, until your breast milk supply has increased).

Give supplement feeds only if necessary after breastfeeding. Use a soft eye dropper, medication syringe or an infant training cup to avoid 'nipple confusion'.

Reasons why your milk supply may decrease

1. Poor latch

The most common reason for decreased milk supply is poor latch-on. If your baby is poorly latched she will get milk only when the flow is rapid. Many babies do well during the early weeks of breastfeeding despite a poor latch-on because most mothers produce an abundance of milk during that time. However, by around 6 - 8 weeks, breast milk supply balances to meet demand. If your baby has a poor latch-on this will result in less effective milk extraction and stimulation and your milk supply may decrease as a result.

2. Poor Positioning

If your baby is uncomfortable or has difficulty remaining latched-on because of the position she is held, she will not feed as effectively, or if you are uncomfortable, it can make it difficult for you to feed for as long as needed. (See Breastfeeding Basics for more about breastfeeding positions.)

3. Changing sides too soon

Changing sides too soon may result in your breasts not being adequately emptied. Breast milk contains a protein, the FIL factor (Feedback Inhibitor of Lactation) that tells the milk producing cells when to cut down milk production. This means if your breasts are not emptied milk production slow down.

4. Not nursing often enough

The principle of 'supply and demand' applies to breastfeeding. If there is less demand, your breasts will start to make less milk. The more often your breasts are emptied the more milk will be made.

5. Formula

The more formula your baby has the less breast milk your body will produce. If the demand for breast milk has decreased, due to formula supplements, starting solids too soon or eating too much solid foods, then milk production will decrease.

6. Solid foods

Either starting solids too soon, or giving too much solid food can impact on breastfeeding. If your baby is healthy and thriving she doesn't need solids, water or juice before the age of 6 months, as your breast milk will provide all the nourishment and nutrients she needs.

If your baby is over 6 months, offer solids shortly after breastfeeds, while attempting to increase your supply. If you offer solids before or mid way between breastfeeds your baby may not be as hungry when you next offer her a breastfeed and therefore she may not empty your breasts as effectively and this can affect your supply.

7. Bottle feeding or using a pacifier

'Nipple confusion' is another reason for poor stimulation. Bottle feeding requires a completely different sucking action to breastfeeding. If your baby uses a bottle feeding action while trying to breastfed, not only will she not get as much milk but she will also not effectively stimulate your breasts to produce more milk.

While attempting to increase your milk supply, allow your baby to meet all her sucking needs at your breast, avoid the use of bottles and pacifiers.

8. Nipple shields

Using a nipple shield can affect your milk supply in two ways. It decreases the amount of stimulation to the breast (needed to encourage further milk production) and it also decreases the amount of milk transferred. If you are currently using a nipple shield try to remove the shield and encourage your baby to latch-on to your breast, if not initially then shortly into the feed.

9. Poor suck due to prematurity, illness, medical condition or disability

Supplementing with pumped breast milk (preferably after breastfeeding), may be necessary in these situations. Pumping will assist you to maintain your breast milk supply until your baby is strong enough to exclusively breastfeed.

10. Medications

The following medications can decrease breast milk production...

Antihistamines
Sedatives
Some decongestants
Some weight loss medications
Diuretics
Very high doses of Vitamin B6
Some birth control pills, especially pills that contain estrogen

11. Cigarettes

Mothers who smoke more than 20 cigarettes a day often experience a low milk supply. Their babies also tend to be more irritable and gain weight more slowly than babies of mothers who smoke fewer cigarettes each day or those who do not smoke at all.

In addition babies can be "turned off" by the smell of nicotine on their mother's hands and may fuss at the breast because of this.

12. Alcohol

For years it has been claimed that beer stimulates milk production. However, research shows that babies don't like alcoholic breast milk and will actually drink less of it. As this may result in inadequate emptying and less stimulation to the breast, alcohol may ultimately decrease milk production.

The level of alcohol in your breast milk will match your blood alcohol level at the time of feeding. (See Alcohol and Breastfeeding).

13. Stress or anxiety

If you are feeling tense, uncomfortable or exhausted, this can affect your milk ejection reflex (let-down).

14. Hormonal changes

Ovulation, menstruation or pregnancy can all affect milk production. Your baby may fuss for a few days if you are ovulating or menstruating, but will generally return to a normal feeding pattern within a few days. Although many women can successfully continue to breastfeed while pregnant, others many find their supply decreases.

15. Illness or medical condition

When a mother is suffering from any sudden illness, particularly one associated with fever, her milk supply may decrease.

Thyroid deficient mothers may not produce enough milk. A mother with a history of thyroid deficiency or a mother who is not producing adequate milk should have her thyroid level tested. Symptoms of low thyroid include excessive hair loss, dry skin, increased sensitivity to cold, loss of appetite, extreme fatigue, depression and a swelling in the neck area.

Anemia can also affect milk production. Symptoms of anemia are paleness of the inside of the lower eyelid, fatigue, lethargy and dizziness.

IMPORTANT: If you suspect you have an illness or are just not feeling like your normal self, see your doctor.

16. Breast surgery

Breast enlargement or breast reduction surgery may reduce milk production. However, many women with past breast surgery can go on to successfully breastfeed their babies.

Written by Rowena Bennett