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ESSENTIAL STEPS TO HAVE A GOOD MILK SUPPLY
Raise your hand if you’ve ever worried if you are making enough milk for your baby.
This is a really common concern expressed by breastfeeding moms (no pun intended).
In fact, it is one of the most common reasons a mom stops breastfeeding.
Keep reading to see if you should be worried about your milk supply.
How much milk do I need to make?
You need to make enough milk so that your baby will grow at a normal rate.
You DON’T need to make enough so that your baby eats at some predetermined interval.
You DON’T need to make enough so that your baby is in the 90% for weight.
You DON’T need to make enough to have a massive amount of breast milk stored in your freezer.
The amount of milk you need to make is a moving target. It will change depending on how old your baby is and how much your baby weighs.
The rate of growth slows down as you baby gets older, so you don’t have to make more and more as your baby gets older and bigger.
Most babies don’t eat the same amount at every meal. They may want a four course meal at one feeding, a small snack at another and the equivalent of a sandwich at another.
Keep reading to see if you should be worried about your milk supply.
Common Reasons a Mom Worries About Her Milk Supply
- Her baby wants to breastfeed more frequently than expected.
- Her baby eats more frequently than someone else expects him to. And they comment on it being too often.
- Some moms make a lot of milk but can’t store a lot of milk. Their baby will need to eat more frequently.
- You have read a book that recommends scheduled feedings. The intervals are longer than your baby wants to go between feedings.
- Some babies need to eat more frequently because large meals make them uncomfortable. This is common with babies who have reflux.
- When your baby goes to daycare, the daycare provider says she needs more milk than what you are providing.
- Formula fed babies often drink larger amounts. They may not eat as frequently as a breastfed baby.
- Make sure your child care provider knows what to expect from your baby.
- Your baby eats a greater amount from a bottle than what you can pump
- Babies can often get more out of a breast than a pump can.
- Your friends can pump larger amounts of milk than you can.
- This doesn’t mean you don’t make enough. And making a lot of milk can cause problems too.
- Your baby isn’t as chubby as some of the other breastfed babies that you see.
- There are adults who are chubbier than other adults too. Everyone is different.
How to tell if your baby is getting enough to eat
These are reassuring signs that your baby is getting enough to eat from breastfeeding.
- 6-8 wet diapers a day
- 4-5 stools of moderate quantity a day in the first two months. This may decrease after two months.
- In the first 3-4 months your breasts get firm between feedings and soften with feeding.
- You hear swallowing for several minutes.
- Your baby is satisfied after most feedings.
- Cluster feeding is normal.
The bottom line is always adequate weight gain.
If your baby is gaining enough weight, he is getting enough to eat. Period.
Weight gain should be consistent from week to week for the first 2-3 months. You may have slow weeks after that. Over the course of a month or two he should be following his growth curve.
I can’t emphasize enough that there is no right on wrong place to be on the curve. You just want her to follow her curve.
Don’t Check Your Milk Supply These Ways!
Sometimes babies are gaining well and moms are still concerned. These are very ineffective ways of checking milk supply:
- Offering your baby a bottle of pumped milk or formula after breastfeeding. Thinking that if he takes it that means you don’t have enough milk.
- Babies can overeat just like adults do.
- Pumping instead of feeding one time, to see how much milk you have.
- Milk supply fluctuates throughout the day.
- Giving your baby a bottle to see how much he takes and comparing it to how much you can pump.
- A baby may take more from a bottle than he normally would take from the breast.
But what if you’ve gotten to this point and said, “those reassuring things aren’t happening.” Or your baby is gaining well, but you are also supplementing now. What then?
First, cover the basics.
The Basics of Ensuring a Good Milk Supply
Some moms will never have a good milk supply, no matter what they do.
Other moms can do everything wrong and still have a great milk supply or even too much milk.
The vast majority of moms make enough milk for their babies, if they are covering the basics.
- Frequency: in the beginning your baby needs to eat at least 8 times every 24 hours.
- If your baby is not able to breastfeed then you need to pump. Something needs to be happening with your breasts at least 8 times every 24 hours.
- It is normal for a baby to eat up to 10-12 times in a 24 hour period
- Your baby may eat even more frequently in the first few days.
- You should be feeding your baby whenever he shows feeding cues.
- Make sure you are thoroughly draining your breasts.
- Every time milk is taken out of your breasts it sends a message to your body.
- If you leave a little bit of milk in your breasts, it tells your breasts to make about the same amount as what was taken out.
- If your drain your breasts as much as possible, then they will usually make more, over time.
- If you leave a lot of milk in your breasts, it tells your body to make less milk.
- It might take a few days for your body to start to make more or less.
- Your breasts are always making milk, even when you are feeding. You will probably always be able to express some drops. Even when your baby has done a really good job of draining them.
- A good latch is very important for effective draining.
- Usually, you will know if your latch is good if it doesn’t hurt when you breastfeed. Your nipple should be round when your baby comes off.
- Some discomfort in the early days can be ok. If you are having any discomfort check with a lactation consultant just to be sure it’s normal.
Make sure you’ve got the basics covered. Make sure that your baby is eating frequently enough, for long enough. Make sure your baby has a good suck and doesn’t have a tongue-tie.
Think long and hard about that sleep training method that is giving you a good eight hours of sleep. It may also be creating a low milk supply.
Find out if you have low prolactin. This is a lab test that your healthcare provider can order.
If your problem is low prolactin you can drink all the blue Gatorade in the world and it won’t change your milk supply.
Low Milk Supply
Causes of low milk supply
- Hormonal problems. This can be from a variety of things.
- Low thyroid
- Pituitary problems
- Not having enough glandular tissue in the breasts (this is NOT small breasts, and it is pretty rare).
- History of breast surgery: reduction, augmentation, lift, even a biopsy. It doesn’t mean if you’ve had one of these procedures you WILL have low milk supply. It means you might.
- Hormonal birth control
- Birth Control pills
- Hormonal IUD’s
- Birth control patches
- Vaginal Ring
- Birth control implant
- Depo-provera shot
- Mom who is dehydrated
- Rigid schedules. These can result in a mom’s breasts not getting emptied thoroughly or frequently enough.
- Timed feedings
- Feeding only on one side when that is not enough for your baby and your breasts
- Babies with an ineffective or weak suck. A weak suck can have many different causes.
- Small baby
- Premature baby
- Chromosomal disorders
- Baby who is sick
- Baby who sleeps long stretches at night
- An ineffective pump
As you can see, there are a LOT of things that can cause low milk supply.
What is causing it will determine what is the best thing to do to increase your milk supply.
Natural ways to increase milk supply
Foods to increase breast milk supply
Some common foods that are believed to increase milk supply include:
- Green leafy vegetables
- Brewer’s yeast
- Fenugreek (I also include this under herbs)
Herbal supplements to increase milk supply
There are some herbs that I have seen moms take that definitely seemed to increase their milk supply.
- Fenugreek – this herb has some scientific evidence supporting its use for milk production (Source)
- The tincture seemed more effective than capsules or teas.
- A normal side effect of taking Fenugreek is that it makes you smell like maple syrup. This actually lets you know that you are taking enough.
- Goat’s Rue – most commonly found as a tincture
- Shatavari – most commonly found as capsules
- Milk Thistle
- GoLacta (Malunggay)
You are likely to come across herbal combinations, like More Milk, Milk Rich and others. I think it is best to start with one single herb and see how your body reacts to it.
If you take a combination of herbs and you have a bad reaction, you won’t know which herb caused it. This is especially true if the herbs are not something you have ever consumed before.
One of my very favorite resources for information about herbs to increase milk supply is the book,“Making More Milk” by Diane West and Lisa Marasco. They talk about the herbs and specifically dosages. How much you take can make a difference.
Herbs are just like pharmaceuticals. They can cause side effects and allergic reactions.
You should always:
Let your doctor know you are taking them.
Check a trusted resource to see if they can interact with any medications you might be taking.
Check a trusted resource to see if a particular herb is contraindicated with any medical condition you might have.
stop taking them if you have any kind of allergic reaction to them. Start your dosage low and increase. decrease the dosage if you or your baby start experiencing any negative side effects.
One of the most common side effects of herbal supplements is GI upset. Decreasing the amount can help with these side effects.
Teas and Drinks
You will see Mother’s Milk Tea at the grocery store. It isn’t going to hurt and can help keep you hydrated. However, it probably won’t help much.
Some moms swear by Gatorade, sometimes Blue Gatorade in particular. I think if it does help it is probably along the same lines as helping with dehydration.
Moms swear by smoothies. This can be attributed to a couple of things.
The increased calories can help. Making milk takes a lot of calories!
The combination of foods may be what helps the milk supply.
Now this is what I’m talking about! Who doesn’t want to increase their milk supply with some yummy cookies?
If someone has a really low supply, cookies are not going to hurt, but they aren’t going to make a huge difference either. Someone who is just a little low may find that they help. You want to make sure they have the things that help milk supply in them. Who knows, maybe their magic power is in those foods being combined, or baked together?
Acupuncture is actually one method that I have seen consistent success with. If a mom is struggling with her milk supply I will always recommend she try acupuncture. Some research studies have looked at acupuncture as a treatment for low milk supply. The results have been encouraging.
Pumping to increase milk supply
Pumping is a tried and true method to increase milk supply. It works for the simple reason that the increase in demand will almost always create an increase in supply.
Just like everything else, it won’t necessarily work for everyone.
- If you are breastfeeding you want to pump right after a feeding.
- This tells your breasts to make more milk next time.
- You will probably get more milk if you wait until you are between feedings. But that is because you are taking milk away from your baby’s next feeding. You don’t want to do that.
- If you are exclusively pumping then you will increase the number of times you pump each day.
- Hands-on pumping is also very effective to help your breasts make more milk.
- Try one of these variations of power pumping.
- Pump every hour for four hours
- Pump X10 minutes > rest X15 minutes> repeat 4 times
- Watch an hour of TV and pump during the commercials
Medications to Increase Milk Supply
Reglan/Metoclopramide – this is a drug that is for GI disturbances.
It also increases prolactin levels, so it can increase milk supply.
It has a black box warning due to the potential side effects.
One of the side effects is depression. Being postpartum already puts you at risk for depression.
Because of its side effects I am not a fan of moms using this drug for low milk supply. I did want you to know about it though.
Domperidone/Motilium– this is another drug that is intended for GI disturbances.
It has been designated an orphan drug by the FDA.
It is not currently FDA approved. Some moms can still get it, from a compounding pharmacy, or online from countries where it is legal.
In some countries it is available without a prescription.
I suggest you do research to understand the pros and cons of this drug. You should definitely not take it without professional advice and supervision
Sudden Drop in Milk Supply
Occasionally a mom will have a sudden drop in her supply. There are things I call “milk busters” because they can decrease milk supply.
- Pseudoephedrine (found in a lot of cold medicines)
- Birth Control Pills
- Significant weight loss in a short period of time
- Baby sleeping through the night
Sometimes it is a mystery.
I always stress that you should work with a lactation consultant if you are not seeing the kind of weight gain that is expected, or if you just want the reassurance to know that everything is normal.
Whether you have documented low milk supply, or you are concerned about your milk supply, it is always best to work with a lactation consultant. She can verify the issue, try to figure out why it is occurring and come up with a plan, and then assess whether the plan is working.
Breastfeeding is not an all or nothing deal.
If your milk supply is low, every bit of it that you can give to your baby is valuable.
STEPS TO A GOOD MILK SUPPL
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.