Increasing Low Milk Supply

By Kelly Bonyata, BS, IBCLC

Is your milk supply really low?

First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn’t. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.

What if you’re not quite sure about baby’s current weight gain (perhaps baby hasn’t had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:

• Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.
• Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don’t offer baby supplements when this happens: supplementing will inform your body that the baby doesn’t need the extra milk, and your supply will drop.
• Your baby nurses more often and is fussy in the evening.
• Your baby doesn’t nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.
• Your baby is fussy. Many babies have a fussy time of day – often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.
• Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).
• Your breasts don’t leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby’s needs.
• Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby’s needs.
• You never feel a let-down sensation, or it doesn’t seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.
• You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.

See also Is my baby getting enough milk?

Who to contact if you suspect low milk supply

If you’re concerned about your milk supply, it will be very helpful to get in touch with a trained breastfeeding counselor or a board certified lactation consultant. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it’s possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk.

Potential causes of low milk supply

These things can cause or contribute to a low milk supply:

• Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.
• Bottle preference. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.
• Pacifiers. Pacifiers can affect baby’s latch. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.
• Nipple shields can be a useful tool in some cases, but they can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.
• Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.
• Sleepy baby. For the first few weeks, some babies are very sleepy and only ask to nurse infrequently and for short periods. Until baby wakes up and begins to breastfeed well, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.
• Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.
• Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you’re trying to increase your milk supply, let baby finish the first side, then offer the second side.
• Health or anatomical problems with baby (including, jaundice, tongue-tie, etc.) can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.
• Mom’s health (uncontrolled anemia or hypothyroidism, retained placenta, postpartum hemorrhage…), previous breast surgery/injury, hormonal problems (e.g. PCOS), anatomical problems, medications she is taking (hormonal birth control, sudafed…), or smoking also have the potential to affect milk supply.

Increasing your milk supply

Milk production is a demand & supply process. If you need to increase milk supply, it’s important to understand how milk is made – understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

• Make sure that baby is nursing efficiently. This is the “remove more milk” part of increasing milk production. If milk is not effectively removed from the breast, then mom’s milk supply decreases. If positioning and latch are “off” then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby’s ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw – it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.
• Nurse frequently, and for as long as your baby is actively nursing. Remember – you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.
• Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).
• Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
• Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to “comfort” sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman’s Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.
• Avoid pacifiers and bottles when possible. All of baby’s sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).
• Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to “challenge” your breasts to produce more milk.
• Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don’t force liquids – drinking extra water does not increase supply), and eat a reasonably well-balanced diet.
• Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful – pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
• Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.

Additional information

@

• How does milk production work?
• My breasts feel empty! Has my milk supply decreased?
• How might I increase baby’s weight gain?
• Protocol to Manage Breastmilk Intake by Jack Newman, MD
• Weaning from formula supplements
• Prescription drugs used for increasing milk supply

@ other websites

• How can I increase my milk supply? by Becky Flora, IBCLC
• Hidden Hindrances to a Healthy Milk Supply by Becky Flora, IBCLC
• Increasing Your Milk Supply by Anne Smith, IBCLC