Increase milk supply when breastfeeding

Low Milk Supply | WIC Breastfeeding Support

Many moms worry about low milk supply, but most of the time your body makes exactly what your baby needs, even if you don't realize it. There are also ways to tell if your baby is getting enough milk. If you aren't making enough, there are ways you can build your supply. And your WIC breastfeeding staff is always there to help!

Am I Making Enough Milk?

First, look for these signs that your baby is getting enough milk. For example, pay attention to the number of wet and dirty diapers and your baby's weight gain.

Things you should NOT worry about:

• How your breasts feel. Your breasts will feel softer and less full as your milk supply adjusts to your baby's needs. This does not mean you have low supply.
• If your baby nurses for shorter periods of time, such as only 5 minutes on each breast.
• If your baby's feeds are bunched together. This is called cluster feeding and happens when your baby starts nursing more often and for longer. This can happen in the evenings or because of growth spurts.
• Not getting much milk when you express. Your baby is much more effective than a pump or hand expression at getting out milk. Find tips to help you pump.

If you are still concerned, talk to your baby's doctor about their growth.

Causes of Low Milk Supply

While most moms make plenty of milk, some do have low milk supply. This might happen if you:

• Limit your baby's breastfeeding sessions. Remember, the more you feed on demand, the more milk you make.
• Give your baby infant formula instead of breastfeeding.
• Introduce solid foods before baby is 4-6 months old.
• Take certain birth control pills or other medicine.
• Don't get enough sleep.
• Drink alcohol or smoke.
• Have had breast surgery.

Talk to your doctor if you have hepatitis B or C, herpes, or diabetes. These conditions may also affect milk supply.

Increasing Your Milk Supply

Breastfeeding frequently—especially in the first hours, days, and weeks—is the main way to increase your milk supply. Your body will make milk to meet your baby's demand.

Try these tips to help you make more milk:

• Breastfeed every time your baby is hungry. In the early weeks, your baby will eat 8-12 times every 24 hours. It's best not to put your baby on a strict feeding schedule. Follow your baby's cues, and let your baby tell you when it's time to eat.
• Make sure your baby is latching well.
• Offer both breasts at each feeding. Let your baby finish the first side, then offer the other side.
• Empty your breasts at each feeding. Hand express or pump after a feeding to draw out all the milk and signal your body to make more.
• Avoid bottles and pacifiers in the early weeks. Feed your baby from your breast whenever you can.
• Get plenty of sleep, and eat a healthy diet.
• Pump or express your milk. Pumping or expressing milk frequently between nursing sessions, and consistently when you're away from your baby, can help build your milk supply.
• Relax and massage. Relax, hold your baby skin-to-skin, and massage your breasts before feeding to encourage your milk to let down.
• Take care of yourself. Get plenty of rest, eat well, drink enough fluids, and let others help you.

Consider Charting Your Progress

Record how often your baby is breastfeeding, for how long, and on which sides. If you are supplementing with infant formula, record how much your baby is getting and decrease the infant formula as your milk supply increases. WIC breastfeeding staff can help you determine how much infant formula your baby needs.

Still Have Questions?

Contact your WIC breastfeeding expert. They can talk to you about supply concerns and give you tips to increase your supply to meet your baby's needs.

Low milk supply? How to increase breast milk supply

Many mums worry they have a poor milk supply, but it can be hard to know for sure. Read on to find out whether you really have low milk supply and what you can do about it

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“Have I got enough breast milk?” is something new mothers often worry about – but chances are, if your baby’s healthy and growing well you’re doing great. However, if you’re concerned about your breast milk supply, it’s important to seek advice early. If it turns out things are fine, you’ll quickly be reassured. Plus, you’ll avoid the trap of giving your baby formula unnecessarily, which may cause your own milk supply to drop.

Reasons for low milk supply

A small number of new mums have difficulty producing enough breast milk due to medical reasons, which include:

• Excessive blood loss (more than 500 ml/17.6 fl oz) during the birth or retained fragments of the placenta can delay your milk coming in (which usually happens around three days after the birth).¹
• A history of polycystic ovarian syndrome, diabetes, thyroid or other hormonal disorders. Mums with these conditions sometimes experience a low milk supply.²
• The rare medical condition mammary hypoplasia, in which there isn’t enough milk-producing glandular tissue within the breast.³
• Previous breast surgeries or breast trauma – although many mums who have had surgery go on to breastfeed successfully.⁴

If any of these conditions applies to you, see a lactation consultant or breastfeeding specialist.

How breast milk supply works

Once your breast milk has come in, your breasts start to make milk through a process of ‘supply and demand’. Each time milk is removed, either by your baby feeding or by expressing, your breasts make more.

That’s why giving bottles of formula can reduce your milk supply – your body isn’t getting the message to produce more breast milk, because none is being removed.

The way your baby nurses also affects your supply. The more frequently and effectively she breastfeeds, the more milk you’ll make. If your baby doesn’t take enough milk during a feed, it’s essential to express regularly to protect your milk supply – see below for more advice.

Signs your baby isn’t getting enough milk

Even though low milk supply is rare, your baby may still struggle to get enough for other reasons during her first few weeks. She may not be breastfeeding frequently enough, or for long enough, particularly if you’re trying to stick to a breastfeeding schedule rather than feeding on demand. She may not be latching well, or might have a condition that makes it harder to take in milk.

The following are signs your baby isn’t getting enough milk:

• Poor weight gain. It’s normal for newborns to lose 5% to 7% of their birth weight in the first few days – some lose up to 10%. However, after that they should gain at least 20 to 30 g (0.7 to 1 oz) per day and be back to their birth weight by day 10 to 14.^5,6,7 If your baby has lost 10% or more of her birth weight, or she hasn’t started gaining weight by days five to six, you should seek medical advice immediately.
• Insufficient wet or dirty nappies. The number of poos and wees your baby has per day is a good indicator of whether or not she is getting enough milk – see our article explaining the pattern your baby should be following in Breastfeeding your newborn: What to expect in the first week. Seek medical advice if you’re concerned or if you have noticed her dirty nappies decreasing in wetness and heaviness.
• Dehydration. If your baby has dark-coloured urine, a dry mouth or jaundice (yellowing of the skin or eyes), or if she is lethargic and reluctant to feed, she could be dehydrated. ⁶ Fever, diarrhoea and vomiting, or overheating, can cause dehydration in infants. If you notice any of these symptoms, seek medical advice quickly.

Find out the top 5 tips to know if your baby is getting enough milk

Misconceptions about low milk supply

Newborns typically feed very often – around 10 to 12 times a day, or every two hours – and this is not a sign that you don’t have enough milk. Don’t forget that your baby also nurses for comfort, and it’s difficult to tell how much milk your baby takes during each feed – amounts can vary.

The following are all perfectly normal and are not signs of a poor milk supply:

• your baby wants to feed frequently
• your baby doesn’t want to be put down
• your baby is waking in the night
• short feeds
• long feeds
• your baby will take a bottle after a feed
• your breasts feel softer than they did in the early weeks
• your breasts don’t leak milk, or they used to leak and have stopped
• you can’t pump much milk
• you have small breasts

What to do if you have low milk supply

If you suspect your baby is not getting enough milk, see a lactation consultant or breastfeeding specialist. They will assess whether you have low milk supply and observe a breastfeed to see if your baby is latched on well and taking in enough milk. They may suggest adjusting your feeding position or your baby’s latch so she can feed more efficiently.

You could also try having more skin-to-skin contact with your baby before and during feeds to stimulate the hormone oxytocin, which gets your milk flowing. Or use relaxation techniques, such as listening to your favourite calming music, to reduce any anxiety that could be affecting your supply.⁸

With support, most mums with low milk supply are able to partially breastfeed their babies, and some will manage to develop a full milk supply.

If your baby is not yet taking enough milk directly from the breast, perhaps because she was premature or has special needs, you may need to express to protect your milk supply, and your healthcare professional may prescribe galactogogues (medication to increase milk production).

If you’re not yet able to express enough breast milk for your baby, you’ll need to supplement her with donor milk or formula, under the guidance of a medical professional. A supplemental nursing system (SNS) can be a satisfying way for her to get all the milk she needs at the breast.

How to increase milk supply with a breast pump

If you need to encourage your milk supply in the first five days after birth, you can use a double electric breast pump with initiation technology, such as the Medela Symphony. This type of pump is designed to mimic the way a baby stimulates the breasts while feeding, and has been found to increase longer-term milk production.⁹

Once your milk has come in, double pumping means you can express more milk in less time.¹⁰ This method also drains the breasts better, which also helps with milk supply.

Although every mum is different, it’s often a good idea to express milk straight after, or an hour after, a feed. This may seem counterintuitive, because it’s usually easier to pump from a full breast. But you should think of your pumping session as ‘putting in a milk order’ for the next day.

At first you may only collect small amounts, but don’t be discouraged – with regular pumping, this will increase. Aim to be removing milk (by breastfeeding as well as pumping) eight to 12 times a day, including one session at night when your levels of the milk-producing hormone prolactin are highest. The more frequently milk is removed, the better. After two or three days of regular pumping you should see a significant increase in supply. For advice on getting more milk from each pumping session, read breast pumping tips.

Hands-on pumping to increase expressed milk

If your baby is not breastfeeding directly at all, or you can’t yet pump enough milk for her, a technique called ‘hands-on pumping’ can be useful. It has been shown to increase the amount of milk mums can express in a session.^11,12 The whole process takes around 25 to 30 minutes. Remember, the emptier your breasts, the more quickly they’ll make milk.

Follow these simple steps:

• Massage your breasts.
• Double pump using an expressing bra to keep your hands free.
• While pumping, use your fingers and thumb to compress your breast for a few seconds. Release and repeat. Use compressions on both breasts until your milk flow slows to a trickle.
• Massage your breasts again.
• Finish by hand expressing or single pumping, using breast compressions and switching between breasts to drain them as fully as possible.

Once your baby is gaining weight and you’ve increased your supply, then you can move on to feeding her exclusively at the breast.

References

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Vanky E et al. Breastfeeding in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2008;87(5):531-535.

3 Neifert MR et al. Lactation failure due to insufficient glandular development of the breast. Pediatrics. 1985;76(5):823-828.

4 Neifert M et al. The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 1990;17(1):31-38.

5 C Tawia S, McGuire L. Early weight loss and weight gain in healthy, full-term, exclusively-breastfed infants. Breastfeed Rev. 2014;22(1):31-42.

6 Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical profession. 7th ed. Maryland Heights MO, USA: Elsevier Mosby; 2010. 1128 p.

7 World Health Organisation. [Internet]. Child growth standards; 2018 [cited 2018 Feb]

8 Keith DR et al. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012;12(2):112-119

9 Meier PP et al. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012;32(2):103-10.

10 Prime DK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med. 2012;7(6):442-447.

11 Stanford University School of Medicine [Internet]. Stanford, CA, USA: Maximizing Milk Production with Hands-On Pumping; 2017. [Accessed 30.04.2018].

12 Morton J et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009;29(11):757-764.

How to increase the amount of milk for a nursing mother? - an article in the blog of the medical center Health for Children in Moscow

Breastfeeding is the key to good health and mental peace of the child for years to come. But besides this, breastfeeding solves most of the mother's issues: from financial issues to the convenience of building your day and bonding with your child. Galina Vladimirovna Loseva, our most sought-after pediatrician with more than 20 years of experience, tells how to increase the amount of milk for good nutrition of a child

The problem of lack of milk can occur both in the early neonatal period, when lactation is becoming established, and later, for example, during lactation crises, which can occur at certain periods of time (3-6 weeks, 3-4 months, 6 months), as well as after temporary weaning during the mother’s illness or the need to take certain medications that are incompatible with breastfeeding.

Ways to increase lactation:

• Feeding on demand , especially during early lactation. Frequent feedings in the first weeks of life are essential for maximizing the number of prolactin receptors to ensure sufficient milk production in the long term. Without these receptors, lactation will be at risk by 2-3 months of age. It is advisable to attach the baby to the breast as soon as possible after childbirth. If possible, do not use bottle supplements without a good reason. Night feedings are obligatory, the need for them usually lasts up to about 6 months. nine0013
• Proper breastfeeding. The baby must include both the nipple and areola. His mouth should be wide open with his lower lip turned outward
• You can use post-feeding pumping to increase milk production. And at the same time, freeze milk to create a reserve in case the mother leaves or a case of illness in which it is necessary to interrupt breastfeeding.
• Rational nutrition for breastfeeding women. The menu should contain cereals, vegetables, fish, meat, eggs, fruits, dairy products are better than sour-milk, a small amount of nuts is acceptable. The use of strict hypoallergenic diets in a woman without an allergic history is unacceptable. Spicy dishes, spices, fried foods are excluded, this can affect the taste and smell of milk. nine0013
• Drinking enough liquid - water, green tea, compotes, fruit drinks. Drinks should preferably be warm or hot. It is recommended to take liquid 20-40 minutes before feeding.
• Eliminate alcohol, nicotine, including passive smoking.
• Compliance with the rest regimen , psycho-emotional peace, positive attitude. This is largely determined by the attitude of close people who can help a nursing mother in household chores, caring for other children, etc. nine0013
• Warm shower, light breast massage just before feeding.
• If you still need supplementary feeding, then it is better to give it with a pipette, spoon, syringe without a needle.
• Pharmacy products: Laktogon, Femilak. From herbs, galega, cumin, anise are considered safe. However, relying only on these funds is not worth it if the above points are not observed. They can be used as ancillary, as an addition to the diet of a nursing mother, which may be insufficient for certain reasons. nine0013

The material was provided by a pediatrician with more than 20 years of experience Galina Vladimirovna Loseva.

All recommendations should be applied after full-time consultation with a specialist doctor.

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