Less than five percent of mothers have reduced, or no, milk production because of medical conditions. Many more mothers struggle with low milk production, but most are dealing with a problem of supply and demand, not a physical condition. Your breasts only make as much milk as is demanded of them, so increasing demand is the base solution for the problem.
There are a variety of ways to do this, from pumping, to diet, to medications, and we’ll walk you through them. But first, it’s important to know how to tell if you have a low milk supply in the first place.
Signs of a Proper Milk Supply
If your baby is gaining an appropriate amount of weight (assuming they are being exclusively breastfed) then your milk supply is enough for them. As long as your pediatrician is satisfied with your child’s growth, there’s nothing to worry about. But, there are a few more signs which may give you further peace of mind. Your child’s poops are a good sign they are getting enough nutrition. They should produce roughly six wet diapers a day at first and at least two stools. At three months that will drop to roughly one poop a day. Light yellow, or colorless, pee which happens a few times a day signals that your baby is properly hydrated.
What Aren't Signs of a Proper Milk Supply
How you feel, including fullness, let down, soreness, or emptiness, is not a good indicator if your baby is getting enough milk. You could be full because your baby’s demand is healthy, or because they didn’t drink enough. The same goes with emptiness, your supply could be dwindling or your baby could have gotten a healthy, full meal. Some women ever feel a letdown, and soreness can come and go.
The baby’s noises aren’t always reliable either. Some babies are quiet eaters, so if you don’t hear him or her swallowing don’t worry. But, if your baby is normally a loud eater and has quieted, he or she may not be getting enough milk.
The same kind of issue arises for a baby’s fussiness. A child could be fussing because she or he did not get an adequate meal, or she or he could be fussy for any of the other reasons a baby has an unsettled mood. It could be an important indicator and could signal you to keep an eye on things, but it's just not reliable.
If you’re noticing that your baby is feeding for less and less time, that’s perfectly normal. As a baby gets older they get more efficient at suckling, eating more in less time. Then again, if your baby has suddenly started to feed for a lot longer, they could be going through a growth spurt. It’s nothing to worry about.
Hormones Responsible for Breast Milk
To understand how to increase a lagging milk supply we have to understand which hormone drives our breasts to produce milk, and what stimulates that hormone.
The hormone responsible for milk production is prolactin. It first hits your blood vessels after the placenta is delivered. For women who have a C-section, this hormonal response may be smaller. Then, prolactin kicks back in after your breasts are drained, signaling to your body that it’s time to make more. So, if your breasts don’t get emptied or your nipples don’t get suckled, for any reason, there’s less prolactin in your body and therefore less milk is produced.
It’s common to struggle with breastfeeding at first, and these early struggles may start a cycle where not enough milk is being demanded of your breasts. At first, the simple solution is to keep at it and then maintain it. You should try to empty your breasts as much and as regularly as your baby wants. In fact, there’s more fat in the latter milk your breast produces, which means if your baby drinks it they get more nutrition and higher weight gain.
If Your breast milk hasn’t come in
Your milk isn’t supposed to come in until a few days after delivery, so if you’re not there yet there is nothing to worry about. Although the first milk, the colostrum, is usually present in the breasts before birth, you usually cannot feel or express it beforehand.
After the placenta is expelled your breasts will start to make milk, but it takes a few days for it to “come in.” When it does happen is an awfully uncomfortable experience for most women, with hard breasts and uncomfortable fullness. Thankfully, the engorgement will die down in a few days.
But What If It Doesn’t Come in After the First Three Days?
Your baby is supposed to be fed by now, right? Relax, your baby has been suckling small amounts of colostrum (which is all they need at first). Plus, it’s common for milk to come in on day four or five. Although, if you find yourself in this position your best bet is to consult a lactation expert.
Generally, they’ll recommend you pump, take hot showers or use hot compresses, and drink more fluids. They should check to see if your baby has an anatomical issue, like a tongue tie, a cleft lip, or another issue which could make their sucking ineffective, and therefore not stimulate your milk.
The pumping should be frequent, even more than every two hours, to properly mimic how the newborn would suckle. If you produce any milk during this you should feed it to your baby. It’s ideal to keep the baby from using a bottle at this point because the sucking motion used for it is so different than for the breast. So, using a syringe or a supplemental nursing system.
What is a Supplemental Nursing System
This neat invention simulates breastfeeding. You fill a bottle with breast milk or formula. It feeds into a small plastic tube, which is gently taped along your breast and to your nipple. As the baby suckles they receive the milk through the bottle, and any milk your breast produces. This system can keep your baby motivated at the breast. Plus, its a huge morale boost for mothers who are struggling with breastfeeding.
If Your Milk Never Comes In
It’s extraordinarily rare for a women’s milk to never come in, assuming her nipples are being stimulated by her baby, or by pumping. If your milk does take a long time it can be a very frustrating wait, especially if your baby is having trouble gaining weight, or you feel like your success as a mother is tied to whether or not you can breastfeed. Some mothers give up, and there should be no shame in that. If breastfeeding turns out to be highly stressful, or your child isn’t gaining weight, you have to do what’s best for the both of you.
Poly-Cystic Ovarian Syndrome (PCOS) and Milk Supply
Although it is rare, there are some conditions which may prevent a woman’s milk from ever coming in, or which may severely reduce their supply. Among these is poly-cystic ovarian syndrome (PCOS).
PCOS can cause low milk supply and low milk quality. However, most women with PCOS will breastfeed successfully. One study found that 75% of women with PCOS were breastfeeding without supplements one month after giving birth. This is lower than the percentage of women without PCOS which were breastfeeding-89%. Although, its important to note that some mothers with PCOS produce too much milk.
There are only theories as to why this is, most scientists considering forms of hormonal problems typical in cases of PCOS. There is also the possibility that those who develop PCOS early in life may not have developed enough breast tissue to make milk at all. In the latter case, there’s nothing you can do. However, if you can produce milk, but just aren’t making enough, any of the suggestions in this article may help you, and medications are available from your doctor.
Hyperthyroidism and Milk Supply
Hyperthyroidism is another serious condition which can limit your milk supply. Treatment options can reduce the effects of this condition, but they may pose risk to a breastfeeding infant. It’s an unfortunate reality that many women with hyperthyroidism are counseled by their doctors to stop breastfeeding. Depending on which medication you’re using and the risks and benefits you and your doctor are weighing, stopping breastfeeding may be the best course for you as a family.
If you’re looking to change medications or otherwise make your condition work with breastfeeding, don’t forget that you can seek a second opinion, and still try any of the other techniques of increasing milk supply discussed in this article.
What if Your Milk Stopped Suddenly?
Chances are, if your milk is slowing down or stopping, lack of demand for the milk is the problem. For example, if you have the gift of a baby who sleeps for long periods of time, four hours or more, you may be going too long without draining your milk to stimulate the prolactin. Talk about mixed blessings!
A similar problem often happens to breastfeed women when they go back to work. They only plan on pumping at lunch, which just may not be often enough to keep production up. Try to pump as many times as your baby would feed during the time you’re gone, and try to make those pumping sessions relatively evenly spaced throughout your day.
Similarly, forcing your baby onto a strict schedule might negatively affect your supply, as your baby isn’t demanding regularly, or isn’t eating fully when you want them to. If your milk supply is lowering, or, even worse, if your baby is not gaining enough weight, ditch the schedule and feed baby on demand.
Shorter feedings, or regular feedings which are pushed too far apart, and dependence on pacifiers, may all lower your milk supply. Too much pacifier sucking may discourage your baby, or get them into the habit of an incorrect latch.
Position and Latch Effect Milk Supply
A proper latch means the baby’s sucking is effective. It also means that they don’t get discouraged and can empty your breast fully. Positioning plays a role in proper latch as well. If you find your child’s suckling is not as efficient as it was at the start of their feeding, you can also massage your breast to help with milk flow and further encourage them.
Differences Between First and Second Babies
Like so many things surrounding pregnancy and childbirth, your body will tend to repeat itself. If your milk came in on day two with your first baby, chances are it will come in on day two for the next baby. But, you’ll also be more experienced, and that can make your second time around much smoother. Though, if you did struggle the first time and are worried about struggling again, consult a lactation specialist ahead of time to calm your anxieties and teach you how to make the second time smoother.
Differences Between Left and Right Breasts
For both breasts to keep up supply they both need to be drained. Express both breasts after feeding, not just the one baby was more recently feeding on. If your baby tends to fall asleep while being fed imbalance between breasts in milk supply could be a bigger problem. The general advice is to offer each breast twice, but switching more often for sleepy babies could help keep the demand on both breasts even. You could also try to end the session with alternate breasts. The last thing you want to do is try to keep your little one awake!
You may also find one breast produces less if is suffered an injury or surgery. You can pump that breast more to make up for it, but there’s nothing necessarily wrong with having one breast produce less, as long as the other is making up for it.
If you have implants and find that your supply is running short, it could be because the surgery cut a few of your milk ducts or nerves. This generally isn’t a problem for traditional implants located below the nipple. But, if you find they are, pumping between feedings can increase your overall supply to make up for it. Implants placed above the nipple are more likely to cause problems.
Dietary Changes to Increase Milk Supply
The basic dietary changes you can make are more about your well-being than any kind of miracle foods. Simply put, if you’re not eating or drinking enough, you’re not going to make as much milk. Eat a balanced diet, drink plenty of water, rest whenever possible, and consult your doctor if you feel like your eating or drinking habits might need some help.
The biggest limit on breast milk production, as far as your diet goes, is usually fluids. If you didn’t drink much liquid during labor, and many women do not, you may find that you’re thirsty already. That’s not to say you should try to drink more during labor, that’s an uncomfortable enough experience without chugging down water! Just focus on filling your thirst needs now. Drink water, or have meals which are high in liquids, like soup or even popsicles.
Fenugreek for Milk Production
Fenugreek is the most popular herb for increasing milk supply. Unfortunately, not a lot of studies have been conducted on fenugreek’s effects on anyone’s body, never mind on pregnant women.
What we do know is that it effects uterine contractions, so it should not be taken while pregnant. No one has assessed if it is safe to take while breastfeeding, and no study has shown it is effective in increasing milk supply. It does have negative effects on people with diabetes and you should definitely tell your doctor if you decide to try it anyway.
Other Herbs for Milk Production
There are a variety of other herbs commonly suggested to increase milk supply. Blessed thistle, goat’s rue, milk thistle, marshmallow, nettle, black seed, and more. One scientific meta-analysis of these remedies found that there is little scientific evidence to support the idea that these herbs help.
Instead, the study found that mothers tend not to explore the possible negative health effects from these herbs. Not all things that are natural are safe to consume, particularly not while pregnant. Some of the side-effects of these herbs are minor, like maple smelling urine and headaches, but you should still consult your doctor about the safety of these substances.
It’s also worth mentioning that most teas, tinctures, and creams suggested increasing milk supply are made of these same herbs, and have not been proven to be safe for lactating mothers to drink.
Foods to Increase Breast Milk Supply
When you’re struggling to feed your child, you’ll try anything. Many websites will pass around unscientific information about foods which increase milk supply, to fill that desperation for a solution. The truth is, little of it has any scientific backing. Try any of those foods in moderation if it’ll make you feel better or give your morale a boost. Especially if a food is part of your cultural tradition, it may give you the peace or strength to keep trying. But this is a psychological, not a physical effect, and there’s no guarantee it will work.
We’ve heard barley, yeast, papaya, dill, beets, and ginger suggested. Most of these suggestions stem from the idea that you may be lacking in a particular nutrient that goes into breast milk. Most women in America simply aren’t lacking in these nutrients, and if you are, changing to a healthier diet under the supervision of your doctor is a better idea than focusing on a specific food.
Domperidone for Increasing Milk Supply
This prescription medicine’s brand names include Motilium. Though occasionally used in Canada, it is not FDA approved. A doctor in the USA can give you a prescription for it, but you may have to import it from Canada. The side-effects can be extreme, including cardiac arrest, so it should certainly not be the first response to low milk production.
The medication has a wide range of uses, including encouraging milk production, especially for mothers of preterm babies whose bodies are more likely to be low on prolactin. It takes roughly a week of taking this medication before you see a result, and it generally takes a few weeks of use before your milk supply is established enough that you can stop.
This medicine works by interfering with the dopamine your pituitary gland produces. Normally, this dopamine limits how much prolactin your body produces. With lowered dopamine, you’ll produce more prolactin and, therefore, produce more breast milk. Dopamine is an important hormone for a variety of other bodily functions, so using this medication should not be a light decision. Always consult a doctor.
Metoclopramide for Increasing Milk Supply
This prescription medication has been thought to increase prolactin, but the claim is questioned as some studies have shown that mothers given the medicine had no significant benefit in milk supply. This drug also may increase your risk for post-postpartum depression, which is likely a more serious issue than low milk supply. As always, you and your doctor are the best people to assess whether the risks of this medicine outweigh the possible benefits.
Pumping and Going to Work
Many women start to see a reduction in their milk supply just after heading back to work. One key reason for this is that they are trying to pump only once a day, or are cutting short their pumping sessions. Remember, a pump is less efficient than a baby, so you’ll be using the machine longer than your sessions with the little one.
If you do have to cut short a pumping session at work, don’t skip it altogether. Even a few minutes of pumping will help keep your supply up. Try not to miss sessions regularly, and make sure you know your rights surrounding pumping in the workplace. Your boss needs to provide you with the time and privacy to pump. You should also be able to communicate with co-workers that they shouldn’t be scheduling important meetings at those times.
If you’re struggling to start pumping at work because you’re not “letting down” then you should stash some baby smelling stuff at your desk, maybe take a fresh blanket with you every morning. The smell of your child releases oxytocin, which stimulates the response. It will also help if you’re relaxed, comfortable, and can envision your child in your arms. Soon, your breasts will adjust and let down reliably at work.
If your milk supply is low it may become necessary to feed your child some bottle formula to keep their weight going up. This doesn’t necessarily mean you need to give up on breastfeeding, but it can start a cycle where your baby makes fewer demands on your milk, so you produce less of it, causing you to rely more on the bottle.
To avoid this cycle, you need to keep demand upon your breasts, which you can do by pumping. Pump between feeding your child and whenever you’re bottle feeding.
State of Mind and Confidence
This same study which found that most women are under-educated about the possible negative effects of herbal remedies suggested that those mothers who feel empowered to make decisions about their breastfeeding efforts were more likely to successfully breastfeed, for longer periods of time.
Having knowledge about breastfeeding and knowing you can make the best decisions for yourself and your family is a key part of successful breastfeeding. When facing a low milk supply, persevere. Keep up demand, and (as long as your child is healthy) it’ll come.
When to Stop Trying
Trust your judgment and the judgment of your doctor on this. If your baby is not gaining weight, they need to be given supplements. If trying to breastfeed after starting formula becomes too much stress for you, it’s time to call it quits. There’s no sense in shaming yourself for this decision or listening to any shame from someone else. A stressed mother isn’t going to make much milk anyway.