Breastfeeding works on a supply and demand basis and the majority of women can and do make enough milk for their babies. Every woman’s body is unique, and while some women’s bodies make more milk than their babies need, others struggle to make enough. Milk supply is a complex topic and the information I give here may not meet everyone’s specific needs or fit every situation. I hope that if you are looking for information on how to increase your milk supply, this will get you pointed in the right direction so you can get the answers you need.
Breastfeeding normally (but not always!) works for mammals. One important key to making it work is to understand that making milk is a biological process that women’s bodies are designed to do after giving birth. In order to get set up for success in breastfeeding, the mother’s body expects certain things. It expects there to be a newborn suckling at the breast at least every few hours and removing milk. This frequent stimulation and emptying of the breasts in the early days of the baby’s life gets the mother’s body on the right track to bring in a full milk supply. If the baby cannot nurse right away for some reason, mothers who want to breastfeed need to begin expressing milk from their breasts, as often as a baby would normally feed, as soon as possible. The first few days of milk removal are very important in getting the mother’s hormones and breasts going and ready to breastfeed.
If this ideal doesn’t happen, all is not necessarily lost, but it will often take more work to bring in a full milk supply if a mother hasn’t been nursing or pumping during the first few days of her baby’s life.
Sometimes mothers breastfeed on cue every few hours right from the beginning, and still don’t bring in a full milk supply. There can be many varied reasons for a low milk supply, and sometimes a reason is never found. Still, most mothers can at least increase their supply, even if they are never able to produce 100% of what their baby needs. Any amount of breast milk is beneficial for babies, so I encourage mothers to persevere with breastfeeding, even when exclusive breastfeeding isn’t going to be an option.
One thing to keep in mind is that many mothers think they have low milk supply when they actually don’t. It’s a good idea to check if the baby is getting enough milk before trying to increase supply.
There are quite a few risk factors that we know often seem to go along with low milk supply. Some of the main ones are (in no particular order):
- Rough start with breastfeeding in the first week
- Sore nipples
- Baby with a short frenulum (tongue-tie) or frenum (lip-tie)
- Baby with a disorganized sucking pattern
- Difficult birth
- Inverted nipples
- Having unusually shaped breasts
- Difficulty conceiving
- Being an older mother, particularly becoming a mother for the first time after 35
- Polycystic ovarian syndrome (PCOS)
- Hormonal imbalance - symptoms of this can (but don't always) include having lots of facial or chest hair, balding, acne
- Losing a lot of blood during the birth (especially if it was enough to require a transfusion)
- Ever having lost enough blood to require a transfusion
- Past breast surgeries
- Past chest surgeries or injuries
- Having breasts that don’t change much or at all during pregnancy
- Baby getting supplemented with formula
- Using a pacifier, particularly in the early weeks
- Thyroid imbalance
- Using hormonal birth control, particularly soon after the birth
- Baby sleeping long stretches at night
- Taking decongestants or possibly some allergy medications
The above list are simply risk factors and having one or several of them is not a guarantee that milk supply will be a problem. Many women have several of them and great milk supplies. As you can see, lots of things can go along with low supply and in many cases it can be difficult to ever figure out what the cause or causes of the low milk supply are. The good news is that no matter what the cause of the low supply, many of the same things normally help. The key ways to increase milk supply are:
- If your baby isn’t removing milk effectively, figure out why. For babies who are not feeding effectively because they were born prematurely or are ill, this may be a matter of pumping until the baby is mature or healthy enough to breastfeed effectively.
- Increase the frequency of breast stimulation. This could be feeding the baby more frequently if the baby breastfeeds effectively, or pumping in addition to feedings otherwise.
- Increase the frequency and effectiveness of milk removal. The more empty the breast, the faster it will make more milk. If the baby doesn’t do this effectively, use hands-on pumping to maximize the effectiveness of pumping sessions. Many people recommend pumping right after feedings, in order to empty the breasts as thoroughly as possible.
- Keep the stimulation and breast emptying going at night, particularly between midnight and 6 am when milk supply is usually highest.
- If you are pumping, make sure you are using a high quality double electric breast pump, and consider renting a hospital grade pump.
- Make sure you are removing milk from your breasts effectively at least 8-10 times every 24 hours. Frequency of breastfeeding or pumping sessions is generally more important than duration.
- Spend lots of time skin-to-skin with the baby
- Get as much rest as you can (sleep when the baby sleeps!)
- Eat to hunger and drink to thirst
Some other things that can help are:
- Research and see if a galactogogue might be right for you
- If baby needs to be supplemented, do the supplementing at the breast if possible
- Get help with household tasks so you can focus on your baby and on building your supply
- Make short term goals
If those steps don’t have a noticeable effect within a few days, some other things to consider include:
- Checking with a doctor to see if your thyroid and other hormone levels are normal
- Checking with a doctor to be sure there isn’t a small piece of retained placenta
- Checking with a doctor about trying a stronger galactogogue
If you are trying to build your supply it can be very helpful to get yourself some cheerleaders - people who will support you, check in with you, and who will be able to offer help and suggestions. A lactation consultant, La Leche League Leader or a breastfeeding support group would be a good place to start.
One thing to keep in mind is that our human, mammalian bodies are designed to be able to meet the needs of our babies. However, particularly in Western society, our culture has begun to base its expectations of infant behavior on formula fed babies. Some parenting books leave parents expecting babies to be able to conform to feeding and sleep schedules that babies are usually only capable of if they are receiving formula, and many mothers’ milk supplies decrease when the baby is breastfeeding on a set schedule.
Breastfed babies tend to feed more frequently than formula fed babies. This is because breast milk is more easily digested than formula and does not stay in the baby’s stomach as long.
Breastfed babies also typically do not sleep as long or as soundly as formula fed babies, and this is a good thing. Some researchers theorize that because breastfed babies need to be fed more frequently than formula fed babies, they don’t enter deep sleep states that can be dangerous and difficult to rouse from. Mothers’ bodies expect babies to feed throughout the day and night, so when babies are being swaddled and trained to sleep long hours at night, many mothers’ milk supplies can't keep up.
Mothers’ bodies expect babies to breastfeed frequently, for nutrition, for comfort, for any reason at all. So when babies are given pacifiers to suck on, rather than being put to the breast when they want to suckle, mothers’ milk supplies can be at risk.
Every mother and baby pair is different, and some mothers’ milk supplies are more flexible than others. Some women can make and store enough milk in their breasts that they can feed their babies only 8 times each day, and can have a baby sleeping through the night and using a pacifier, and still have plenty of milk. Other mothers find that their supplies are less flexible and though they can make the same amount of milk over a 24 hour period, they must feed their babies much more frequently and be mindful not to introduce any risks to their breastfeeding relationship or milk supply.
If at this point you still have questions about your milk supply and how to increase it, I suggest finding a copy of “Making More Milk” by Lisa Marasco and Diana West - a great book that can help you do some detective work into your own situation. And please find and schedule an appointment with a lactation consultant near you.
* All material in this article (and on this website) is provided for educational purposes only, although every effort is made to provide accurate and up-to-date information. This article and others on this website are not written by doctors or other healthcare professionals. If you are concerned about your health, or that of your child, consult with your healthcare provider regarding the advisability of any opinions or recommendations with respect to your individual situation.