The most effective techniques to resolve low breast milk supply and to boost your breast milk production are those THAT ADDRESS THE MOST LIKELY CAUSES. In many cases, there will be a combination of causes, not just one.
There is, therefore, no one-solution-fits-all for low breast milk supply. Increasing breast milk production is rather personalised. Why? The causes for low breast milk supply vary from one mother to another. Hence techniques that bear positive results for one mother may not necessarily be suitable for another mother.
Causes of low breast milk supply
A few causes of low breast milk production are stated below (there may be many others).
Mother’s state and actions
Related to breastfeeding management
— Separation from baby.
— Rigid or strictly scheduled feedings – they interfere with natural baby milk demand and supply.
— Return to work – after maternity leave – plus stress associated with work.
— Using formula supplements – babies fed using these will demand breast milk less often.
— Using pacifiers regularly – may lead to addiction of the baby to the pacifier and preference of it over the breast.
Related to Mother’s health
— Illnesses and hormonal disorders e.g. pituitary imbalances, thyroidism, mastitis, flu, post-natal depression, yeast infection, others.
— Birth control pills (with both estrogen and progesterone hormones) and pregnancy during breastfeeding – both of these will affect your ability to produce breast milk.
— Past breast surgery.
— Heavy smoking.
— Taking certain medications.
— Status of your nipples and milk ducts – inverted nipples and painful sore nipples will hinder your letdown reflex and likely subconsciously make you delay breast feeding sessions.
— Status of your breast nerves – e.g. due to surgery.
— Unhealed Cesarean Section scar – that makes it physically difficult to holding baby in latching position.
- Poor latching – this will lead to less than optimal feeding and much lower stimulation of the breasts to produce more milk.
- Baby’s poor health (which reduces frequency of breastfeeding, sending signals to the body that breast milk production is not needed). A sickly or weak baby may not nurse appropriately.
The demand-supply principle of breast milk
Breasts are naturally “programmed” to produce milk based upon sensing “demand” for the milk. The first two to three weeks after delivery are crucial in programming this milk production. The more your baby suckles, or as you pump your breast milk out, the more the milk your breasts will start producing. If you are within the first three weeks post-delivery, do everything in your ability (breastfeeding, expressing by hand or expressing by pump) to get as much milk out of your breasts as possible. If you are past this period, however, there are things you can do to improve production.
Properly latching the baby during breastfeeding, and switching from one breast to the other, are two key considerations in effective breast milk extraction.
How to tell you are not having enough breast milk supply
- Nappy/diaper change — check the “wetness” of the diaper. Note: expect about four “susu” diaper changes and three “pupu” diaper changes per day for a baby that is up to six weeks old. Observe to see if the amount of waste is increasing or decreasing. A decrease or nearly dry “wet” diaper indicates the baby may not be feeding adequately.
- Baby weight monitoring — keep a weekly record / chart of your baby’s weight and ensure it is increasing, not decreasing or stagnant. Remember that in the initial few days the baby’s weight may “drop” typically by 5-7 % (due to extra birth fluids in the baby’s tissues and excretion of pre-birth accumulated stool), then steadily rise as weeks get by.
In general, there are two main avenues to pursue in the effort to increase breast milk supply: (i) Natural ways; (ii) Medication.
NATURAL WAYS TO IMPROVE BREAST MILK PRODUCTION
1. Physical techniques
These are based on the principle that more demand will lead to more supply. The body understands that. These techniques capitalize on frequency and effectiveness of milk extraction from the breasts, and stimulation of milk production.
Physical technique 1 – Relaxation
Breastfeeding is a special session between you and your baby. During this session, milk is produced and milk is dispensed. It is therefore important that you relieve yourself of stress before going into such a special session, since a stressed breastfeeding environment can diminish your milk production capabilities. Before you breastfeed your baby or express milk whether by hand or using a pump, take some deep breath, sit, relax.
If possible, have some soothing music you love in the background. You need to engage in things that make you happy at this time, rather than stressful work-related stuff or other soul-dampening preoccupation. You will for example do yourself no good reading a horror novel while breastfeeding. Relax your breasts using a warm, moist cloth. Remember that any cloth or item you use on your breasts must be germ free! Your breast is your baby’s feeding “plate” — it must be totally hygienic. If you are at home, taking a shower, sponge-bathing your arm pits, immersing your legs in reasonably hot water or washing your face with warm soapy water may all be some of the ways of getting yourself to feel refreshed and relaxed.
Physical technique 2 – Deep latch
Ensure your baby can suckle your breast effectively by placing him/her in the most favorable position. How well your baby is attached to your breast can be observed from the ease of his/her suckle. A good latch is referred to as a deep latch indicating the baby can extract milk so effectively as to empty your breasts.
One important thing to recognize is that a baby is born with the ability to find the most comfortable feeding position. Unless the baby has had complications or a difficult birth and needs much help, you as the mother should not be too pushy in helping the baby find the best baby-breast position. Instead, you should give the baby space to lead the way, while you FOLLOW by placing him/her in more comfort at the position the baby has found most suitable to suckle. It’s a partnership approach! Don’t think you know best all the time ; God has given the baby strong instincts to recognise and handle the situation too!
How a baby suckles: Note that a baby does not extract milk the way you do with a straw in a soda bottle. No! The baby’s tongue and lips work on both the nipple and areola, in motions that transfer the milk through your breast milk ducts through the nipple into the mouth of the baby.
That is why the baby’s mouth MUST capture well not just your nipple but also your areola, for a deep, effective latch, which seals like glue the grasp of your baby’s lips on your breast. If you hear your baby making “clicks” or “popping” sounds as he/she suckles, that is a sign that the latch is not good enough.
Physical technique 3 – Breast Compression – Getting more milk out of your breast
If your breast is drained of milk, it is a signal to the breasts that more milk is needed; hence more production follows! When your breasts have less milk, there is little milk volume left to aid in pressurizing milk out of your breasts. You must therefore apply methods to help the breast drain the available milk. Breast massage comes in handy, and is best done both before and during breast feeding, expression or pumping.
Some studies show that breast massage can increase milk removal by as much as 50 per cent. You can for example use your hand to exert pressure on the breast with strokes that push the remaining milk towards the milk ducts, in a process known as “breast compression”
Physical technique 4 – Breastfeed Frequently
Monitor how many times you are breastfeeding your baby in a 24-hour cycle. You should administer a new feed at least every two to three hours, in daylight, and every 4 to 5 hours in the night time. This amounts to at least 8 to 12 feeding rounds in 24 hours for an infant. If you are breastfeeding your baby infrequently, your breast milk production may be affected adversely.
Note that a baby does not feed three “main meals” in a day like an adult, but rather takes “snacks” over day and night. Wake up your baby to take his/her “snack”; feed him/her at every possible opportunity. When it is time for that “snack” and he/she does not feel like it, wait a few minutes and make another offer. Persist. On the other hand, if your baby is a demanding feeder, allow him/her to nurse on demand and as frequently and as long as he/she wants. These repeated feeds are what will stimulate more milk production.
You may also try putting on sling and carrying your baby in it. A baby on a sling stays close to his/her milk supply source and is likely to occasionally demand the breast. On the other hand, the closeness of your baby to your breasts and the occasional feel of the baby against the breasts send a message to the breasts that milk production is needed. Ensure you offer the baby both breasts; ideally the baby should suckle each breast twice in one feeding session, therefore switch the baby alternately from one breast to the other whenever you sense he/she is slowing down.
Physical technique 5 – Nursing and baby bonding “vacations”
This means spending an uninterrupted bonding retreat with your baby – say an entire weekend or a couple of weekdays with your baby. You may for example dedicate two full days of sleeping, snacking, listening to music while in bed with your baby, breastfeeding at every other turn, and maximizing on skin-to-skin contact. Your body will feel rested and highly responsive to your baby’s needs, lactation being one of the leading ones. This will result in nursing cues that persuade your breasts to produce more milk. If you do not have the luxury of being rested two days in a row, that is still fine — you can sneak into frequent naps and breastfeeding sessions and find quiet moments of rest with baby, occasionally through your normal days.
Physical technique 6 – Stimulation of milk ejection
The milk ejection reflex otherwise known as the let-down reflex is the motion that pushes out milk from the breast — without necessarily being suckled. The hormone oxytocin acts on the muscle-like cells of the alveoli (mammary alveoli are the milk-making and storage cells in the mammary gland) and causes them to contract in motions that push out the breast milk. How does this happen? Well, both mental stimulation and physical stimulation cause it. This means a mother can influence milk production by practicing these two types of stimulation, as explained below:
• Moist warmth and breast compressions — Before nursing or pumping. These may include use of moist heat commercial products, home-made heat retainers, e.g. warm moist sock, wet bathing flannel/washcloth and hot baths/showers.
• Breast rubs and massages – before nursing or pumping — These may be neck, breast, back, shoulder, or “spine walks” (neck to waist level).
• Nipple stimulation — May include gentle tickles and presses that make the mother more relaxed and less distracted by pressures of life.
• Psychological conditioning — Creating a routine that makes the mind anticipate nursing can trigger the release of the oxytocin hormone. An example is when you have created a particular spot in your home or office where you go to nurse the baby. Just thinking about the station or walking into it can cause emotions that trigger the milk ejection reflex.
Physical technique 7 – Manual expression of breast milk
— This is the first hand extraction of milk by a mother using her bare hands. The milk is squeezed out of the breast using special techniques. It is directed to and collected in a container. You can read more about effective breast milk expression at Pregnant Magazine.
Physical technique 8 – Pumping out breast milk
— Many working mothers find it necessary to use a breast pump to hasten the process of expressing breast milk, especially if the mum cannot find adequate time to manually express breast milk. Breast pumps exert a suction routine that stimulates the nipple and results in hormone release, specifically the milk-making hormone known as prolactin, and the milk delivery hormone, oxytocin.
— A baby will typically leave as much as 25% of breast milk untouched; pumping will get this residual milk out and increase production of more breast milk. It is important to note that pumping is recommended only if the baby is not suckling well, or the mother needs to preserve breast milk to be used to feed the baby later.
One great advantage of pumping breast milk is that it gives the breasts a chance to make more milk, meaning you increase the stock of milk that you can avail to your baby during feeding time. You should aim to pump when your baby least needs the milk — not when the baby’s feeding time is close or due. The objective is to obtain and store breast milk after your baby has had enough. Note the importance of investing is an effective and efficient pump, lest the exercise becomes frustrating and tiresome.
You should pump both breasts, in equal intervals of one session. This is important even when you may feel that there is more milk in one breast than the other; you still need to stimulate milk production in both breasts. It is recommended that you pump for say 5 to 10 minutes after breastfeeding (as said earlier, the baby does not always empty the breasts completely so there is opportunity to get out what is left). You can also pump regularly, for say 10 to 15 minutes, after every few hours. In general, you may pump 8 to 10 times in a 24-hour cycle.
Physical technique 9 – Touch: skin-to-skin cuddles
You can give your baby a cue that it is breastfeeding time through touch, and skin-to-skin contact. This can be achieved while holding the baby, bathing him/her or while sleeping in bed beside your baby. You can for example hold your baby nestled between your breasts, while baby is dressed with nothing but a diaper. It may also be your baby against your skin while you wear an open top, or you have no top at all.
You can undress your baby during some of the breast feeding sessions, retaining only the diaper, remove your own top and bra and wrap a warm blanket on both of you, and snuggle warmly. Alternatively you can wear a shirt that can be unbuttoned on the front to promote skin-to-skin contact.
How fast do these physical techniques show results?
Two to three days. If you do notice change in this time frame, it is likely that you are either not implementing the physical techniques well or there may be other root causes for low production, in which case you need to try out the other techniques stated below.
2. Nutritional techniques
Nutritional technique 1 – Water consumption
You need to consume enough water to provide your body with the right amount of hydration as a lactating mum. There is no specific evidence linking the amount of fluids you take to amount of milk produced; however, it is common knowledge that fluids make you healthier in general. Drink ideally 8 glasses, but at least 6 glasses of fluids during this period.
Nutritional technique 2 – Calorie boost
It is recommended that you consume a minimum of 1,800 calories a day during lactation. So what is a calorie? It is a unit used to measure energy. Most food packages have the symbol “kcal” which represents a kilocalorie, or 1,000 calories. One kcal is equivalent to the amount of energy needed to heat one kilogram of water by one degree Celsius. If you want to know how much calories you are taking from which foods, check out this Calorie Counter website.
Given this calorie requirement, it is not advisable to be dieting while breastfeeding. Some mums, in an attempt to “get back that sexy” resort to dieting, without realizing it could affect their ability to produce breast milk. Wahu Kagwi, a musician and mother of two pretty girls, Tumiso and Nyakio, has narrated, in her Babylove Network Blogspot, how she manages to keep her weight in check after baby. She has also talked about her Organic Resolution. Bear in mind that what you consume has a significant influence on both the amount and quality of the breast milk you will produce.
Your body will require fiber, vitamins, calcium, minerals and other key nutrients. Therefore make a good selection of fruits and vegetables (for the vitamins, minerals, fiber), and leafy veges, selected fish, e.g. salmon, tilapia, trout (be careful on fish selection – avoid fish that are likely from sources that may have mercury).
Take more of the organic low-fat dairy products (for the calcium). If you are a meat eater, lean and white is a good rule; avoid fatty meats – you can trim the fat on beef and mutton, and remove the skin of chicken which carries a lot of fat underneath. When taking starches, settle for browns – whole-meal bread, whole-grain pasta, brown rice, brown sugar, etc. Augment that with legumes – e.g. beans.
MEDICATION TO SOLVE LOW BREAST MILK SUPPLY
There are two categories of medication: (i) Herbal supplements; and (ii) Prescription medicines.
Using herbs to increase breast milk production
• Examples of popular herbs are blessed thistle, fenugreek and red raspberry.
Using prescription medicine to increase breast milk production
• These should be the absolute last resort after trying all else to no avail – and after determining for sure that your baby is having insufficient feeding. Medicines include Metroclopromide – Reglan or Maxeran and Domperidone – Motillium. You need to note the side effects of any prescription medicine that you take, and these are no exception.
It is outright crucial that you do not take any medication while lactating without consulting your doctor – whether it is herbal or prescription drugs.
You need to bear in mind that some medications – specifically prescription drugs – may find their way into your breast milk and harm your baby’s health, hence this strong caution.
- Pinky Ghelani has also written a personal blog here at Babylove Network, “The Benefits of the boob are fantastic.”
- Recommended further reading: Can I Eat That? I’m Breastfeeding