Whenever I breastfed one of my four children, or returned from a lactation consult with a new mom, I’d joke to my husband that if I could invent a flow meter for breast milk, I’d be a millionaire. Worries about milk supply are front and centre in a new mom’s mind. Google trends show a steady increase in searches for the term “increase breast milk” over the last 10 years, suggesting that the demand for information on galactagogues (substances that increase breast milk supply) has been growing.
For some moms, breastfeeding is easy. Their baby latches from day one, they never have any pain and baby grows consistently; they get fantastic support from all health professionals and their family is encouraging. This, however, is not the norm.
Breastfeeding is a learning experience for both mom and baby. Those idyllic soft-focus pictures of contented mom and blissed-out baby feeding take a while to achieve (or a whole lot of editing!).
In the beginning, there may be engorgement, latch issues, frequent feeding (24/7 sometimes) and sleepless nights. Having babies later in life, high rates of caesarean section, stressful labour, and obesity can create physiological issues with getting lactation started and can lead to supply issues.
But it gets better… and we all know the benefits of breast milk, so it’s worth it in the end.
How do you know if baby is getting enough milk?
If baby is having about six wet nappies a day and their stools are yellowish by day five, baby is likely getting enough milk. Some weight loss in the first few days is normal but should have been gained back by day 14. If baby seems content after a feed, is alert and is meeting milestones, then milk supply is likely good.
Frequent nursing, fussiness, soft breasts and not feeling a letdown reflex are NOT signs of low milk supply, nor is the amount of milk you can pump a good indication of how much milk you are producing.
How does milk production work?
Milk production is supply and demand – the more you feed, the more you make. This means that baby has to be efficiently removing milk from the breast (good latch is vital). If baby is sleepy, has lip or tongue tie, or if you are using nipple shields, removing milk from the breast may be difficult. Until these issues are resolved, pumping may be necessary to keep supply good.
“Milk production is supply and demand – the more you feed, the more you make.”
There are other reasons that supply may have dropped:
- Have you cut back on the number of feeds or pumping sessions?
- Have you changed your diet? Not getting enough calories will affect milk supply. Are you drinking enough?
- Are you experiencing hormonal changes due to birth control, menstruation or ovulation, or pregnancy?
- Are you looking after your mental health? Fatigue and stress affect milk supply negatively.
- Have you been sick recently or on any medication?
What’s the solution?
There are several ways you can increase your supply simply by adjusting the way you feed. Rather try one or more of these methods before reaching for a pill to solve the issue:
- Nurse often. And then some more! Don’t time feeds. Baby should be allowed to feed as long as they are actively nursing. Every one-and-a-half to two hours during the day and two to three hours at night is All sucking needs should be met at the breast, so no pacifiers.
- Switch sides frequently during the feed – every time baby is falling asleep or not actively swallowing. This is very helpful for sleepy or distracted babies.
- I can hear the eye-roll from here, but rest is vital. I pumped exclusively for a year for my daughter, so I got to see exactly what affected my milk supply. Rest was the biggest factor.
- Pump after each feed or between feeds if baby isn’t feeding often. Even 10 minutes after a feed is helpful. Continue pumping for three to five minutes after that last drop of milk comes out. Letdown is cyclical and often you will get another ejection of milk.
- Exclusively breastfeed. In babies under the age of six months (even “big” babies) avoid solids, formula, and cow’s milk. If baby is older, temporarily decrease solids to increase the demand for milk. If you have been supplementing with formula, decrease this slowly as your breasts produce more.
One of my favourite things to recommend to moms is a “lactation vacation”. Load up your favourite series or books, have some snacks and water handy and go to bed with baby for a couple of days. Rest skin to skin with baby and do nothing but nurse and rest. Everything else can wait.
How much should you be pumping?
How much you pump is NOT an indication of how much milk your baby is getting per feed. Full bottles are not the goal. For a mom who is breastfeeding full time, 15-60ml from both breasts per session is normal. With practise, you can increase how much you can pump. Pumping three times to get enough for one feed is normal. Remember, you’re already feeding baby, and the pump is not as effective as baby at removing milk from the breast.
When do you need to take something to boost milk supply?
Galactagogues may be needed when there is insufficient glandular tissue (following breast reduction surgery for example, not if you have small breasts), inducing lactation, or exclusively pumping or nursing a baby with cleft lip or palate.
Before trying one, keep these things in mind:
- Visit a lactation consultant to rule out any other factors that could be remedied. It will only work if milk is removed from the breast.
- Even herbal remedies can have side effects, so consult a healthcare provider with knowledge in this area, like a homoeopath or naturopath.
What does the evidence say?
Fenugreek appears to be the herb that is most often recommended. Fenugreek can be used short-term to boost milk supply or long-term to keep supply up. Studies show that it is most effective at 3500mg to 7500mg a day, with no long-term problems. If you smell like maple syrup, you’re taking enough. If you have low thyroid hormone levels, are hypoglycemic or diabetic, allergic to peanuts or taking blood thinners, you may want to avoid fenugreek.
Traditionally used in India and Europe, scientific studies now show that the phytoestrogens milk thistle can help a nursing mother to make significantly more breast milk. If you’re taking antipsychotic or anti-anxiety drugs, certain cancer medications, or blood thinners, or are allergic to the daisy family of plants, then rather avoid milk thistle.
Moringa has been shown to increase milk production after four to seven days of treatment. It stimulates prolactin and is useful when taken in the first week after birth. Moringa has been used safely in doses up to six grams daily for up to three weeks. If you are HIV positive, on treatment for TB, are diabetic or have low blood pressure, rather avoid moringa.
No doubt someone has advised you to drink a bottle of beer to boost milk supply. This is because brewer’s yeast contains phytoestrogens, protein, and iron, giving you more energy and making you feel happier. You can rather take a brewer’s yeast supplement.
Many moms use them and they may have some benefits, depending on the ingredients. If they contain oats, the pituitary gland may be stimulated to increase milk supply. Perhaps try this recipe. Avoid eating too many and accidentally consuming too much sugar.
Ultimately, milk supply issues should be approached with a holistic approach. Moms and babies need support with breastfeeding, and the answers are not always in the medicine chest.