Most women who stop breastfeeding do so because they feel they don’t have enough milk supply. The idea of not being able to provide in the needs of this little baby they love so much is daunting. In the majority of these cases the mother actually had enough milk, but simply didn’t understand normal breastfeeding patterns and didn’t receive the right information and support. There are various false alarms that wrongly indicate low milk supply.
Dr Chirstina Smillie, a paediatrican and International Board Certified Lactation Consultant (IBCLC) makes a strong case for believing in our bodies’ ability to make enough milk for our babies. Mothers should try to not look at their production as a ‘milk supply’, as this implicates a stash that can run out. We don’t worry about running out of other bodily fluids, like tears or sweat. We know that we will make it as we need it! You should rather focus on your breasts milk production capacity. While there are some things that can increase this capacity and other factors that can hamper it a bit, the capacity is there.
In short, if your baby is having 5-6 wet and/or dirty nappies in 24 hours and have a sufficient weight gain, you don’t have a low supply. If this is not the case you may have reason for concern.
There are various medical reasons for low supply. Milk supply is also a special challenge for mothers expressing milk for their babies, as the stimulation from a breastpump is never as good as that of a baby sucking on the breast.
For mothers with babies in NICU, mothers exclusively pumping and bottle feeding, and those breastfeeding while back at work this is unfortunately their reality.
Lastly there are many other breastfeeding practices that can accidentally lead to a low supply, many of them advised by healthcare professionals who should know better.
Below, a few tips to help you boost and maintain your milk supply
You should also consider seeing a lactation consultant to help you determine the extent of the problem as well as the possible causes.
Back to breastfeeding basics
The main factors involved in milk supply are nipple stimulation and proper breast emptying.
Anything that interferes with these will affect your milk supply.
- Make sure your baby is latching correctly and emptying the breast well. The latch shouldn’t be painful, you should hear baby swallowing, and your breasts should be soft after feeds.
- A lactation consultant or a healthcare professionals experienced with tongue ties should exclude the presence of a tongue tie, as this is a common reason for low supply, even in a baby who was initially feeding well.
- Feed baby on demand – as much as he wants, when he wants. There really should not be a time schedule to breastfeeding.
- Allow your baby to empty the breast and come off on his own, before moving him to the other breast. Some babies drink from one breast a feed, while others may ask for both.
- Do skin-to-skin contact with your baby, the more the better. Use a wrap or a sling to help you with this during your daytime activities.
- Do not use a dummy to stretch the time between your baby’s feeds. Even if your baby is only sucking for comfort it still is an important component of nipple stimulation.
Be aware of nipple shields. Although they are worth gold in some instances, the stimulation on the nipple via the silicone shield is not as good as without, and supply may be affected.
Avoid top-up feeds
Remember that you make milk on demand. If part of baby’s demand comes from a formula bottle, your supply is going to be lower than it should be. Many mothers start with a small top-up that gradually becomes bigger and bigger until she eventually is giving mainly formula.
Any problem that is big enough to warrant top-up feeds need the support of a lactation consultant to ensure that you deal with it in a way that will yield the best possible breastfeeding outcomes.
Where possible rather express breastmilk for topping up. IF you give formula you should continue expressing milk to stimulate your breasts in the place of any feedings missed.
Expressing breast milk for stimulation
Expressing extra sessions with a breastpump will help to stimulate your own supply. There are a few ways to go about this.
Ideally you should express a few minutes extra after every feeding that baby had on the breast. This is extremely time-intensive. If you are unable to manage you can choose to add in 2-3 expressing sessions to your daily feeding routine. You should express in the place of any feedings that you miss (for example when you are back at work).
If your reason for expressing is to boost your supply, the amount of milk you manage to express is less important. There will be some sessions where you express and get no or only a small amount of milk. But keep going as the stimulation is what you’re after, and you will reap the rewards later.
There are many tips for better expressing. You should try to relax and not focus on the outcome too much. Read a book or listen to some music. Cover your breast and the pump so that you’re not tempted to sit and focus on the expressing, which can cause anxiety and indirectly lower the volume you express. Massaging your breasts before and during expressing, and applying heat to the breasts can yield a better milk volume.
Choosing the correct breastpump plays a major role in the success of the whole process. You need a pump that can maintain a minimum of 40 cycles in a minute, something that many of the on-the-shelf breastpumps are unable to do. A double pump will offer better stimulation and higher milk volumes than a single pump, and will save you a lot of time. The flange size should be correct for your nipples, as a flange too big or too small can substantially influence supply. Considering the cost of formula feeding the money spent on a good-quality breastpump is well worthwhile.
Power pumping is a method of expressing milk that can give you that extra boost for your milk supply that you need. It’s more effective for some mothers than for others, and although there are no guarantees that it will work it is definitely worth a try.
Power pumping simulates cluster feeding in baby, where a baby has some periods in the day where he has a few feeds on top of each other.
A power pumping session should not replace any of your regular feeding/expressing sessions, but should be added on top of your normal regime. One session of power pumping a day is usually enough. It can take up to 7 days to see a difference in your supply.
Power pumping needs takes an hour and work as follows:
- Pump for 20 minutes
- Rest for 10 minutes
- Pump for 10 minutes
- Rest for 10 minutes
- Pump for 10 minutes
Galactogogues – natural remedies to help boost milk supply
Our society love quick fixes, and most mothers who experience milk supply issues envision the solution to lie in a tablet/herb/food/lactation cookie. The sad truth is that these may offer supportive treatment but will rarely on its own have a massive effect.
Galactogogues are herbs and ingredients that increases milk production. There are many natural products marketed for this purpose, but they are difficult to comment on. What work for one person may not work for another. Most of the products do not have much research and evidence behind it. Herbal products are poorly regulated, so dosages and the quality of different brands can differ vastly, making research even more challenging.
Products for boosting milk supply are also expensive, and mothers often end up spending a fortune on something which may or may not help. Even though herbal products are natural, they can still have side-effects on mom and baby, and interactions with other medications that the mother is taking.
Fenugreek is a herbal supplement that can increase supply for some women. However, it can influence blood sugar levels and should be used with caution in women with blood sugar problems. It can also cause side-effects like a dry mouth and a change in body- and urine odour.
Alfalfa, blessed thistle and caraway are herbs typically recommended for milk supply. Moringa leaf supplements are used by many women for energy and vitality, and many report a positive effect on milk supply.
A popular juice mixture containing blackthorn berry elixir is recommended by many healthcare professionals. The independent research done on this mixture showed no effect on milk supply, but did find that the high sugar levels can predispose mom and baby to thrush infections. This mixture should no longer be recommended.
Medication to help with boosting milk supply
Your doctor can prescribe medication to boost your supply, though this should not be the first course of action.
Traditionally women are put on Esperide (Eglynol), which is an antipsychotic drug with the side-effect of causing milk supply. Eglynol can have many side-effects and it’s concerning that some doctors prescribe it routinely to their clients, without considering any of the other factors involved in supply.
Newer medication protocols make use of the drug Domperidone, which is considered to me more effective and safer. However, it’s very expensive and should be used with caution in clients with cardiac arrhythmias.
A word of hope
With the right help most women will be able to successfully produce the breast milk their babies need. But circumstances differ, and a mom is by no means failing if she is struggling to do so. Remember that there is not only one correct way to breastfeed.
For some moms and babies a bit of extra help may be necessary. Any breastmilk that your baby is getting is worth gold. Find joy in this gift that you are giving your baby, and be proud of yourself for persevering. Because that is what a big part of motherhood is all about.