Almost all mothers worry about their milk supply, especially when they first begin breastfeeding. This is normal. In fact one of the most common reasons why women stop breastfeeding is because they feel like they don’t have enough milk for their baby. If you are worried about your milk supply, it is important to determine first and foremost if your milk supply is in fact low. This article will help you work out if your milk supply is in fact low. It also nicely summarizes common causes of breast milk insufficiency, and gives practical tips on how to boost your milk supply if needed.
HOW CAN I TELL IF MY MILK SUPPLY IS LOW? Often mothers think that their milk supply is low when it really isn’t. Here are 4 tell tail signs that your baby is getting enough milk.
1- Weight Gain If baby is gaining weight well on mom’s milk alone, then baby is getting enough milk. A 5-10% weight loss during the first 3-4 days after birth is normal. Baby should regain birth weight by 2 weeks. Baby should gain an ounce per day in the first three months of life and half an ounce a day from age 3-6 months.
2- Wet Diapers Expect one wet diaper on day one, increasing to 5-6+ sopping wet disposable diapers after the first week (7-8+ cloth diapers). To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45mL) of water into a clean diaper (if baby wets more often, then the amount of urine per diaper may be less). Urine should be pale and mild smelling.
3- Dirty Diapers Expect 2-3+ dirty diapers per day (after day 4). After the first month the stools may become less frequent. Some babies will even go a day or two between stools. Stools should be yellow (no meconium) by day 5 and the size of a quarter (2.5cm) or larger. The normal stool of a breastfed baby is usually yellow and is loose.
4- Other Positive Signs After feeding, mom’s breast feels softer and baby seems reasonably content. Baby is alert, active and meeting developmental milestones.
If there are problems in any of these areas you may have a low milk supply. In these cases it is important to get evaluated by your health care provider so they can help determine the next course of action. It is important to address low milk supply issues as it can lead to malnutrition, and growth/developmental delays.
WHAT CAUSES INSUFFICIENT MILK PRODUCTION?
Waiting too long to start breast-feeding.
Not breastfeeding often or long enough (ie. due to nipple pain, lethargic nurser, poor latch-on technique).
Large blood loss during or after labour.
Previous breast surgery.
Insulin dependent diabetes.
Medications containing pseudoephedrine.
Alcohol and nicotine.
WHAT CAN I DO TO BOOST MY MILK SUPPLY?
Increase feeding frequency. Remember breast milk production works by supply and demand – the more demand, the greater supply. Breastfeed your baby at least every 2 hours during the day. If your baby has been napping for more than 2 hours, wake her up for feeding. Consider waking your baby for at least one extra feeding during the night, especially if you have a baby who sleeps for more than a 4 or 5 hours straight.
Undress baby to his diaper during feedings. Skin-to-skin contact helps awaken sleepy baby and stimulates less enthusiastic feeders.
No pacifiers, no bottles. When there are concerns about weight gain, all your baby’s sucking should be done at the breast. Bottles of formula will interfere with the balance between your milk supply and baby’s need, so will satisfying baby’s sucking need with a pacifier. If it is medically necessary to give you baby supplementary feedings, try alternatives to bottles that don’t involve artificial nipples (ie. cup feeding, spoon-feeding, using an eyedropper or feeding from a syringe).
Nurse longer. Allow baby to finish the first breast before switching to the other side (ie. continue as long as your baby is actively nursing). This allows baby to fill up on the high fat hindmilk brought down by the milk ejection reflex.
Switch nursing. This is helpful for the sleepy baby, or for babies who suck at a leisurely pace. Switch sides 3 or more times during each feeding, every time the baby is about to fall asleep, switches to comfort sucking, or loses interest. When switching sit him up, burp him, or change his diaper to help wake him.
Double nursing. This is an alternative to switch nursing. After you feed your baby and she seems finished, hold or carry her upright and awake for 10-20 minutes, allowing any trapped air or bubbles to be burped up. This makes room for more milk. Then feed her again on both breasts before you let her go to sleep. Double nursing, like switch nursing, stimulates more milk ejection reflexes, thus increasing the volume and calorie content of you milk.
Night and nap nurse. One of the most powerful things you can do to stimulate breast milk production is to take your baby to bed and nurse. This relaxes both you and the baby, stimulates longer and more frequent nursings, and increases your milk-producing hormones.
Contact your local lactation consultant to evaluate your baby’s latch-on and suck so you can be certain your baby is nursing effectively.
Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful – pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or increase the frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump has removed an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drop of milk.
Self care. Rest. Sleep when baby sleeps. Have your partner share in non-feeding infant care. Take a walk. Take a shower. Let go of other responsibilities for a while.
Drink fluids and eat a balanced diet. Foods that have historically been used to enhance milk supply are oats, barley, peas, legumes, walnuts, almonds, sunflower, sesame, flax seed, pumpkin and hemp seed/oil. Avoid coffee, black tea, pineapple and sage, as these foods tend to decrease supply.
Try herbal medicine. I use two different classes of herbs in my clinical practice to help women enhance their milk supply – galactogogues and nervines. These herbs are most often dispensed as teas or capsules. Talk to your naturopathic doctor, midwife, or herbalist about safe and effective dosing strategies, and formulas!
Galactogogues are a class of herbs that safely aid in initiating and maintaining adequate milk production, and are particularly useful for women who are unable to produce adequate breast milk. Common galactogogues are Fennel, Goat’s Rue, Blessed Thistle, Chaste Berry, Milk Thistle, Nettle and Fenugreek.
Nervines are relaxing herbs that help promote milk ‘let down.’ Common nervines are Lavender, Motherwort, Chamomile, and Blue Vervain.
Try Acupuncture. In Traditional Chinese Medicine (TCM), insufficient milk supply is viewed as insufficient energy (Qi) and blood supply in the mother. Problems with let-down on the other hand are viewed as stagnation of energy (Qi) which prevents the flow of milk through the ducts and out of the nipple. During acupuncture treatments, specific acupuncture points will be selected based on your TCM diagnosis. Treatments range from 30-60 minutes in length. You may need 4-6 treatments depending on your individual case. Qualified health care practitioners that offer acupuncture are naturopathic physicians, licensed acupuncturists and TCM doctors.
Sometimes medication is needed. In certain cases your midwife, family doctor, or naturopathic physician may recommend a medication called Domparidone. This medication increases milk production by increasing prolactin secretion from the pituitary gland. For more information on Domparidone please see Dr. Jack Newman’s link http://www.breastfeedinginc.ca/content.php?pagename=doc-DGS.
Best of luck to all you mommies out there! Remember, worrying about your milk supply is common, you’re not alone! Working with a qualified health care professional is key during this time, as they will help ensure that your baby is an efficient feeder and gaining weight, and that you’re doing everything you can to boost your milk supply.
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