Increasing milk supply

Before starting on a programme of trying to increase your milk supply, it's important to make sure that this is what you need to do. Lots of mothers assume they don t have enough milk to feed their baby, or even that their milk is too weak or of poor quality. In fact, one of the most common reasons given by mothers for ceasing breastfeeding is because they feel they are not producing enough breast milk. But for the majority of breastfeeding mothers, milk supply is not the real issue. A baby's behaviour can be due to all sorts of reasons and not solely related their milk intake. Crying, unsettledness, wakefulness and protests can also be due to overstimulation and tiredness rather than genuine hunger.

Even when a mother's breast milk supply is low, this is most often a temporary problem. Within a couple of days of using strategies to build up their supply, most mothers produce more milk.

Remember

It is normal for breastfed babies in their early months to demand to be fed as many as 8-12 times in a 24-hour period. Regulating and timing their feeds can create unnecessary stress and anxiety for mothers who can then become doubtful about their milk supply.

Is your baby:

• Gaining weight regularly? An average weight gain for babies from birth to 3 months is around 150-200 grams/week, from 3-6 months a gain of 100-150 grams/week and from 6-12 months a gain of around 70-90 grams/week.
• Showing good skin colour and muscle tone? Do they look well and as if they are gaining weight?
• Are they growing out of their tiny newborn jumpsuits and nappies? Do they have little fat folds on their legs and arms or do they look thin and scrawny?
• Back to their birth weight or over by the time they are two weeks old?
• Tracking along the same percentile (growth) curve for their weight, head circumference and length? Or, are they dropping down from one line to another?
• Is your baby bright and alert, responsive and animated? Or are they sleepy and difficult to wake up?
• Is your baby feeding actively and strongly at the breast? Are they hungry for feeds, waking themselves and wanting to feed regularly?
• Is your baby wetting at least 6 pale, wet nappies a day? Are their poos golden yellow and soft? Even though they may not poo very often, as long as the consistency of their poos is soft then this is a sign that their milk intake is sufficient.

Common reasons why babies may want to feed more frequently

• For comfort and reassurance. Babies have a strong, inbuilt urge to suck and often they just want the comfort of sucking, not always because they are hungry.
• Frequent demands to breastfeed help with establishing and boosting a mother's milk supply.
• Because they are very young and small. Because of the small size of their stomach and their body, newborns need to feed frequently.
• When they are going through a growth spurt, babies need more kilojoules (energy) intake to fuel their growth. Demanding more frequent breastfeeds is one way for them to ensure their nutritional needs are met.
• If their mother's supply is low. Successful breastfeeding relies on a supply and demand principle. The more milk a baby needs the more they will demand to feed. In turn, the more breast milk their mother will produce and so the cycle continues.
• Sometimes babies want to feed more frequently if they are unwell. Breast milk has naturally occurring antibodies and these help with fighting infection. Frequent feeding helps to support immune function and fight viral, as well as bacterial infections.

Ways to increase breast milk supply

• Make sure your baby is positioned and attached correctly at your breast. They need to be turned into face you chest to chest and chin to breast . Poor attachment can result in poor suckling.
• Skin to skin contact can help. Undress your baby and just leave their nappy on. Hold them close to your body this will help to keep them awake and boost the production of your lactation hormones.
• Breastfeed frequently and encourage your baby to suck whenever they want to. Avoid timing breastfeeds and offer your baby both breasts as frequently as they demand.
• Have your baby close to you. Absences away from each other such as an early return to work, overly supportive caregivers (who restrict a mother's access to her baby) and focusing too much on the baby's sleep periods can all impact on frequency of breastfeeds.
• Offer top up breastfeeds within an hour or so of starting a breastfeed.
• Switch feed e.g. When your baby starts fussing on one breast then switch them over to the other side. You can do this a few times through each feed.
• Aim to offer each of your breasts twice at each feed. Sometimes your baby may want to feed more or less, but generally babies need to feed every couple of hours to boost their mother's milk supply.
• During breastfeeds, massage and compress your breasts at the same time as your baby is sucking. This can assist with breast emptying which in turn, helps the breasts to produce more milk.
• Aim to empty at least one breast at each feed. You may need to express the other side for comfort and to maintain your supply if your baby is not keen to feed directly from you.
• Express after breastfeeds, either by hand or with a pump. You could store the expressed breast milk (EBM), or offer it to your baby as a complimentary feed if you feel they need it.
• Stop offering your baby a dummy. If they want to suck for comfort offer your breast.
• Aim to eat a really healthy and nutritious diet. Avoid having a high intake of caffeinated drinks such as tea and coffee.
• Rest as much as possible. If you are up frequently during the night, then it's really important to try and have a daytime nap. Even lying down for an hour or so can really make a difference to a mother's breast milk supply and energy levels.
• Aim to stay calm and relaxed. Lactation can be affected by a mother's stress levels and the let down response, works most efficiently when a mother is not feeling anxious.
• Spend time with your baby and focus on enjoying them. When breastfeeding is seen as a chore this can affect the pleasure of care giving and in turn, milk supply.
• Surround yourself with people who support your decision to breastfeed. The support of your partner, family and friends could make all the difference.
• Accept all reasonable offers of support. Practical help with the house and child care, shopping and cleaning can really ease up valuable energy which can be directed into increasing your lactation.
• Be confident and positive. Reassure yourself that breastfeeding is one of the most natural processes in the world. Your body knows what it needs to do, so give yourself time and be patient.
• Avoid giving your baby any formula milk, bottles or nutrition other than your breastmilk. A hungry baby tends to suck more efficiently and empty the breast. It is these two factors which will have the most positive effect on your breasts producing more milk.
• Ensure you get enough rest and sleep as this can impact upon milk production.
• Speak with your doctor about getting a prescription for medication to help boost your supply When taken as prescribed, galactagogues can be very useful for increasing breast milk supply.

Ways to express more breast milk

Expressing milk can help to boost supply. The best time to express is after or in-between breastfeeds. Some women feel they express more after they've just woken up or during the night.

Expressing can also be useful when a baby is sleepy or disinterested in feeding. You have choices about how to express either by hand or using a pump – experiment with what you find suits you best.

Use a warm cloth against your breast before you start expressing and have your baby close to you. Try to relax, this will support your let-down response which will help the milk to flow. Use gentle massage and breast compression with your hand.

What's valuable about expressing is that it stimulates the breast to produce more milk. It's easy to feel disheartened if only a small amount of milk is expressed, but the stimulation is equally as important as the amount of expressed breast milk (EBM) which results. Try not to judge how much milk you're producing by how much EBM you obtain. Your baby will get more milk from your breasts than you can when you express. Any amount of EBM is worth offering to your baby, rather than discarding it. Try not to introduce a bottle to your breastfed baby and instead, offer EBM from a spoon or small cup after they have fed.

Causes for low breast milk supply

• If a mother has previously had surgery on her breasts such as a breast augmentation or reduction. Although surgeons aim to maintain as much lactating breast tissue as possible, surgery can still impact. Severing the nerve pathways and ducts which lead from the breast to the nipple can cause lactation issues.
• Breast infection, such as mastitis or thrush of the nipples.
• When a baby does not have a strong and coordinated suck and swallow technique.
• When a baby is not correctly attached to the breast. If you are at all unsure about your baby's attachment, check with your child health nurse, lactation consultant or health care professional.
• Some medications, such as the oral contraceptive pill.
• Hormonal changes menstruation, conceiving or taking artificial hormones.
• Insufficient breastfeeds and not enough breast stimulation and breast emptying.
• Smoking cigarettes, drinking alcohol and taking illicit drugs.
• Pregnancy.
• Some over the counter drugs inhibit breast milk production. Likewise, some herbal remedies can impact on the amount of milk produced.
• When breastfeeding is painful e.g., when a mother has tender nipples, this can inhibit lactation.
• Starting solid food too early so the baby is not as keen to suck effectively on the breast.

Where to get more information

• Your Child Health Nurse, GP or a Lactation Consultant. Check Lactation Consultants of Australia and New Zealand. www.lcanz.org
• The Australian Breastfeeding Association Telephone www.breastfeeding.asn.au or 1800 mum 2 mum 1800 686 268

Edited and reviewed by Jane Barry, Midwife and Child Health Nurse July 2021.