Increasing Milk Supply

BreastfeedingBefore 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 are often 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 issue. 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 up 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 and not because they are hungry.
  • Frequent demands to breastfeed help with establishing a mother’s milk supply.
  • Because they are very young and small. Because of the small size of their stomach and their overall 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”.
  • 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. Don’t time feeds and offer your baby both breasts as frequently as they want.
  • Avoid not having your baby near you all the time. 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.
  • Try to offer each of your breasts twice at each feed. Sometimes your baby may want to feed more or less, but generally they 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 then this impacts on the pleasure of care giving and milk supply.
  • Surround yourself with people who support your decision to breastfeed. The support of your partner, family and friends can 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.
  • Speak with your doctor about getting a prescription for medication (see below) to help boost your supply. This can be very effective, especially when it is taken within the first three months of having a baby.

Guidelines for taking Motilium/Domperidone

NB It can take a week or more for the benefits of Domperidone to become obvious. For best results, Domperidone should be taken in conjunction with frequent and regular breastfeeding.

Start on After a few days Once your milk supply is established How Domperidone works
1 tablet (10mgs) three times each day. Increase to 2 tablets (20mgs) three times a day. Decrease to 1 tablet (10mgs) three times a day before stopping. This is a drug normally prescribed for nausea and vomiting. But it also has the effect of boosting the hormone Prolactin.
Aim to space these 8 hours apart. Stay on this dose until directed by your doctor. It is important not to take more than 80 mgs of Domperidone in one day.

Reference: The Royal Women’s Hospital Victoria Australia Fact Sheet. Domperidone for increasing breast milk supply.
www.thewomens.org.au/breastfeeding

Potential side effects of Domperidone include:

  • A dry mouth.
  • Skin rash.
  • Headaches.
  • Feeling sleepy.
  • Although Domperidone does cross over into the breast milk there are not considered to be any risks to breast fed babies.

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 problems.
  • 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 or health care professional.
  • Some medications, such as the oral contraceptive pill.
  • Hormonal changes within a mother such as 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 being 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