Many breastfeeding mothers of the western and modern world wonder how to increase milk supply.  Maybe you were given a nipple shield quickly after birth or you use a pacifier (for any reason).  Maybe you're just trying to keep baby on a routine schedule, night weaning or feel overwhelmed and need a break.  These are some of the most common reasons for a decrease in milk supply.  Increasing milk supply is often a matter of putting baby on the breast at the first sign of hunger.  However, sometimes for known or  unknown reasons you need a little support to increase milk supply, especially when time is of the essence.

Is my Breastmilk Supply Low?

So many moms not only feel like their baby's need to nurse regularly is an indicator of low supply, but that comparing to bottle-fed babies, they might be pumping much less.

• Babies like to nurse a lot.  Very little of breastfeeding is nutritional.  It is physical and neurological development.  They should be nursing an absolute MINIMUM of 8 times a day.... minimum... they will very very likely nurse MUCH more than this
• Babies go through growth spurts and developmental changes as well as illnesses that will temporarily increase their desire to nurse, naturally increasing your supply.  A desire to nurse more does not mean you don't have enough milk.  Sometimes after one of these nursing spurts they will want to sleep for quite a bit the next day triggering engorgement and a normal decrease of supply back down to your normal amount
• Breastmilk supply is an average of 2 ounces total between BOTH breasts per feeding.
• Pumping is NEVER an indicator of the storage you have nor the supply you can create - no matter how good your pump.  (Sometimes manual expression works more efficiently than pumping, but it still doesn't compare to baby at the breast).
• Some moms can store more milk than others (like having a smaller cup of water than someone else).  A mom with a smaller storage tank will need to refill more often, but the source of the supply is still the same amount.  So, some babies will need to nurse more often to be satisfied with the flow.
• Breast size is NOT an indicator of storage capacity or supply you can create.  Some moms have more or less breast and fatty tissue, which can vary widely.
• Breastfed babies rarely every drink more than 4-5 ounces at a time.  (Even during growth spurts, a baby will temporarily increase milk supply because they need the extra nutrients for whatever developmental change they are experiencing, but after this, the supply goes back to the normal average - no matter how old their baby is - 4 months, or 4 years)
• Babies will drink more from a bottle, especially if bottle feeding isn't mimicking the breastfeeding relationship (lots of breaks, switching sides, bottle parallel to the floor just enough to fill the nipple)
• Babies like flow.  If there is a concern for supply, it is often related to latch, positioning, and flow of the milk.  Rarely would it be the supply itself, especially in the early weeks when the supply is getting established.
• Babies will get fussy at the breast when they have tight muscles in and around their mouth and body which makes it difficult for them to transfer milk, especially if it affects breathing.  This doesn't mean you have low supply - it means your baby needs bodywork and evaluation for oral restrictions.
• Don't push the back of your baby's head to get them to latch.  They have a reflex that helps them to be born and when you push at the back of their head, their head will naturally push back and not latch.
• Babies will get fussy with slow flow milk.  Use breast compressions to increase the flow rate of your milk.  Then, switch to the other side.  Do it over and over again until your baby is satisfied.

Causes of Decreased Milk Supply

In cultures where breastfeeding is not the norm, especially beyond 3-6 months - low milk supply quickly becomes a common reason mothers stop breastfeeding.  In reality, low milk supply is rare when we're talking the biological function of making milk and otherwise is often birth and provider caused through lack of knowledge, lack of biological birth support and overall lack of adequate care for breastfeeding families.  Breastfeeding is a biological function that was typically shared through visually seeing others breastfeed and listening to the stories of your culture.  When your culture only knows bottle feeding and pacifiers, it makes it really hard to have this innate understanding of breastfeeding and breastfeeding remedies.  Decreased milk supply is often caused from the following:

• Engorgement surrounding the birth where adequate latch was not achieved
• Early supplements surrounding the birth
• Stressful or difficult birth
• Stressful postpartum/life (including simply lack of a LOT of help)
• Returning to work (early or later)
• Limited Nursing (length of feeding and extending times between nursing especially over 2-3 hours)
• Nipple Shields
• Pacifiers
• Bottles & Supplements (including formula samples, pacifiers and nipple shields handed out in hospitals)
• Thumb Sucking
• Less than ideal pregnancy and birth position of the baby (baby's development influences how their soft and hard tissue develops which can not only cause baby to not be able to move their head or jaw/tongue in the necessary positions, but may also mimic tongue tie)
• Oral Restrictions include Tongue and/or Lip Tie
• Plugged Ducts
• Unbalanced Food Choices
• Dehydration
• Low Maternal Food Intake

Lifestyle Choices to Increase Milk Supply

• Eat within 30 minutes of Waking (this can be an herbal cup of tea and then a full meal within an hour)
• Hydrate
• Eat in general to be sure you have enough sustenance to make the milk (which takes about 500 extra healthy calories - more than what you needed during pregnancy)
• Eat plenty of greens, including wild foods and herbal foods.  Nettles is excellent for tea and soup and omelets and any way you would use spinach (only more nutrient-packed).  Red Raspberry Leaf and Strawberry Leaf are other great green herbal teas.
• Lactation Cookies I will note here because they are heavily marketed.  While they can be tasty many boxed options and recipes are loaded with sugar, and not what we're looking for with health.  They aren't really going to do a lot for supply, unless you don't eat well, you don't eat fiber, or you don't eat enough in general.  So, if this is how you eat healthy, then by all means find a low-sweetened option, or just go for a bowl of steel cut oats, nuts, seeds, and fruits and wash it down with a few glasses of water.  You can also use these banana-sweetened recipes to get in some healthier snacks if you need to improve your nutrition.
• Move daily - Movement gets blood (nutrients) flowing where it needs to go.  Don't overdo it in the first few weeks, though
• Rest.  Be sure you've planned, or change your plans, to allow for 3-4 weeks after birth of nothing but rest and breastfeeding.  Have a friend or family member live-in (dad needs rest, too) or hire a postpartum doula, or give people tasks to feed and clean for you or throw a frozen pre-prepped meal into a crock pot.  Be skin to skin as much as possible with baby to regulate baby's temperature, stress levels, and allow baby to be close enough to be properly positioned.  You can throw a picnic blanket outside or rest on the sofa, but you are healing from blood and fluid loss, a "wound" the size of a dinner plate on the internal part of your uterus, and learning a new task.  Exhaustion is stressful and reduces necessary hormones.  Rest is vital after birth, and anytime you're struggling with milk supply.
• Do not limit nursing at any time.  If you need to stop a session to go pee or take a break, do so - but as soon as baby cues that they want to nurse, offer the breast or two, or three or four or however many it takes until they're satisfied.
• Eliminate or significantly limit the coffee (even decaf), black tea and any other foods high in acids and tannins.  If this sounds like an issue for you, determine your stress load and adrenal health as both the stress and the coffee/black tea can be contributors to low supply.
• Bed share.  Not just room sharing, not just co-sleeping with a co-sleeper.  I'm meaning actually sleeping right next to your baby.  Your baby's breathing and stress levels regulate when they are right next to you.  They will snuggle up close to you.  They may even latch on all by themselves without you even waking up, eventually.  This means everyone from baby, to you, to Dad sleeps much better.  Baby doesn't totally wake up to nurse.  You don't totally wake up to nurse.  Baby nurses longer at night when your prolactin levels are highest allowing you to make more milk (score for growth spurts!).  You can read this article for specifics on safely co-sleeping.

Physical Methods to Increase Milk Supply

Ways to increase milk supply can sometimes come from manual support.  Here are a few options:

• Shake and massage your breasts before/during nursing.  This is especially helpful if your baby has a tongue and/or lip tie or you deal with plugged ducts.
• Use breast compression while nurse and while pumping where you squeeze your breast to help increase the flow of the milk (not necessary if baby is choking during nursing due to forceful letdown)
• Get baby Osteopathic Therapy, Massage Therapy, and/or Cranio Sacral Therapy early and often (once is not usually enough). This helps baby's soft and hard tissue move into a supportive place so baby's jaw muscles can work the way they're intended and baby's tongue can reach the necessary milk sinuses.  Also seek support of a qualified provider than can assess for tongue and/or lip tie (not just your pediatrician, and not just any IBCLC - know their history of diagnosing this issue).  If a revision is necessary, be sure to continue the bodywork as the tie will only release tissue - it will not fix underlying osteopathic/tissue complications.
• Pump one breast while nursing the other or pump between nursing sessions.  Follow these breast pumping tips for more guidance.  Hands-free nursing bras and pumps like the Freemie are great for being more discrete while pumping in any location.  If  pumping full or part-time, always pump as much as baby drinks from a spoon/SNS/cup/bottle in a 24 hour period.
• Hand express your milk which may be helpful especially when engorged or when you aren't responding well to a pump (or don't have one nearby and need to prevent too much milk from building up in your breasts).
• Remove (or significantly limit) artificial nipple use including pacifiers, nipple shields and thumb sucking.  Artificial nipples change the latch (hard and soft tissues of the facial structure) which reduces baby's ability to efficiently drain the breast causing the supply to drop.  Additionally, if baby wants to suck it means they actually want to be at the breast or comforted by you/someone in some way.  When there are milk supply issues, at least, all sucking/nursing should be at the breast.  Perfect way to increase supply.
• Nurse when baby has a cue (long before crying) like smacking lips, putting their hand towards their mouth, turning their head towards your breast.  In the early weeks, and during developmental changes like growth spurts, teething and learning new things, this will feel like it is all the time.  Get emotional and house support to help you through these times.  The longer milk sits in your breast, the more proteins, that signal the body to slow production, are present.  Going longer than 2-3 hours between nursing sessions (especially in the first 3 months) can significantly decrease supply and effect the rest of breastfeeding making it more difficult to increase supply as needed later.
• Reduce stressors.  Get more sleep.  Get more help for you AND dad.  Say "No" more to scheduled tasks.  Go to bed, nurse all day, take an herbal lavender bath, rest and drink tea.  Oxytocin is the love, calm, and trust hormone and is also the hormone that causes contractions (which you likely remember from birth and after).  Stress hormones (like adrenaline) suppress oxytocin.  Stress of any kind - from doing too much to going back to work or feeling depressed will decrease oxytocin.  Oxytocin allows the alveoli that hold the milk in the breast to contract and express milk through the ducts as baby stimulates the breast or you are otherwise triggered to release oxytocin (such as orgasm, strong feelings of love and intimacy, or hearing a baby coo or cry, for example).

Herbs that Increase Milk Supply

Other than food in general and herbs like alfalfa tea (or tablets), nettles and red raspberry leaf to increase milk supply (which can often be enough on their own due to nutrient content) other herbs are considered specific galactogogues - milk producing - herbs.  These herbs can be used on their own, though as with most herbs their effects are enhanced when blended together.  Note that the first three herbs can be blended together to total 5 ml per dose (plus additional Avena Sativa) which may enhance their efficacy.

• Goat's Rue - Galega officinalis - *May increase the strength of hypoglycemic medications.  Otherwise, Infuse 1 tsp. per 1 cup of water.  Steep 10-15 minutes.  Drink 1-2 times daily.  Alternatively, take 1-2 ml of a 1:10 in 45% tincture three times daily.
• Fennel - Foeniculum vulgare - *Slightly crush seeds.  Infuse 1-2 tsp. per 1 cup of water.  Steep10 minutes.  Drink 1-3 times daily.  Alternatively take 1-2 ml of a 1:5 in 40% tincture three times daily.
• Blessed Thistle - Cnicus benedictus - Infuse 1 tsp. per 1 cup of water.  Steep 10-15 minutes.
• Oat Straw - Avena sativa - This is useful for stress and nutrient-related low milk supply to be used with other supporting galactogogue-specific herbs.  *Infuse 1-3 tsp. per 1 cup of water.  Let steep 10-15 minutes.  Drink 1-3 times daily.  If you know nursing is linked to stress (busy schedule, working, exhaustion...etc.) use the tincture of Avena sativa when tinctured in its milky form - this is crucial.  The milky form is the only form of Avena sativa that actually provides direct calming support.  In this case, take 1-5 ml of a 1:5 in 25% solution three times daily.
• Fenugreek - This is not one I typically recommend since it is not really indicated as a galactogogue and with its other effects on the body (particularly those with thyroid complications) it isn't my first choice.  However, it can be helpful so I am including this here for information sake.  You typically need to take enough to start smelling like maple syrup which is a surprising amount.  This is a demulcent herb which increases mucous and soothes the nervous system (like oat straw).  May lower blood cholesterol.  This herb should be taken in capsule form or tincture.

Infusion - Pour hot/boiling water over the herb - do not heat the herb in the water.  Cover.  Let steep (sit unbothered) as directed.

*Dosages from: Medical Herbalism: The Science and Practice of Herbal Medicine by David Hoffmann, FNIMH, AHG.

Prescription Medications to Increase Milk Supply

According to Dr. Jack Newman, Domperidone (a category L1 and a drug used to increase intestinal peristalsis) is the most useful prescription medication to increase milk supply.  Though not its direct-use, off-label Domperidone does increase prolactin levels - the hormone needed to produce milk.  This is not a first-approach and often not easily available in the US.  In fact, it typically has to be purchased online from international pharmacies as it is unavailable through your provider in the US - which is unfortunate.  For more specific information about Domperidone safety and dosages visit the Dr. Jack Newman website.

Reglan (a category L2) is the prescription medication typically used in the United States to increase milk supply, according to KellyMom.com.  Unfortunately Reglan has strong links to severe depression.  Sulpiride is another option in some countries with limited safety data.

Have you managed low milk supply?  What did you use to increase milk supply for you and your baby?

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