Increase Milk Supply While Breastfeeding
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.
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 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
- Bottles & Supplements (including formula samples, pacifiers and nipple shields handed out in hospitals)
- Thumb Sucking
- Tongue and/or Lip Tie
- Plugged Ducts
- Unbalanced Food Choices
- Low 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)
- 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.
- Move daily - Movement gets blood (nutrients) flowing where it needs to go.
- 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.
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)
- 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.
- 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 alveolie 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 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. Additionally, you can check out the Land of Milk & Honey Nursing Chai in the Esali Shop.
- 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 especially useful for stress-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.
- 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?