Establishing a Good Milk Supply

Breastfeeding Help

One of the biggest concerns for breastfeeding mothers is “Am I making enough milk for my baby?” Although this is a real concern, most women are able to produce enough milk. In fact, only about 3% of women are physically not able to produce enough milk for their babies. If this is the case for you, it is still the best thing for baby to breastfeed as much as possible. A doctor or lactation specialist can help you know if supplementation is necessary. Remember, some breast milk is always better than none. Even if you cannot breastfeed exclusively, you can still breastfeed as much and as long as possible.

There are several things that can affect the quality and quantity of breast milk. This article will discuss ways to establish and maintain a good milk supply. It will also discuss ways milk supply may decrease, and how to increase the supply if it does.




Keys to Establishing a Good Milk Supply

About 97% of mothers are physically capable of producing enough milk for their babies. Many mothers even produce more than enough milk. The first few hours and days after a baby is born are the most important in creating milk supply. The key to creating a good milk supply is to nurse early and often. Breastfeeding is a supply and demand process. The more baby drinks, the more milk you will produce. If your breasts do not receive enough stimulation in the hours and days after birth you may have persistent problems with milk supply. Listed below are recommendations for establishing a good milk supply:


Breastfeed Soon After Birth

Breastfeeding as soon as possible after birth will help baby get off to the best breastfeeding start. Try to breastfeed within a half hour after delivery when baby is most alert. This will stimulate your brain and tell your breasts to begin producing milk.


Establish a Good Latch

If baby does not latch on correctly it will be more difficult for him to remove milk from your breasts. It can also cause nipple and breast pain. Check with a lactation consultant, or other professional, to make sure baby is latching on properly before you leave the hospital. Taking the time to establish a good latch in the beginning will decrease problems in the future.


Stay in the Same Room as Your Baby Both Day and Night

This will allow you to feed baby often, even during the night. Women who have their baby sleep in the same room at night have fewer problems maintaining a good milk supply. Stimulation throughout the day and night will increase milk production.


Breastfeed Your Baby Often

Any time baby is showing hunger signals feed her. For the first few days of life, baby will usually feed between 10 and 12 times in a 24 hour period. As baby grows she will become better at nursing. She will be able to get more milk from your breasts more quickly. The number of feedings in a 24 hour period will naturally decrease over time. If baby does not wake on her own to feed, it is important to wake her up during the first few weeks. If you do not feed often enough, especially in the early weeks, it may be difficult to establish an adequate milk supply.


Avoid Supplements

Do not give baby supplements of formula, water, or sugar water unless there is a medical reason for them. If supplements are medically necessary use a lactation aid, cup, spoon, or eyedropper to give the supplements to your baby, as use of a bottle may make breastfeeding more difficult.


Express Milk if Needed

Milk can be expressed by hand or pump. Most women find expressing milk a great way to keep milk supply up, as well as to store up a supply of breast milk for times when they are away from baby. Expressing milk will both stimulate milk production and reduce engorgement.


Do Not Use Bottles or Pacifiers

Using artificial nipples of any kind while establishing your milk supply can make it more difficult for baby to learn to latch on the breast properly. This is especially important right after birth when you and baby are just getting used to breastfeeding. Let hospital personnel know before birth that you plan to breastfeed and do not want artificial nipples given to your baby. Even bottles containing breast milk should not be given until milk supply is well established. Use your breast to soothe baby instead of a pacifier. This extra stimulation will help you produce more milk.


Establishing good milk supply usually takes between 4 and 6 weeks, but it may be longer. Once established, the best way to maintain a good milk supply is by feeding baby on demand. Whenever baby is hungry feed her. Watch for feeding cues and do not wait until baby is hungry to feed her. This will keep the supply and demand process working to provide all of the milk baby needs.

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Decreased Milk Supply



How to Tell if Your Milk Supply Has Decreased

It can sometimes be difficult to know whether or not your milk supply has decreased. Every mother and baby pair is unique. This means that each breastfeeding experience will also be unique. Pay attention to your own experiences when you are concerned about your milk supply. It is also important to remember that breastfed babies are different than formula fed babies. Do not compare the eating habits and growth of a formula fed baby to your breastfed baby. These comparisons may give you an inaccurate idea of how your baby should be acting.

Many mothers suspect their milk supply has decreased even if they are producing plenty of milk. As you and baby become better at nursing, your milk supply will adjust to fit baby’s needs. These normal changes may lead you to believe that your milk supply has decreased; when in fact, you are producing all the milk baby needs. Each of the following concerns alone usually does not indicate that your milk supply has decreased.


Length and Frequency of Feedings

If you have a healthy infant the length and frequency of feedings can change from time to time. Sometimes baby will need to nurse more, other times she will nurse less. A newborn may need to feed longer and more often while she is learning how to breastfeed. As baby gets older she will become better at removing milk from the breast. This may mean that she does not need to feed as often, or as long at each feeding. Other times baby may go through a growth spurt and will need more milk to keep up with her growth. During this time it may seem like she wants to nurse almost constantly. All of these situations are normal, even when you are producing enough milk.


Baby’s Behavior

Many people believe that if a baby is fussy, especially right after nursing, it means the mother is not producing enough milk. This can be true in some situations. However, some babies are fussier than others regardless of how much milk they are getting. If your baby is fussy and you suspect you milk supply has decreased look for other factors to confirm your suspicions.


Breasts Feel Soft

As soon as your milk came in your breasts were probably very large and full. They may have even become engorged. After several weeks of nursing you may notice that your breasts feel softer and less full. If baby is still nursing well, softer breasts do not indicate any problem. Your body has simply adjusted the amount of milk produced to fit baby’s needs. At different points during breastfeeding your breasts may seem harder or softer depending on baby’s needs. It does not necessarily mean you are not producing enough milk. This change in the breasts is normal.


Small Breasts

The size of your breasts does not determine the amount of milk you will be able to produce. Each woman has about the same amount of milk ducts even when breast size varies. Some women with very small breasts are able to produce more milk than women with very large breasts.


Difficulty Expressing Milk

The amount of milk you are able to express, using a pump or through hand expression, does not indicate whether or not you have a good milk supply. Just like breastfeeding, expressing milk takes practice. Baby is often much better at getting milk out than a pump. Also if you express milk after you feed baby there is probably not much milk left and you will get less out.




What are the Most Accurate Ways of Determining if You are Producing Milk Well and Baby is Getting Enough?



Remember, even these indicators may have some limitations. Always talk with a doctor or lactation specialist if you have any concerns.


Weight Gain

Weight gain is probably the best indicator in determining if baby is getting enough milk. Babies often loose weight during the first few days of life, and then gain back the weight by about day ten. After the initial weight loss, a baby gains about 1 ounce a day for the first 2 months. After that, baby will gain about half an ounce a day until baby is about six months old. If your child is steadily gaining weight, you are most likely producing enough milk. However, there are a few things to keep in mind when using weight to determine if you are producing enough milk. Different scales may give you different results. Also children may be weighed with their clothes on, while other times are weighed with the clothes off, causing different weight measurements. Another factor that may change the weight of a baby is a diaper. Make sure that you weigh your baby with a clean dry diaper. It is important to make sure you do not look at just one single weight when deciding if your milk supply is low. Look at baby’s weight over time. As long as baby still weighs close to what he should, small decreases should not be a concern. If you have any concerns about baby’s weight gain talk to your doctor.


Number of Wet Diapers

If baby has at least 5 or 6 wet diapers a day, she is probably getting enough milk. It is important to remember, however, that diapers can hold different amounts of liquid. If you use clothe diapers it is easier to tell if baby has 5-6 wet diapers a day. If you use disposable diapers it can be much more difficult to tell how many wet diapers baby has. Some brands of disposable diapers are so absorbent that they may still seem dry after your baby has urinated.


Number of Bowel Movements

A newborn baby will pass meconium, which is in baby’s intestines before birth. By about the fifth day baby should pass mustard colored stools. By the time baby is one week old she should pass at least 2-3 bowel movements each day. If baby has infrequent stools, or brown bowel movements, she may not be getting enough milk. When your baby is about 3 or 4 weeks old, her bowel movements may decrease significantly. This does not mean your milk supply has suddenly decreased. Some babies may continue to have bowel movements every day, while others have a bowel movement only every three or more days. As long as baby is healthy and the stools are still mustard colored this is most likely not a cause for concern. Once baby is older it can be more difficult to use the number of bowel movements as an indicator of poor milk supply because there is so much variation in the amount of bowl movements each healthy baby has. If you notice a change in the normal bowel habits of your baby, talk to your doctor.




What Causes Decreased Milk Supply?

There are several reasons that your milk supply may decrease. Although there are several things that can decrease your milk, finding a solution is generally not difficult. It is best to look for help to resolve a decreased milk supply as soon as possible. The longer you wait to correct the problem the harder it may be to increase the milk supply.


Supplemental Feedings

The more time baby spends at your breast the more milk you will produce. If you give baby formula, water, juice, or solid foods she will breastfeed less. This will decrease your milk supply. Until baby is 6 months she does not need anything except breast milk.


Overuse of Bottles

Using a bottle to give breast milk occasionally once milk supply has been established usually does not cause problems. However if you use a bottle too often it can interfere with milk supply. Drinking milk from a bottle is different than drinking from your breast. Using bottles too often may affect baby’s latch or ability to breastfeed. It may be easier for baby to drink milk from a bottle than your breast. Depending on your baby he may prefer the bottle, and he may even refuse the breast.


Feeding on a Schedule

Baby should determine when and how often she eats. If you feed on a schedule there may be times baby is hungry but you do not feed her. Or times when you try to feed her but she is not hungry. If baby does not feed when she is hungry the supply and demand process of breastfeeding does not work as well. Your body may not produce the right amount of milk for baby. It is also important to let baby feed as long as she wants. Do not force baby to finish feeding. And do not make baby wait to eat. This will keep the supply and demand process working as it should.


Poor Latch

A good latch is essential to a good milk supply. A poor latch can cause problems in a few different ways. If baby is not latching on properly she cannot effectively get the milk from your breast. Even if baby spends several hours a day at the breast, if she does not latch on properly she may not be getting enough milk, and your breasts will not receive proper stimulation for milk production.


Stress

Having a baby can be one of the most stressful events you will ever experience. This stress can make it more difficult for your body to produce milk or have a milk let-down. Eliminate as much stress as you can in the days and weeks after baby is born. When you are calm and relaxed your body will be more likely to produce enough milk.


Overuse of Pacifiers

Using pacifiers instead of feeding baby when she is hungry may reduce the amount of time baby spends at the breast, which can reduce milk supply. It is best to avoid pacifiers until after the first 4-6 weeks so breastfeeding can get well established. Then it is best to only use a pacifier when baby is going to sleep in order to reduce the risk of SIDS.


Plugged Ducts or Mastitis

Plugged ducts and mastitis may cause damage to the milk ducts. Damaged milk ducts are not able to produce as much milk. If you have had plugged ducts or mastitis in the past you may find it will affect milk supply in the future. However, in many cases the other undamaged milk ducts can produce extra milk to make up the difference.


Hormonal Birth Control

The hormone estrogen, which is found in many birth control products, can decrease milk supply. If you choose to use hormonal birth control use a method that contains progesterone only. Wait 6-8 weeks after having your baby before using hormonal birth control. This will give your body enough time to establish a good milk supply.


Losing Weight Quickly

As soon as baby is born it can be tempting to try and loose as much weight as you can as quickly as you can. Remember that when you are breastfeeding you are still providing all of baby’s nutrition. When you loose too much weight too fast it can be difficult for your body to produce enough milk for your baby. A healthy weight loss goal while you are breastfeeding is one pound per week. You can talk with a registered dietitian or lactation counselor if you have more questions about how to lose weight while breastfeeding.


Breast Surgery or Injury

Breast enhancement, augmentation, and reduction surgeries can affect your ability to breastfeed. Most women who have had these types of surgeries can still produce enough milk. Problems may occur if the surgery was recent, or if the milk ducts were damaged during the surgery. If a woman has had a major trauma, such as a car accident, to the breasts she may also have problems with milk supply. The way to know if you will have difficulties producing enough milk is to try and breastfeed. If you have had breast surgery or injury talk to your doctor and lactation specialist about any concerns. They may want to monitor baby closely during the early weeks after delivery. They can help identify if baby is getting enough milk or not.


Pregnancy

If you become pregnant while you are breastfeeding your milk supply can
decrease. The hormones in pregnancy can affect milk production. Some women who become pregnant will still choose to continue to breastfeed and provide as much milk as possible.


Going Back to Work

Going back to work can affect milk supply because you are not with baby as often. If you are working full-time or are away for long periods of time you will need to express your milk. This will allow you to continue to provide breast milk to baby. Expressing milk will help keep your milk supply up and reduce the chance of engorgement.


Smoking

Smoking more than 20 cigarettes a day can decrease your milk supply, as well as cause many other problems for baby. If you have a baby it is recommended to quit smoking.


Hypothyroidism

Even if you have no history of hypothyroidism it is possible to develop it while you are pregnant. If you try several methods to increase your milk supply without success, hypothyroidism may be to blame. Talk with your doctor if you suspect problems with your thyroid.


Anemia

Anemia is also a condition that can develop while you are pregnant. Talk to a doctor if other methods of increasing milk supply do not work.


Use of Certain Medications

If you need medication make sure you tell your doctor that you are breastfeeding. Your doctor will be able to let you know if the medication has the potential to reduce your milk supply. The doctor may also be able to prescribe another medication option that will not affect your milk supply.


Health or Developmental Problems

A baby with certain medical problems may not be able to breastfeed effectively. However, you may still be able to pump your milk to give to baby. It is important to give baby as much breast milk as you can even if it is given to him in a bottle or tube. A lactation consultant may be able to help you find ways to breastfeed babies who have special needs.

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Increasing Milk Supply

Fortunately, even if your milk supply decreases there are several things that you can do to increase you supply again. Many of these are similar to the things you do to establish a good milk supply in the first place. Although others may tell you that switching baby to formula is fine if your milk supply decreases, it is always best to breastfeed as long as possible. Even if the following suggestions do not help to increase your milk supply, continuing to feed baby breast milk as long as possible will help your baby to be healthier.


Fix Latch Problems

Improper latch is one of the most common contributors to low milk supply. The first step to increasing milk supply is to make sure baby is latching on correctly. The supply and demand process can only work if baby is correctly removing the milk from your breast. Talk to a lactation consultant or someone else who knows what proper latch looks like to assess your latch. Once your latch is fixed, your breasts will receive better stimulation to produce more milk. This may be all it takes to produce enough milk for baby.


Nurse or Express Milk Often

As mentioned previously, nursing is a supply and demand process. The more time baby spends at the breast, the more milk you will produce. When you are trying to increase your milk supply it is critical to let baby nurse often. Baby may want to nurse as often as every 1 to 2 hours during the day and night. Some mothers take what they call a nursing vacation to help increase milk supply. This is when mothers spend a few days where nursing and resting are their most important priorities. They focus on getting lots of rest, eating healthy food, and cuddling with baby. Other duties and activities are put on hold, as much as possible, during this time. Having someone else help with these extra duties or other children will allow the mother to focus on breastfeeding. If you are struggling with your milk supply it may also be a good idea to add extra pumping sessions, or power pump, throughout the day, in between nursing sessions. Nursing and pumping this much can sound overwhelming, but most of the time it is worth it as milk supply increases.


Breast Compression

Breast compression is a method that helps baby drink more milk at each feeding. This will help to increase the supply in the supply and demand process. When you are feeding baby watch to see when her sucking begins to slow. Once the sucking has slowed gently squeeze your breast. This will increase the flow of milk to baby, which will often cause her to begin active sucking again. This is also helpful for a baby who falls asleep easily at the breast. Dr. Jack Newman, a breastfeeding expert, describes breast compressions in detail (http://www.drjacknewman.com/index.php?option=com_content&task=view&id=82&Itemid=112).


Do Not Limit Feedings

Make sure baby is in charge when it comes to how often and how long you feed. Never pull baby off the breast when he is still actively sucking. If feedings are long try breast compressions or switching breasts to help keep the milk flowing well.


No Pacifiers or Bottles

While you are trying to increase your milk supply pacifiers and bottles should not be given. If baby is fussy let him suckle at your breast instead of giving a pacifier. The more time your baby spends at the breast the more milk you will produce.


No Supplements

If baby is less than 6 months old she does not need anything except breast milk. However, if your milk supply has decreased baby may have difficulty gaining weight. If baby requires a little extra while you are building your supply, the best supplement you can give her is your own breast milk. Pump milk to give to baby between feedings at the breast. Use a lactation aid, cup, spoon, or eye dropper to give the extra breast milk to baby instead of bottles.


Eat Healthy

Eat healthy snacks to ensure you have enough calories to make enough milk for baby. When you are breastfeeding you may need about 500 extra calories a day.


Drink to Thirst

In order to be able to produce enough milk for baby you need to drink enough water. You do not need to drink lots of extra water. Just drink so that you are not thirsty. Drinking too much water may actually make it more difficult for you to make enough milk.


Switch Nurse

Switch nursing is a method that may increase your breast milk by keeping baby on the breast longer. If baby is having a hard time with breastfeeding try offering each breast 2-3 times at each feeding. Start feeding, when baby stops actively sucking switch him to the other breast. Repeat the process 2-3 times each time his sucking slows down. This method can be particularly helpful for sleepy babies.


Herbs

Fenugreek is an herb commonly used to increase milk supply. It can be found at most health food and nutrition stores. Take 2-4 capsules 3 times a day for about 1-3 days. Some women have diarrhea while taking Fenugreek, but it usually goes away when you stop. Fenugreek can cause uterine contractions, so do not take it if you are pregnant. Other herbs that may help increase milk supply are Blessed Thistle and Alfalfa. Some women have found that combination of drugs works better. Remember that herbs are not regulated by the FDA. Be careful when choosing which herbs you want to take. Dr. Jack Newman gives more information about substances that may help increase milk supply (http://www.drjacknewman.com/index.php?option=com_content&task=view&id=149&Itemid=240).


Medication

There are also some medications that have been shown to increase milk supply. The most commonly prescribed drug to increase milk in the U.S. is Reglan. It is most effective when taken in doses of 10-15 mg 3 times a day. You should not take Reglan longer than 2-4 weeks. Reglan may have some side effects such as depression and mood swings. There are other drugs available outside the U. S., such as Domperidone, that have fewer side effects.

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