A common concern of breastfeeding mothers is whether they are producing enough milk to nourish their babies. In many cases, milk supply is actually fine – a fussy baby or a pediatrician who is not educated about breastfeeding may create problems where none exist. Before digging into this article and trying to influence your milk production, please see my articles on "Is My Newborn Getting Enough?" and "Do I Need to Increase My Milk Supply?" through the related links at the bottom of this article.
Sometimes, however, milk supply must be managed. A few reasons for this may include:
-- Uncorrected latch problems that interfere with milk coming in properly
-- "Lopsided" milk production between breasts
-- Induced lactation by an adoptive mother
-- Prematurity or heath problems of the baby.
-- Early formula supplementation that interfered with proper milk production
-- Changing one's mind about formula and wanting to reestablish breastfeeding (Yes! This is possible!)
-- Use of breast shields or other breastfeeding accessories that interfere with stimulation (sometimes these *are* necessary, but care should be taken to watch supply).
-- Working moms who have engaged in long-term pumping may sometimes need to periodically increase supply to maintain extended breastfeeding.
There are several ways to increase milk supply. Remember that if your supply is actually fine, attempts to increase it can cause plugged ducts or feeding difficulties for the baby, so first be sure you have a good understanding of what is going on.
• The Basics – Feed on cue and drink lots of water. I have a personal friend who ceased nursing and gave formula for an entire week, and was able to restore exclusive nursing basically by simply nursing. Keep the baby close and breastfeed whenever the baby wants or needs. Offer the breast frequently. Nurse upon waking and nurse the baby to sleep. Try not to get bogged down in watching the clock, timing side-switches (although do make sure you are nursing relatively equally on both sides, or you can become lopsided!), or following a schedule. Let the baby nurse at will until falling asleep or detaching, then offer the other side. Keep doing this for as long as the baby will nurse. The more often the milk lets down, and the more milk that is removed from the breast, the more the breasts will produce. Sleep with the baby and nurse throughout the night. Use breast compression (gently squeeze from far back on the breast) to extend feedings and fully empty the breast. Like all nursing mothers, increase water intake, but even more so.
• Galactagogues – Galactagogues are supplements that are known to or thought to increase milk supply. Common herbal preparations include drinking Mother's Milk Tea by Traditional Medicinals (be sure to let it steep covered per the instructions) and Fenugreek capsules (a *minimum* of about 3600 mg total a day spread over three doses). There is also a product called More Milk Plus is expensive, but does produce excellent results in my tests of the product (see my full-length review). These are available at most vitamin or health food stores. Fennel seed made into tea or eaten is also thought to help. Other foods like Oatmeal and Dark Beers are thought to help as well, although evidence is contradictory. In truth, success of various methods tend to vary from woman to woman – one may have worked well for a friend, but not for you (and vice versa). Personally, I have used Mother's Milk Tea and fenugreek when increasing supply with my first baby to good effect. I still have a cup of the tea each night simply to promote healthy herbal balance while nursing. There are also prescription medications, such as Domperidone, that your doctor can prescribe. Domperidone is not primarily intended to increase milk supply, but is a medication that produces this side effect. However, it must be prepared by a compounding pharmacy, and can be tough to find in the US.
• Pumping – Pumping is the method that for me has yielded the most reliable results for increasing supply. First of all, have a quality electric double pump. A Medela Pump-in-Style-type can be sufficient, but for more acute supply-increasing needs, renting a hospital-grade pump is recommended. An outpatient rental program is available at many hospitals. The trick is to pump after breastfeeding to completely empty the breast and then *continue pumping* for 3-15 minutes *after* milk stops coming out. This is how you tell your body that more milk is desired. Please note that the change will not be immediate, but most mothers start to notice an increase after 3-4 days and a significant increase within a week. It really is important to pump after every feeding, including nighttime. This can be a stressful process, and is best accomplished with a partner's help to care for the baby while pumping (and if applicable to your situation and advised by a doctor or lactation consultant, feeding expressed milk after nursing sessions while your supply adjusts)
If you are managing a slow weight gain or health issue, changing over from formula feeding, or trying to make up for a less-than-perfect start, the process of increasing supply can be incredibly emotional and stressful. But again, this is one of those things that is temporary, and the payoff is HUGE. I had to rebuild my milk supply three times with my first daughter, due to various challenges , and I can tell you that despite everything, I don't regret it for a moment. I nursed my daughter until she was 18 months, and treasure the experience so deeply. And as hard as it is to believe, the stress and work of building supply quickly recedes in favor of the joy of exclusive breastfeeding.