How can I increase my milk supply?

Do I have low milk supply?

Before we can begin to think of how to improve low milk supply, it’s really important to think about whether you actually do have a low milk supply. We have a really strong idea in the UK that milk supply is fragile, temperamental and prone to suddenly disappearing. I think it’s worth taking a moment to wonder where this perception comes from.

We are now 2-3 generations from when breastfeeding was the standard method of feeding babies. The last 70+ years of scheduling feeds, limiting time at the breast, automatic separation of mums and babies, medicalised births and more have altered our thinking and behaviour. All of these have contributed to many women not being encouraged to feed responsively, and the communication between their body and their baby being seriously disrupted. It has caused a huge problem with milk supply for many pairs. What it amounts to is a cultural belief that breasts as an organ system frequently just don’t work.

We know of course, that this isn’t the case. Breasts are no more prone to failure than ears, livers or hearts. Sure, there are cases of heart failure, but it’s not the norm in healthy bodies, or something we need to overthink. Letting our babies act like tiny primates – skin to skin, close to their parent, feeding responsively – is a cultural hurdle we have to leap before we ever have a chance to establish breastfeeding.

And yet, often low milk supply does happen. It’s real, and can be devastating for those experiencing it. We don’t have good studies allowing us to distinguish between those who physically have issues breastfeeding, and those whose problems were caused by inappropriate breastfeeding management. All the unhelpful advice given to our mothers and grandmothers – such as limiting access to the breast and scheduling feeds –is still happening. Plus, many still don’t have anyone around who knows what is normal or to help attach the baby well in the first place. We know that in countries like Norway or Senegal, less than 2% of babies are fed formula. This tells us that if socially and culturally supported, most breasts can do the necessary. But we know that often doesn’t happen in this country, and so the numbers of women facing real supply issues becomes much higher.

If that’s true for you, then that’s where an IBCLC or voluntary breastfeeding counsellor can help. They can try to track down what the problem is or has been, and look for solutions to help. They can help you process the big emotions around it too – feeding can be part of our vision of the type of parent we will be, and if that reality doesn’t happen, support to re-assess our feeding goals in light of new information is essential.

What are the signs that I’m not producing enough milk?

There are lots and lots of signs that people believe are an indicator that they don’t have enough milk, that aren’t actually signs of low milk supply at all. These might be:

• The baby will take milk from a bottle after a breastfeed: this is a reflex – the firm teat of a bottle will cause the baby to suck regardless of hunger.

• The baby won’t go three (or four, or eight) hours between feeds: There is no “normal” interval between feeds. All breasts have different storage capacity, and babies have different preferences for how much they want to eat. We all know some adults who like a couple of big meals a day and others who just want to snack constantly. Babies are the same.

• Your breasts feel empty – When your breasts feel soft, they are making milk at their fastest rate, they slow down as they fill to prevent you eventually exploding!

• You have small breasts – there’s no relationship between the amount of glandular (milk producing) tissue and breast size. Larger breasts have more fat, not more milk making tissue.

• The baby cries whenever she’s put down – this is really hard, but really normal. In our ancestors, a baby who would happily be put down might have found themselves eaten by wolves. Insisting on being held is a survival technique (albeit they aren’t at much risk in a moses basket in London).

• You can’t get much out with a pump – the volume you pump is not indicative of the milk you can produce. Some exclusive breastfeeders never pump a drop!

• The baby wakes frequently – again, this is normal (hard) behaviour. Babies frequency of waking is sadly not related to their food intake (just ask my centile climbing firstborn who was waking 8+ times a night).

• Cluster feeding – again, this is normal baby behaviour. Cluster feeding sends messages to your breasts to make more milk, by keeping them well drained for a prolonged period of time. It’s nature’s way of boosting supply.

None of these are indicators that you don’t have enough milk. The first true indicator to review is your baby’s growth – are they gaining an appropriate amount of weight for their size? This varies over time, but in the first few weeks, between 155 – 241g per week is a normal range, based on the WHO centiles. Your baby will also have half a dozen wet nappies, and at least two good sized poos each day. If these things are true, then your baby IS getting enough milk, which means you are making enough milk – congratulations!

My baby isn’t getting enough milk

If there is a problem with weight gain, or a lack of poos, that’s when we start to look for reasons why the baby isn’t drinking enough. It may be that the issue isn’t with milk supply, but with milk transfer – how good the baby is at getting the milk out. It’s a scenario for skilled help – call me! Call the National Breastfeeding Helpline. Call another IBCLC near you, because this is a puzzle with many possibilities for how the pieces fit together. This is where we have to drill down into what is going on. Maybe the baby isn’t latching well- is that just an issue with technique, or is there something like a tongue tie preventing them from feeding effectively.

Maybe there is an issue with the milk supply – there are conditions that make problems with milk supply more likely. Hormonal conditions like polycystic ovary syndrome (PCOS) or thyroid issues can reduce the breast’s ability to make milk. Maybe you had a huge haemorrhage at birth that has impacted your ability to make milk. Maybe during puberty or pregnancy your breasts had limited development.

Increasing milk supply:

Thankfully, the solution to low milk supply doesn’t have to be complex for the majority (which is not to say it is always easy). The more milk you remove from a breast, the more milk it will make. Frequent, effective milk removal is the single most important thing to improve milk production. That could be pumping, hand expressing, or simply putting your baby to the breast more often. Don’t feel like you have to wait for your breasts to fill up – the fuller the breast, the slower it makes milk, so keep draining them.

Sadly, there isn’t much evidence that foods, herbs and supplements make much of a difference. Fenugreek can help for some, but it can reduce the supply in others. There is some evidence that moringa works. The others (oats, brewer’s yeast, blessed thistle, goat’s rue) just haven’t been shown to have a significant effect. Lactation cookies, teas, smoothies fall into the same category. I’m pro-cookie under virtually all circumstances, but these are generally over priced and making promises they can’t keep. Some people feel they have made a difference, but they aren’t a substitute for regular breast simulation. There is a medication called domperidone that has been shown to have an effect, but it is not licensed for that use in the UK, so it is at the discretion of individual doctors whether to prescribe.

Skin to skin is a low tech intervention that really helps get the oxytocin flowing, which is essential for milk flow – also a nice excuse to camp out on the couch with Netflix (other providers are available).

When feeding directly, switching from one breast to another whenever the baby fusses, and

adding in breast compressions can help maximise breast drainage and milk transfer.

Pumping in addition to feeding can help send the message that you want your breasts to make more milk. Frequency of breast stimulation is the biggest factor – four x fifteen minute feeds would be a far more effective schedule than two x half hour feeds. Eight times daily is considered optimal, but that can present a big challenge when also looking after a baby. You’re going to need your village around you, because it’s impossible to look after a baby, pump multiple times, do skin to skin, walk the dog, eat food and wash occasionally. Support from family or your partner can make the difference between successfully increasing your milk supply or not.

There are people for whom no amount of pumping or working hard will make exclusive breastfeeding viable, and that can be emotionally extremely hard to deal with – breastfeeding grief is real and valid. It can help to know that even tiny amounts of breastmilk have been shown to alter the gut microbiome and confer immune benefits, so please know that it is never all or nothing. I feel immensely grateful to live in an era where there is a safe alternative milk available so that families have a safety net when things don’t go as they planned. Combination feeding has worked well for many families. As an IBCLC, most of the families I see are having feeding problems, and a good chunk of those are using formula, either temporarily until they can get breastfeeding going, or permanently out of choice or by necessity, so please don’t feel that breastfeeding supporters aren’t there for you too.

As a final thought, I’ve never met a mother or parent who wasn’t doing everything they could to make the right choices for their family. Feeding your baby (like everything else) is a parenting choice – we balance our ideal with what is achievable for us in the moment. Whatever you’re doing, it’s enough, and you’re doing it right.