How to increase your milk supply

When I am training nurses in breastfeeding management, I usually ask them this question: “Insufficient breast milk production is a common problem – true or false?”. And the answers are all over the board! The funny thing is, the correct answer is: both true and false! True, because it’s one of the things breastfeeding women most often complain about; but at the same time false, because most of the time the problem that is being blamed on insufficient milk supply has nothing to do with milk supply at all. And then again true, because many women get terrible advice from uninformed healthcare providers, which causes their supply to decrease.

The truth of the matter is, almost every breastfeeding mother worries about her milk supply at some point. “How can I increase my milk supply?” remains one of the most frequently asked questions among breastfeeding mothers. In this post, I will explore some effective ways to increase your milk supply, and also expose a few urban legends.

Before you read any further!

Before we start talking about ways to increase your breast milk supply, you should just do a double check to make sure you really do have a supply problem. Rather than me writing pages and pages of information here, I’ll just link you to a few posts that I wrote in the past:

• This one on how milk production works. If you understand how your body regulates milk production, everything else I say in this post will make a lot more sense.
• These posts on how to know whether you have enough milk:
  • Four signs that you have enough milk
  • Milk supply false alarms – this is an important read!
  • How to interpret your baby’s weight gain and growth charts
• And if your problem is that you’re not able to pump enough milk, look at this post on increasing pumping output.

So, if we’re clear on all that, we can now start talking about ways to increase your milk supply.

Get to the root of the problem

As always, before we can find a solution, we have to find out what is actually causing the problem. If you have low milk supply, it can be caused by one of two factors:

• A problem with the production “machinery” – either your breasts or your hormones are limiting your milk production. PCOS and low thyroid hormones are common culprits here – please get them tested and treated by your doctor!
• Insufficient stimulation of the breasts. This means that you have all the necessary “machinery”, but either baby’s suck or your pumping is ineffective.

In either case, I strongly recommend you work with a lactation consultant so that you can identify and address the problem.

Strategies to increase milk supply

The common methods to improve milk supply basically fall into two categories:

1. Methods that increase breast stimulation, usually by improving milk removal from the breast. Because of how the physiology works, more milk removal = more stimulation = more milk production.
2. These are substances – medicines, herbs, foods, drinks and so on that are believed to increase milk production.

We’ll look at each of these in turn.

Increasing breast stimulation

I’m starting here, because this will be the make-or-break factor. If your breasts aren’t being stimulated by regularly having milk removed from them, nothing else you do will help. Nothing. So it’s absolutely critical that you have to get this right. We’re often so keen to just pop a pill to make more milk, but please trust me when I say that you can’t skip this stuff. In fact, most of the time, just implementing these things will give your supply the necessary boost without needing any pills.

Make sure baby is latching and suckling effectively

This is the number one most important thing you can do! If you’re not sure what a good latch looks like, or how to achieve one, check out this post. You will know that your baby is suckling effectively if you can see or hear him swallowing regularly – one swallow every 1-3 sucks is a good ratio (one swallow every 10 sucks means he’s just swallowing his own saliva). If your baby is struggling to get a good latch, keeps falling off the breast or is simply not swallowing much, I strongly suggest that you see a lactation consultant to find and fix the problem.

Feed more often

One of the best ways to boost your milk supply is simply to fed more often. Take a “babymoon” if you can – just spend a day or two in bed with baby, breastfeeding as much as possible. Babies instinctively increase their feeds when they are going through a growth spurt and need more milk: those every-five-minutes feeds give your milk supply a huge boost!

If you’ve been feeding on a schedule, trying to “stretch” baby between feeds, stop immediately. You should never limit baby’s time on the breast; it’s a recipe for milk supply issues. Feed baby at the first sign of hunger. Those books that say a baby should go 3 or 4 hours between feeds are lying, plain and simple. You can read more here about why babies need to feed so often.

Breastfeed exclusively

This one goes hand-in-hand with breastfeeding more often. Assuming your baby is suckling effectively, the very best way to stimulate your breast is to allow baby to suckle as often as possible! That means no bottles and no dummies when you and baby are together. Yes, I’m seriously suggesting that you let baby use you as a dummy – it will give your milk supply a good boost.

Feed at night

For some reason unknown to science, our bodies secrete more of the milk-making hormone (prolactin, specifically) when baby feeds at night. So throw out the sleep training books and work in an extra night feed if you can. “Dream feeding” is an excellent way to do this – it simply means feeding while baby is still half asleep. Of course, if you have one of those babies that feeds ten times in the night, you can skip this suggestion!

Skin-to-skin

Keeping your baby skin-to-skin can give your milk supply a great boost. In my experience, this works especially well with newborn babies and premature babies. The skin-to-skin contact stimulates your body to secrete more milk-production hormones. It also allows baby to suckle more often, which increases breast stimulation. Try putting baby skin-to-skin for naps, or carrying baby skin-to-skin in a special KMC wrap.

Express in addition to breastfeeds

If you are feeding as much as possible and still need a boost, expressing your milk may be just the thing you need. You can hand express or use a breast pump, whichever is easiest for you. For maximum breast stimulation, express after baby finishes breastfeeding. You may not get much milk out, but by demanding milk from an already emptied breast you are sending a very strong message to your body that you need more milk.

If your baby is not suckling well at the breast for any reason, pumping is non-negotiable. You will need to thoroughly pump your breast at least 8 times per 24 hours to maintain a good milk supply. You can also have a look at this post for more tips on maximising the impact of your pumping sessions.

Keep your breasts empty

It may sound counterintuitive, but you don’t want your breasts to get too full. A full breast sends the message to your body that “whoa, there’s too much milk, slow down!”. So aim to keep your breasts soft. This is wehre extra feeds and pumping come in. If you can feel fullness in your breast, then congratulations – you have enough milk, and you can stop worrying about increasing it even more.

Galactogogues

Like I said above, galactogogues are substances that increase milk production. If you go to your doctor with any complaint relating to your breast-fed baby – regardless of whether you have an actual milk supply issue – you are likely to leave with a script for a galactogogue. I must confess, that makes me see red! Galactogogues are at most an adjunct to your breastfeeding plan. I will say this again and again and again: if you haven’t addressed issues of milk removal, breast stimulation and hormonal imbalances, all the galactagogues in the world won’t make a difference! So please make sure that you implement the strategies I discussed above.

How galactogogues work

The ironic thing about galactogogues is that most of them are totally ineffective. Even the ones that do work, only work in certain situations – good breastfeeding management is a much more sure-fire way to increase milk supply. True galactogogues – the ones that really do increase milk supply – work by increasing the amount of prolactin secreted by your brain. Prolactin is the hormone that tells your breasts to make more milk. And guess what else will increase your prolactin levels? Regularly removing milk from the breasts! So galactogogues are only really necessary if, for some reason, your body is not producing enough prolactin on its own.

Here’s a quick run-down of the most common galactagogues you’ll find in South Africa:

Sulpiride (Espiride or Eglonyl)

Sulpiride is the most common galactogogue used in the private sector in South Africa – which is interesting, since it isn’t favoured as a galactogogue anywhere else in the world. Sulpiride is actually a potent antidepressant and antipsychotic drug that is usually used for the treatment of schizophrenia. One of its side effects is that it increases prolactin levels, which is why it is used as a galactogogue. It’s a schedule 5 medicine, so you can only get it on prescription.

There’s no doubt that sulpiride is effective in increasing milk production in some women, but it is doubtful if it is the wisest way to increase your milk supply. The biggest problem is the side-effect profile: by far the most common complaint is weight gain, but it can also cause sleep disturbances, lack of sex drive and emotional upsets. Fortunately, the medicine is not secreted into the breast milk in large quantities, so side-effects in infants are nearly non-existent.

Metoclopramide (Maxalon or Clopamon) and Domperidone (Motilium)

Metoclopramide is the most commonly used galactogogue in public hospitals in South Africa, although Domperidone is the preferred choice amongst most lactation consultants. Both these drugs work on the same hormone system, and they have the same basic function: they are used primarily to treat vomiting, because they speed up the movement of food through the digestive tract. Once again, increased prolactin levels are just a side-effect.

These medications are also effective in increasing milk supply, but once again the side-effect profile may be a problem. Metoclopramide, especially, can be a problem if used for a long term, since it can cause severe depression over time. Domperidone fortunately does not have that side effect, but it can cause problems in persons who are prone to heart arrhythmias. Both these drugs can cause diarrhoea and other stomach upsets. Neither of these are known to produce side-effects in the breastfed babies of mothers who receive them.

Fenugreek

Fenugreek is an herbal preparation that is sold in tablet form. There is limited research about its effectiveness, but many women have found that it significantly increases their breast milk production. The dose that you need to take is quite high – 3 tablets 3 times a day – so side effects are not uncommon. It can cause diarrhoea and stomach upset in mom and, more rarely, in baby too. Fenugreek will also make your urine and sweat smell like maple syrup – that’s how you know you’re taking a high enough dose. IMPORTANT: if you are allergic to peanuts or chickpeas, don’t use fenugreek, since there can be cross-reactivity.

Jungle juice

Ah, jungle juice. If you’re not familiar with this concoction, it’s a mixture of fruit juice, water, blackthorn berry elixir and a few other optional ingredients that is widely touted as a way to increase milk supply. How exactly jungle juice got a reputation as a galactogogue is a bit of a mystery, since none of its ingredients has the slightest effect on milk production. Most people assume that it’s the blackthorn berry elixir that does the trick, but that is just an energy tonic, nothing more. So it seems that jungle juice is just a yummy but expensive way of staying hydrated. In fact, you would be better off drinking plain water: jungle juice is very high in sugar, which can predispose you to thrush and also cause weight gain. Just avoid this one.

Milk stout

Milk stout is another one of those mysterious folk remedies. I guess the work “milk” in its name caused people to think that it will increase milk production. Why else would anyone think it’s a good idea to give beer to a breastfeeding mother? It’s a bad idea for one simple reason: alcohol inhibits the let-down reflex, which means baby cannot get as much milk out of the breast (so if your breasts feel fuller after drinking a milk stout, that’s why! And that’s a bad thing – full breasts signal your body to decrease milk production.)

Interestingly, there is a little bit of research that shows that something in beer may increase prolactin levels – and the interesting thing is that whatever it is, it’s present in non-alcoholic beer too. So if you want to drink a beer to boost your milk supply, that’s the better alternative.

Oats, rooibos, Stoney ginger beer, lactation cookies, coconut oil and other foods

I’m not even going to expend a lot of words saying this: there’s no magic food that increases milk production. If you believe that eating or drinking a specific thing is helping your milk supply, then by all means go ahead, but it’s probably all in your head.

If something works because of the placebo effect (in other words, it helps you because you think it’s going to help you, not because it actually has any physiologic effect), that’s not necessarily a bad thing. I’m just worried about the “you must eat these things when you are breastfeeding” mentality that’s going around. Some time ago I saw a mother post on Facebook about how she was terribly worried that she won’t be able to produce milk, because she can’t stand oats or rooibos tea. Luckily, I could reassure her that she doesn’t need to eat either of those things. Please people, let’s stop spreading the story that you need to eat special foods for milk production, and instead focus on good breastfeeding management and letting nature do its thing!

Summary

So, in short, what can you do if you need to boost your milk production?

• If you have an underlying hormonal imbalances, such as PCOS or an underactive thyroid, get it treated by your doctor.
• Make sure your baby is latching well and suckling effectively – you should hear or see lots of swallowing. If not, see a lactation consultant to sort it out.
• Feed more often. Feed baby at the first sign of interest, and even offer when baby doesn’t express interest.
• Add a night feed.
• Pump after breastfeeding, and keep pumping for a few minutes after the milk stops flowing.
• If you use a galactogogue, do so under the guidance of a lactation consultant and your doctor. But remember, you must still ensure proper milk removal and breast stimulation.
• There is no magic food to increase milk production, so eat what you like.

What are your top tips for ensuring that you have a good milk supply? Please share in the comments!