Breast is best. We all know that.
If we all agree that breastfeeding is so great, then why are only 44% of American women still breastfeeding at 6 months? The most common reason women give for stopping breastfeeding is “low milk supply.” These women do not feel like they are making enough milk for their babies. I was not at all surprised at this statistic. One of the most common breastfeeding questions I get from my patients at their postpartum visit is “How can I increase my milk supply?”
What I found as I researched this topic is that the keys to good supply are also the keys to successful nursing in general.
Establishing a good milk supply is kick started by frequent feedings during the first few weeks of life. A newborn should nurse 8-12 times a day for the first week. By the time he reaches one month old he should be down to 7-9 feedings a day. That first week is extremely challenging, but commitment to regular feedings early on is truly helpful for establishing a plentiful supply.
A poor latch can lead to nipple injury, pain, swelling and poor supply. Most nipples are sensitive to breastfeeding initially. Normal breast pain usually lasts for 1-2 minutes as the baby latches then slowly resolves. This pain is usually only noted for the first week postpartum. Nipple pain that is outside this range should prompt a visit with a lactation consultant to help prevent nipple injury. Proper latch techniques are illustrated here.
Know Risk Factors for Late Let-Down
Most women’s milk will come in by day 2 or 3 postpartum, however certain medical conditions can effect the hormonal shifts that cause milk let down. This can lead to delayed milk production for a few days. In these instances you should continue to nurse, but supplementing may be necessary while you wait for your milk to fully come in.
Common conditions that can delay your milk coming in include:
Complete Emptying of Breasts
Some babies like to feed frequently enough, they just want to fall asleep in the middle of the feeding, not fully emptying the breast. Encourage your baby to finish each feeding. Common strategies for keeping a baby awake for a full feeding include taking off his clothes or gently rubbing his cheek with a wet cloth. If these strategies don’t work, pump the rest of your milk to fully empty your breast. If you continually have incomplete feedings, your breasts ‘will learn’ to not produce as much milk.
Breast pumps are now required to be covered by your health insurance under the Affordable Care Act. Contact your insurance company to find out how to obtain one.
Breastfeeding can literally suck every bit of moisture out of your system. Drinking lots of water is crucial. Instead of aiming for a specific amount of water to drink (because you really don’t need another thing to keep up with in your exhausted postpartum state), drink enough so that your urine stays pale yellow.
A lot of postpartum moms are very concerned with weight loss. While some calorie restriction can be tolerated, an extremely low calorie diet can lead to decreased milk supply. Your body needs 500 calories a day just for breastfeeding. Dropping calorie intake below 1500 will often interfere with supply.
There is ongoing controversy as to the safety and effectiveness of medications and herbal supplements given to improve milk supply. A trial of supplements should only be used after all other options have been pursued. These are the common supplements given and what we know about them:
Reglan (metoclopramide) is a drug originally prescribed for nausea that has been shown to increase milk supply by up to 15% in some studies, however other studies have shown no effect. Reglan does pass into the milk but the long term effects of the drug on the baby have not been studied. Maternal side effects can include headaches, mood swings and diarrhea.
Motilium (domperidone) is a drug originally used for nausea that has been shown to increase milk supply in some studies but not others. The FDA issued a warning against the use of the drug in 2004, after the IV form was found to be associated with heart attacks. The oral form was also found to cause EKG changes in the baby.
Fenugreek is an herbal supplement that is very widely used despite the lack of any studies to measure its safety or effectiveness. In the US, there is no quality control or regulation of herbal supplements. There is no way to be certain of the exact dose of the supplement you are receiving. Many patients and lactation consultants swear by the effectiveness of this herb, often taken in the form of tea.
Additionally, there are medications that have been associated with decreased milk supply:
- birth control pills containing estrogen
- antihistamines (bendryl, claritin, ect.)
My heart for writing this post is not only to guide women to breastfeeding success, but also to alleviate the fears of those whose breast milk did not flow as freely as they had hoped. I’ve talked to a lot of women who are desperately searching for a magic potion to improve their supply and help them succeed in breastfeeding. Most of them will eventually try all these strategies and many more. If you have tried these strategies and you are still not able to nurse, then you can rest assured that you have genuinely done all that you can do.
Have you struggled with inadequate milk supply? If so, what did you find helpful?