This thread is for those who think they have a low milk supply, how to identify if you DO, and would like help regaining a normal supply, as well as those who are attempting relactation! Questions, of course are more than welcome, but let's stay drama-free, friendly, and supportive of one another.
I have bolded and italicized things I think are important. If you're interested in relactation, this information can also be very useful, but that is specifically covered at the bottom of the thread
Increasing Low Milk Supply
By Kelly Bonyata, BS, IBCLC
Is your milk supply really low?
Who to contact if you suspect low milk supply
Potential causes of low milk supply
Increasing your milk supply
Is your milk supply really low?
First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well
on breastmilk alone, then you do not
have a problem with milk supply.
It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby.
What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers
then the following things do NOT
mean that you have a low milk supply:
Your baby nurses frequently
. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.
Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt
. The baby nurses
more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.
-Your baby nurses more often and is fussy in the evening
-Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.
--Your baby is fussy
. Many babies have a fussy time of day
- often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.
--Your baby guzzles down a bottle of formula or expressed milk after nursing.
Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply
. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).
--Your breasts don't leak milk, or only leak a little, or stop leaking. Leakinghas nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.
--Your breasts suddenly seem softer
. Again, this normally happens after your milk supply has adjusted to your baby's needs.
--You never feel a let-down
sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.
--You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill
(different than nursing), and can be very dependent on the type of pump
. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time
See also Is my baby getting enough milk?
Who to contact if you suspect low milk supply
If you're concerned about your milk supply, it will be very helpful to get in touch with a La Leche League Leader
or a board certified lactation consultant
. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it's possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk, not formula.
Potential causes of low milk supply
These things can cause or contribute to a low milk supply:
. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.
. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.
. Pacifiers can cause nipple confusion. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.
can lead to nipple confusion. They can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.
interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.
. For the first few weeks, some babies are very sleepy and only demand to nurse infrequently and for short periods. Until baby wakes up and begins to demand regular nursing, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.
Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself
can interfere with the supply-demand cycle. Also, your milk increases in fat content
later into a feeding, which helps baby gain weight and last longer between feedings.
--Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.
--Health or anatomical problems with baby can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.
See Reasons for Low Milk Supply
and Hidden Hindrances to a Healthy Milk Supply
from more information on things that can decrease milk supply.
Increasing your milk supply
Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made
- understanding this will help you to do the right things to increase production.
To speed milk production and increase overall milk supply, the key is to remove more
milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.
OK, now on to things that can help increase your milk supply:
-Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed
--Nurse frequently, and for as long as your baby is actively nursing.
Remember - you want to remove more
milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.
--Take a nursing vacation
. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!)
--Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
--Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to increase intake of breastmilk by the baby. This can be particularly helpful for sleepy or distractible babies.
--Avoid pacifiers and bottles. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).
--Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.
--Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst
(don't force liquids - drinking extra water does not
increase supply), and eat a reasonably well-balanced diet
--Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying.
When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after
the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
--Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one?
for more information
Additional information on increasing your supply:
--How does milk production work?
--My breasts feel empty! Has my milk supply decreased?
--How might I increase baby's weight gain?
--Protocol for "Not Enough Milk" by Jack Newman, MD
--Weaning from formula supplements
--Herbal Remedies for Increasing Milk Supply
--Prescription drugs used for increasing milk supply
@ other websites
--How can I increase my milk supply? by Becky Flora, IBCLC
--Hidden Hindrances to a Healthy Milk Supply by Becky Flora, IBCLC
--Increasing Your Milk Supply by Anne Smith, IBCLC
--Increasing Milk Supply by Janet Talmadge, IBCLC. This also has some great suggestions for mothers who work and pump.
--[PDF] Increasing the Milk Supply by Dr. Carolyn Lawlor-Smith (BMBS, IBCLC, FRACGP) and Dr. Laureen Lawlor-Smith (BMBS, IBCLC)
--Thoughts on the appropriate use of supplements by Kathy Kuhn, RN, BSN, IBCLC
--The First Six Weeks: Milk Supply by Paula Yount
Relactation and Adoptive Breastfeeding: The Basics
By Kelly Bonyata, BS, IBCLC
Relactation or induced lactation (for those who did not give birth to their baby) is essentially a two-fold process:
- You will be teaching (or re-teaching) baby to nurse at the breast, and to equate nursing with comfort. If you're having problems getting baby to nurse, see Help -- My Baby Won't Nurse!
- At the same time you will be developing (or re-developing) a milk supply. Developing a milk supply requires nipple stimulation (via baby nursing, hand expression, pumping or a combination) and milk removal (once there is milk to remove). If your baby will nurse, regular and frequent nursing sessions (even if baby is just learning in the beginning) will be very helpful.
If your baby is 4 months old or younger it will generally be easier to relactate. It will also be easier if your milk supply was well established (frequent and effective nursing and/or pumping) during the first 4-6 weeks postpartum. However, moms with older babies, moms who did not establish a good milk supply in the beginning, and adoptive moms who have never breastfed can also get good results. Keep in mind that breastfeeding is not just about the milk
. Your child will get numerous benefits from breastfeeding even if you do not have a full milk supply
If baby is willing to latch on, then nurse often (at least every 2-3 hours). Also, offer baby the breast for comfort any time you see a chance- at the end of a feeding when he is not hungry, when he is going to sleep and just waking up, and whenever he needs to comfort suck. Even if baby is not getting any milk at first, the nursing will be signaling your breasts to make milk.
What if baby will not latch? Keep working at it - some babies have gone back to the breast after many months of bottle feeding. Even if you are not able to persuade baby to latch, you have the option of re-establishing your milk supply via pumping and giving baby your milk via bottle or cup (this is called exclusive pumping
If baby is not nursing well (or not yet latching at all), pumping will make a big difference in increasing your milk supply. Even if baby appears to be nursing well, additional pumping will speed up the relactation process. See Establishing and maintaining milk supply when baby is not nursing
for more information.
You will also want to take a look at Hidden Hindrances to a Healthy Milk Supply
to see if there are any factors that may compromise your milk supply.
Consider giving your baby his feedings via an alternative feeding method
(rather than a bottle), such as a nursing supplementer, feeding syringe, finger feeding setup, flexible cup, spoon, medicine/eye dropper, etc. If your baby is latching well, a nursing supplementer can be a big help: it will encourage your baby to nurse at your breast by giving him a constant flow of milk (expressed milk and/or formula) while he stimulates your breasts to produce more milk. Read more about nursing supplementers in Notes from "Induced Lactation and Adoptive Nursing"
Some mothers use herbal supplements, such as fenugreek or blessed thistle, to stimulate milk production. You can usually buy these at health food stores or herb shops and occasionally at some large supermarkets or pharmacies. For more information see What is a galactagogue? Do I need one? ...Herbal remedies for increasing milk supply
. There are also several prescription medications
that increase milk supply. These herbal and pharmaceutical methods for stimulating milk supply will not be particularly effective unless combined with frequent nursing and/or pumping.
Finally, get in touch with a La Leche League Leader
or Lactation Consultant/IBCLC
(in person if at all possible) who has experience with relactation. It's great to have one-on-one support as you work through this.
For addional information, see:
--Adoptive Breastfeeding & Relactation
--Relactation and Induced Lactation Resources
Relaction from http://www.fourfriends.com/abrw/Boot%20Camp/bcr.htm
Boot Camp Regimen:
Announce your plan for success and try to get everyone on board. Keep doubters at a distance. Tell your baby too!
Day 1, 6:00 am
Feed baby as usual. They use all senses when feeding and may associate the sight of bottle, smell and taste of formula with food. You need to reprogram them to associate feeding with your breast (and your scent) so offer to comfort nurse at the end of their usual feed. Rest until 7:00 am.
7:00am - 9:00 am
Set up pumping area and get a glass of water. Wash hands. Massage breasts to help foster the let-down reflex. Drink 4 oz of water. Pump 5 minutes on each breast. Drink 4 oz water and repeat pumping. Breakfast to include a generous serving of oatmeal fixed anyway you like; juice and a warm drink (decaf tea, coffee, lemon and water). Take prenatal vitamins. Clean up kitchen. Rest until 9:00 am.
9:00am - 11:00 am
Repeat pumping and water as before. Bathe self and baby - together if possible. Feed baby using supplementer if needed or bottle, then comfort nurse. Stand up and walk while offering your breast. If baby refuses, gently ease into rocking chair and rock to sleep (or sing and talk).
Gently, stroke your baby's head. Put wash in machine. Have a snack of muffin or toast, fruit and milk or other healthy drink.
11:00am - 1:00pm
Repeat pumping and drinking water. Go outside and take a walk or go to a store. If not, open a window and get some fresh air. Breathe deep, do gentle exercise (like bending and stretching). Feed baby and offer nursing as before. Eat lunch (fruit and cottage salad, tuna sandwich or peanut butter and jelly, apple, 2 cookies tea, milk or other drink)
1:00pm - 3:00pm
Pump and drink water as before. Nap with baby with skin to skin contact. Offer breast in sleep if willing. Massage baby or stroke arms, head and legs.
3:00pm - 5:00pm
Pump and drink water. Feed baby and have a tea or lemonade break (carrot cake or peanut butter cookies). Put some clothes in dryer and do one other chore or phone call. Try to get outside for 1/2 hour. If you have questions - use the computer to briefly check in.
5:00pm - 7:00pm
Pump and drink water. Fix dinner of choice;
1) meat loaf, baked potato, gingerbread and salad
2) pasta and meat sauce with garlic bread, salad
3) macaroni salad with tuna, eggs, celery, sliced olives and carrots on lettuce
Add a drink (and vitamins if you forgot them in the morning).
Feed baby and offer nursing.
7:00pm - 9:00pm
Pump and drink water. Feed baby and have Dad take over for bonding time while you relax with a glass of wine/ imported beer or sparkling cider and dessert. You may use nonalcoholic beer or wine if you like. Use a fancy glass as you relax and unwind. Visit with Dad and or friends. Computer time ok.
9:00pm - 11:00pm
Pump and drink water. Feed baby, nurse. Get ready for bed (people expect less of you when youre in a nightgown! This is why you do not dress until after 9:00am). Rest with baby. Drink milk, juice, decaf tea or ?
Pump and drink water. Sleep until baby wakes or 4 hours ( set clock).
Feed baby and offer to nurse. Use pump and drink water.
Repeat yesterday.............. Set timer or alarm to remind yourself of pumping. Let all else go for 10 days. If you get distracted, maintain pumping routine within each 2 hour segment. Do this even if they are close to equaling 10 times a day. If you have other children, try to find a place for them to visit for days 1 and 3. Ask them to be your helpers and do one job daily for each year old they are.
1) help fix meals
2) bring you drinks
3) pick outfits to wear (for you, baby and themselves)
4) help with bath
5) plan trips
6) draw pictures
7) cut up scrap paper to make confetti for the party you'll have when milk returns
read you stories as you pump
9) sing to you etc.
Reward with having helpers or Dad take them out for a run, trip to store or a treat. Ask for help, relax and have confidence in yourself.
1) the song Moon River and imagine milk flowing "wider than a mile"
2) sing the Beatles song "Hey Jude" ( make it better, better, better)
3) the Little Train That Could- I think I can, I think I can.....
You'll find lots of encouragement and support in the bootcamp support area on our message boards
Check in on day 3 (minimum). Use half of your morning chore time or
half of your evening "Daddy bonding" time to check in. Note: Babys siblings should be in charge of baby's happiness as part of their everyday routine. It is amazing to see what that means to them. From keeping a pacifier plugged in or a chewy toy in reach to advice on going to school (girls are there to help with zippers and shoe tying said one brother to another).
Questions to Ponder
1) Any signs of milk production?
2) How is baby responding to your offers to nurse?
3) How are you feeling?
4) Do you have any requests, questions or insights to share?
Check in again on days 5,7 and 10.
I know this is a lot of information to take in at once, that's why there are a few INVALUABLE ladies here to help answer any question have about the above issues, 2 who've EPed, one who successfuly relactated, and myself who has a little training in being an LC.