Boosting your low supply

Babies need enough breastmilk so that their brain and bodies can develop, and they can grow. This is a huge responsibility for mums! So many mums worry they have a low supply of breastmilk, especially in the early weeks. These worries are often brought on by their baby’s unsettled behaviour or their baby wanting to breastfeed really frequently. The truth is, if mum has low supply and baby isn’t getting enough breastmilk, bub may behave in these ways, but they are not reliable indicators. The true reliable indicators that show if a baby is getting enough breastmilk are:

• Your baby is having at least 5 heavily wet nappies each day
• Your baby is doing 3 runny/soft poos each day (babies older than 6 weeks may do less, but they should still be runny/soft)
• Your baby is gaining weight
• Your baby is growing in length and head circumference
• Your baby is generally content (remember, all babies have fussy periods at some point throughout the day)

If you are noticing things that make you worry about your supply, bring your focus back to the reliable signs! Use this as your reassurance when you are doubting yourself.

 

If your baby is NOT showing the above signs, then you may have a low breastmilk supply. Finding out you have low supply can be devastating to hear and bring on all the mum guilt, but there are things you can do to boost it. It is so important get help and support from an International Board Certified Lactation Consultant (IBCLC) ASAP to help you work out the cause and get back on track. Book a home visit or online consultation with me HERE. 

 

Disclaimer: This information is general in nature and doesn’t take into consideration yours or your baby’s individual situations. You will likely find it helpful to work with an International Board Certified Lactation Consultant (IBCLC) to help you work out a plan that works for you and your baby’s individual situation.

 

The most important thing to remember about your breastmilk supply is that it works on a supply = demand basis. The more milk taken from your breasts, the more your breasts will make.

 

There are 3 steps to the process you need to work through when trying to boost your supply:

1. Feed the baby
2. Protect/build your supply
3. Find the underlying cause

Feed the baby

Most babies will need to feed AT LEAST 8 times per day (the average is 10-12 times) to get the calories and nutrients they need for growth and brain development. Priority number one is to make sure your baby is getting what they need.

Check the latch

A baby who isn’t latched well often struggles to get milk from the breast or can’t get any at all, so it’s really important to make sure your baby is latching well so they can breastfeed well (which will remove more milk from your breasts and increase your supply). Watching for how much nutritive sucking your baby is doing will tell you if they are breastfeeding well. You can find out about nutritive sucking and how to tell if your baby is breastfeeding well HERE.

Breastfeed more often

If your baby is feeding less than 8 times per day, increasing to at least 8 breastfeeds will increase the amount of milk they’re getting (and help to boost your supply – remember supply = demand). Even if your baby is already feeding 8 times, you can try offering breastfeeds closer together temporarily until your supply has increased.

Offer both breasts at every feed

Offering both breasts at each feed will mean your baby gets more milk, which will tell your breasts to make more milk. As your supply increases, you may find that your baby doesn’t feed for as long on the second side, and that’s ok. You can start on the least drained side for the next feed to even things out.

Breast compressions

Breast compressions can help increase the amount of milk your baby is able to transfer from your breasts to their mouth. This helps them gain more weight and increases your supply (more milk removed = more milk made). To do breast compressions, squeeze and hold the breast gently, up far away from the nipple while your baby is latched. You are looking for your baby to do some more swallows. If they do swallow, keep gently squeezing the breast until they stop. Then let go of your breast and repeat. Continue this until your baby doesn’t respond with any more swallows. If your baby doesn’t do any more swallows when you do a breast compression, you can switch breasts.

Switch feeding

Along the same lines, switch feeding helps to trigger a new let down and release more milk to your baby. Switch feeding is changing sides 3-4 times during a breastfeed. You will find it helpful to watch your baby’s suck pattern when you do this. After they have finished nutritive sucking (more on nutritive sucking HERE), change sides and keep doing this until bub has had both sides twice. This also helps stimulate supply because more milk is removed.

Top ups

If the above techniques do not help your baby to do more nutritive sucking, your baby may need to have some extra milk so that they get what they need while working on your supply and getting to the underlying cause of your low weight supply. If you’ve gotten to this point, please seek help and guidance from an IBCLC as giving top ups can actually reduce your supply when used incorrectly or used too much. There are a few options for giving your baby extra milk (listed in order of benefit to your baby, as per the World Health Organization):

• Express your breastmilk (by hand expressing or breast pump) and feed this to your baby with a spoon or a syringe (if the top up amounts are small), a cup, breastfeeding supplementer or a bottle. If you choose to use a bottle, use paced bottle feeding to avoid overfeeding and interfering with your supply. More info on this HERE. 
• Source donor breastmilk and feed to your baby using the methods above (find out more about donor milk in the Australian Breastfeeding Association’s Donor Milk Position Statement.
• Use infant formula via methods above.

Your lactation consultant will be able to advise you on how much top up milk to give and how often. If you use donor breastmilk or formula, expressing after or in between breastfeeds will help to stimulate your supply while you do this.

Protect/build your supply

As mentioned above, your breastmilk supply works on a supply = demand basis. The more milk taken from your breasts, the more your breasts will make.

Many of the techniques discussed in the “feeding your baby section” work to increase your supply:

• Check the latch – effective latch = more milk removed from your breasts = more milk made
• Breastfeed more often – more milk removed = more milk will be made
• Offer both breasts at every feed – more milk removed = more milk will be made
• Breast compressions – more milk removed = more milk will be made
• Switch feeding – more milk removed = more milk will be made
• Expressing your milk – more milk removed = more milk will be made

 As well as the above techniques, you can also try:

Expressing your breastmilk

Expressing your breastmilk (by hand or breast pump) after or in between breastfeeds gives your breasts the message to make more milk. When expressing your breastmilk, it’s important to remember that the amount of milk that comes out does not necessarily show you how much you’ve got in your breasts. Some mums respond well to pumps and can easily get milk out, but some mums find it hard to get anything out, even though there is definitely milk in there. This is often because your baby triggers the letdown (reflex that releases your milk from the storage area of your breast to the nipple) much more easily than a breast pump.

To make expressing as effective as possible, make sure the breast shield/flange of your pump is the right size for you. You can find a great measuring tool HERE. Many mums find using a hands-on expressing technique increases the amount of milk they’re able to express. There’s a great video HERE.

Breastfeeding supplementer

If top ups are required, using a breastfeeding supplementer (also called supply line/supplemental nursing system) to give your baby the top ups can help to boost your supply by encouraging your baby to stay at the breast longer, further stimulating your breasts at the same time they are getting any extra milk they need.

Medication

If the above techniques have not worked well, you can discuss the use of medication that can help boost your supply with your GP/midwife. In Australia, the most common medication used for this is motilium/domperidone. Medications won’t help unless milk is being removed from your breasts, so you will need to continue working on the other methods of building supply alongside the medication to see the best effect.

Some herbs are thought to increase low milk supply such as fenugreek, goat’s rue, milk thistle (Silybum marianum), blessed thistle, fennel seeds and moringa leaf. There is no research that proves the effectiveness or safety of herbs for increasing low supply of breastmilk. Herbal supplements are not regulated by the Therapeutic Goods Administration (TGA) like other medications as they are considered a food, so there are no standard dosages.

It’s important to discuss the use of any medications, herbs, or supplements you wish to take with your health professional to make sure they’re safe for you.

 

A word on lactation cookies:

Many mums eat lactation cookies advertised to increase supply, but there is no research evidence to say that these actually work. We do know that the more milk you remove, the more you will make, so this is the most important thing to focus on.

 

Find the underlying cause

There are many potential causes of low supply of breastmilk. It’s important to figure out the cause as if this is not addressed, all the hard work of the techniques above may not make a difference.

Ineffective latch

A baby with an ineffective latch is the most common cause of low supply of breastmilk. Sometimes small changes to the way you hold your baby can make a big difference to how well they are able to suck and swallow. If they’re not able to suck well, they won’t be able to remove much milk and your breasts won’t get the message to make more milk. You might like to work with a lactation consultant on this to figure out the position that best suits you and your baby. You can book a home visit or online consultation with me here.

Hormonal conditions or imbalances can also interfere with your milk supply:

• Contraception – the contraceptive pill is not safe to take while breastfeeding as the hormones interfere with breastmilk production. The mini pill and progestin only methods (such as Implanon implant) are considered safe, but research is starting to suggest that even these can interfere with supply for some women who are particularly sensitive to these products.
• Hypothyroidism – Thyroid hormones play a role in normal breast development the process of making breastmilk. If thyroid hormones are too low, breastmilk supply can be affected. Many mums with hypothyroidism that is well controlled by medication can produce enough milk for their babies.
• Retained placenta – Your milk “coming in” (ramping up) is triggered by the separation of the placenta from your uterus after your baby is born. If fragments of the placenta remain in your uterus, this can stop your milk coming in properly. It is possible that ingestion of placenta capsules can contribute to low supply for the same reason.
• Pregnancy – pregnancy hormones can reduce your supply.
• Polycystic ovarian syndrome – the hormone imbalances that affect fertility can also interfere with breastmilk production.

Excessive blood loss/haemorrhage

Excessive blood loss during or after birth can cause damage to the anterior pituitary gland that releases the milk making hormone (called Sheehan’s syndrome). Blood loss (without pituitary damage) or anaemia can delay the milk coming in and cause make establishing breastfeeding difficult.

Breast surgery

Breast augmentation usually does not affect the ability to make a full supply of breastmilk. Mastopexy (breast lift) and other breast surgeries where a cut is made around the areola (the coloured skin around your nipple) potentially cuts the nerve that allows your milk to be released from the storage areas of the breast to the nipple/your baby’s mouth and therefore have a significant impact on breastmilk production. Reduction mammoplasty (breast reduction) often cuts the nerve allowing let downs too, and also removes a lot of the milk making glandular tissue and ducts of the breast. This can also have a significant impact on breastmilk production. The amount of milk that can be made after these surgeries is very individual from mum to mum. Some mums can make a full supply, and others need to supplement with donor milk or infant formula. Working with a lactation consultant can help you to optimise your breastmilk production so your baby can get as much breastmilk from you as possible.

Inadequate Glandular Tissue (IGT)

Inadequate Glandular Tissue (IGT) (also known as breast hypoplasia) is a rare condition where there is not enough milk making tissue in the breast. Often, mums with IGT are unable to build a supply enough to meet their baby’s needs and need to supplement with donor milk or infant formula long term.

 

If you’re living this story right now, I see how hard and upsetting this is for you. You may feel overwhelmed, guilty and like you’re failing your baby (you’re not BTW!). It is super important to surround yourself with support. If you’re not working with an IBCLC yet, it might be helpful for you to find one. You can book a home visit or online consultation with me below.

 

** Please note that this information is general in nature and doesn’t take into consideration yours or your baby’s individual situations. You will likely find it helpful to work with an International Board Certified Lactation Consultant (IBCLC) to help you work out a plan that works for you and your baby’s individual situation. **