Nearly all nursing
mothers worry at one time or another about whether their babies are getting
enough milk. Since we can’t measure breastmilk intake the way we can formula
intake, it is easy to be insecure about the adequacy of our milk supplies.
The “perception” of insufficient breastmilk production is the most common reason
mothers give for weaning or early introduction of solids or supplements.
Although there is a very small percentage of women who can’t produce enough
milk no matter what they do, this is very rare.
The first thing
to determine is whether your supply is really low or not. Some mothers
have unrealistic expectations, and feel that if their baby isn’t on a three-
hour schedule, or sleeping through the night by six weeks, they must not have
enough milk. There is a tendency for a nursing mother to blame everything
on her breastmilk – for example, if your baby spits up or is gassy, it must
be something you ate…if he has a day when he feeds more often than usual, it
must be because you don’t have enough milk…Be careful not to get into the habit
of attributing everything your baby does to nursing. All babies, formula
or breastfed, have laid back, easy, and fussy days.
Often mothers worry about their
milk supply if:
The baby nurses often, or seems
hungry soon after being fed. Remember it is normal for babies to feed often.
They have a strong need to suck, and love to be held close. Breastmilk
digests faster than formula, so nursing babies tend to eat more often.
Nursing 10-12 times or more in 24 hours is not unusual. In fact, we
lacation consultants worry a lot more about the baby who is sleeping long
stretches than we do about the baby who wants to nurse “all the time”. Growth
spurts commonly occur at around 10 days to 2 weeks, at 3 weeks, at 6 weeks,
at 3 months, and again at 6 months. The baby will nurse more frequently
during a time of rapid growth and not seem satisfied. After nursing
frequently on demand for a few days, most babies will level off and go back
to their old schedule. Also, many babies will ‘cluster feed’ in the
evenings before going to sleep. This is a normal pattern for a breastfed
babies. Formula fed babies also have fussy periods in the evening, but
their mothers don’t have a built-in way to comfort them, so they cry more.
The baby spends less time at the
breast (maybe 5-10 minutes rather than 15-20), he takes one breast rather
than both at a feeding, or your breasts feel softer and don’t leak as much
as they did in the early weeks of nursing. These changes are normal and
just mean that your body is adjusting your supply to meet your baby’s needs.
You compare your baby’s nursing
patterns, weight gain, or sleep habits to other people’s babies, or even your
previous baby. Remember that each baby is an individual, and the same
rules don’t apply to everyone, just as the same rules don’t apply to formula-fed
and breastfed babies.
To determine if
you really do need to increase your supply, see the article on “How To Tell
If Your Baby Is Getting Enough Milk”. If your baby is losing weight or
not gaining rapidly enough, you need to determine why your milk supply is low,
and take steps to increase it.
The following factors can contribute
to an inadequate milk supply:
Not getting enough sucking stimulation.
A sleepy, ill or jaundiced baby may not nurse vigorously enough to empty your
breasts adequately. Even a baby who nurses often may not give you the stimulation
you need if he is sucking weakly or ineffectively.
Being separated from your baby
or scheduling feedings too rigidly can interfere with the supply and demand
system of milk production. Nursing often is the best way to increase
your supply.
Limiting the amount of time your
baby spends at the breast can cause your baby to get more of the lower calorie
foremilk and less of the higher fat content hindmilk. Usually babies
need to spend from 20-45 minutes nursing during the newborn period in order
to get enough milk. Offer both breasts at a feeding during the early
weeks in order to receive adequate stimulation. While some babies can
get plenty of milk from one breast, and after nursing only a few minutes,
usually this happens after the milk supply is well established, and not in
the early stages of breastfeeding.
If you are ill or under a lot
of stress, your milk supply may be low. Hormonal disorders such as thyroid
or pituitary imbalances or retained placental fragments can cause problems.
Many mothers find that their supply goes down when they have a cold, or when
they return to work.
Using formula supplements or pacifiers
regularly can decrease your supply. Babies who are full of formula will
nurse less often, and some babies are willing to meet their sucking needs
with a pacifier rather than spending time at the breast. If you need
to supplement with formula, try to pump after feedings to give your breasts
extra stimulation. If you use a pacifier, make sure that it isn’t used as
a supplement for nutritive sucking.
If your nipples are very sore,
pain may inhibit your letdown reflex, and you may also tend to delay feedings
because they are so unpleasant. See the article on “Sore Nipples” for
causes and treatment. Often careful attention to positioning will correct
the problem.
Previous breast surgery can cause
a low milk supply. Anytime you have breast surgery, there is a risk
of breastfeeding problems, especially if milk ducts have been damaged.
Generally, breast implants or breast biopsies cause fewer problems than breast
reduction surgery.
Taking combination birth control
pills (those containing both estrogen and progesterone) and getting pregnant
while nursing can alter your hormone levels and cause a decrease in your supply.
Smoking heavily, and taking certain medications can also adversely affect
your supply (see article on “Drugs and Breastfeeding”).
If your milk supply is low, here
are some suggestions on how to increase it:
Monitor your baby’s weight often,
especially in the early days and weeks. In general, the longer your supply
has been low, the longer it will take to build it back up. Get help early,
before weight gain becomes a big concern.
Take care of yourself. Try
to eat well and drink enough fluids. You don’t need to force fluids
– if you are drinking enough to keep your urine clear, and you aren’t constipated,
then you’re probably getting enough. Drink to thirst, usually 6-8 glasses
a day. Your diet doesn’t have to be perfect, but you do need to eat
enough to keep yourself from being tired all the time. It is easy to
get so overwhelmed with baby care that you forget to eat and drink enough.
Don’t try to diet while you are nursing, especially in the beginning while
you are establishing your supply. You need a minimum of 1800 calories
each day while you are lactating, and if you eat high quality foods and limit
fats and sweets, you will usually lose weight more easily than a mother who
is formula feeding, even without depriving yourself.
Nurse frequently for as long as
your baby will nurse. Try to get in a minimum of 8 feedings in 24 hours,
and more if possible.
Offer both breasts at each feeding.
Try “switch nursing”. Watch your baby as he nurses. He will nurse
vigorously for a few minutes, then start slowing down and swallowing less
often. He may continue this lazy sucking for a long time, then be too
tired to take the other breast when you try to switch sides. Try switching
him to the other breast as soon as his sucking slows down, even if it has
only been a couple of minutes. Do the same thing on the other breast
until you have offered each breast twice, then let him nurse as long as he
wants to. This switch nursing will ensure that he receives more of the
higher calorie hindmilk, while also ensuring that both breasts receive adequate
stimulation.
Try massaging the breast gently
as you nurse. This can help the rich, higher calorie hindmilk let down
more efficiently.
Make sure that you are using proper
breastfeeding techniques. Check your positioning to make sure that he
is latching on properly. If the areola is not far enough back in his
mouth, he may not be able to compress the milk sinuses effectively in order
to release the milk. (See article on “Sore Nipples” for tips on positioning).
Avoid bottles (if possible) and
pacifiers. You want your baby’s sucking needs to be met at the breast. If
your baby needs to be supplemented, try to use a cup, syringe, or tube feeding
system, especially in the very beginning (babies under 2 weeks old). This
is less of a concern with older babies who are well established with breastfeeding,
as they are much less likely to have trouble switching back and forth between
breast and bottle.
If you want to increase your supply
quickly, consider renting a hospital-grade breast pump for a few days, unless
you have a good quality double pump at home. The best way to increase
your supply is to double pump for 5-10 minutes after you nurse your baby,
or a least 8 times in 24 hours. Try to set the pump on maximum unless
your nipples are very sore. Most pumps work better on the higher suction
settings. Minimum is kind of like the baby sucking in his sleep toward
the end of the feeding, and maximum is more like the vigorous sucking he does
for the first few minutes of the feeding. If you live in the Winston-Salem
area, call me and I can provide you with a hospital grade pump for a few days
while you are building your supply. For all other areas, call Medela
at 1-800-TELL-YOU to find a rental outlet in your area.
There are certain food supplements
as well as prescription medications that may increase your milk supply. Before
using any of these, it is important to rule out other problems such as illness
in mother or baby. Many herbal supplements have been used for many years
to increase milk production, with the most popular being Fenugreek, Blessed
Thistle, and Red Raspberry. Brewers Yeast (containing B vitamins) is
another commonly recommended treatment for low milk supply. I usually
recommend that mothers try Fenugreek capsules (2-3 capsules taken 3 times
daily) along with Blessed Thistle tablets (same dosage). You many want to
add Brewers Yeast tablets (3 tablets taken with meals, 3 times per day) and
Red Raspberry tea or capsules several times each day. I know that seems
like a lot of capsules to take, but if you don’t want to take them all, the
Fenugreek seems to be the most effective. Fenugreek is rated GRAS (generally
regarded as safe), but when taken in large doses may cause lowered blood sugar,
so should be used with caution by diabetics. It is in the same family
with peanuts and chickpeas, and may cause an allergic reaction in moms who
are allergic to them. It may cause a maple syrup odor in urine and sweat.
For the majority of mothers, it causes no problems, and can be very effective. It
has not been known to cause any problems for the babies of the mothers who
take it.
There is one prescription
medication available in the US that is often used to increase milk supply. It
is usually reserved for cases where all other factors have been ruled out, and
other treatments have failed. It is often used for mothers who are nursing
premature infants who are hospitalized for long periods of time, and who are
under a great deal of stress. Metoclopramide (Reglan) is most commonly
prescribed to treat reflux in infants, and to prevent nausea in mothers after
a cesarean birth. When given to lactating women, it stimulates prolaction
production and will usually increase milk output. Many studies have shown
an increase of 66 to 100% in milk production, depending on the dose given and
how much milk the mother was producing before taking the drug. A dose
of 30-45 mg per day seems to be most effective, with the average dose being
10 mgs taken 3 times a day. If a mother responds to Reglan, she will usually
see an increase in her supply within 2-3 days. Once she stops taking it,
her supply will usually drop off again. If you are taking Reglan, you
should also work on addressing the cause of the problem, by correcting positioning
or pumping frequently, or your supply will drop back to previous levels when
you discontinue it. Tapering off the dose over a period of several
weeks is generally better than discontinuing it abruptly.
Reglan is
commonly used in pediatric patients, and no adverse side effects have been noted
in nursing infants. Mothers may experience cramping and diarrhea, and
long- term use (more than four weeks) has been associated with depression.
The
most important thing to consider when dealing with an infant who is not gaining
weight is your baby’s welfare. You need to work closely with his doctor,
and monitor his weight carefully. It is often necessary to supplement with
formula while you are working to increase your supply. Don’t have the
feeling that giving formula is the ‘kiss of death’ for breastfeeding. Often,
supplementing with formula is just what you need to put weight on the baby quickly
so that he can nurse more vigorously and effectively.
If you are one
of those women who fall into the small group of those who can’t produce enough
milk no matter what you do, you can always combine breast and formula feedings. Any
amount of breastmilk that your baby receives provides nutritional and immunological
benefits, and the special closeness that you feel while nursing your baby is
not dependent on how many times a day he nurses.
NOTE: The text of this article was
reduced for this publication. For more information on this topic, click
here.
About the Author
Anne Smith, anne@breastfeeding-basics.com http://www.breastfeeding-basics.com
Anne Smith is an IBCLC – International Board Certified Lactation Consultant
and La Leche Leader since 1978. More importantly, she is a mother to 6 breast
fed kids with twenty plus years experience of counseling nursing mothers. Her
site, www.BreastfeedingBasics.com
, provides expert advice and solutions to breast-feeding problems and gives
basic information on how to breast feed. Anne also features her recommended
breast feeding products and breast pumps.
if you have any questions or comments!