Got questions about your breast milk supply, mama? We bet you do! It's totally normal to worry about whether you're producing enough milk or not – and with good reason. A study that evaluated breastfeeding success at three weeks postpartum found that approximately 15 percent of women experience inadequate milk supply, even when given close follow-ups and support. Here are some things you should know about your milk supply.
Supply and demand: In the beginning, your body may make more milk than your baby needs. But very quickly, it adjusts to make how much your baby drinks. In other words, it works on a supply-and-demand basis, supplying your baby with as much as he demands. It will even adjust as your baby goes through growth spurts or short periods when baby is not drinking as much. Full-term infants tend to have growth spurts in predictable patterns. The first growth spurt happens shortly after a mother's milk volume increases—between three to seven days postpartum. After that you'll typically see growth spurts at three weeks, six weeks, three months, and six months. During a growth spurt, it's normal for an infant to suddenly begin to nurse 14 to 16 times a day with shorter breaks between nursing sessions. Growth spurts typically last anywhere from three to five days, sometimes stretching to a week.
Filling baby's belly: When baby is drinking, you'll see his jaw working all the way back to his ear, and hear and see him swallowing. A nursing session should last at least ten minutes, and afterward your baby should look sleepy and satisfied—or even drunk on milk!
The importance of the pediatrician: Keep baby's well-baby visits—among other things, the pediatrician will weigh your child to make sure he's gaining weight, a sure sign that breastfeeding is providing the nutrients he needs.
The role your diet plays: Making milk can take a lot out of you! Specifically, it requires water, so you'll need to drink even more than you did during pregnancy. Keep a water pitcher on hand and drink all day long, but especially during nursing sessions. Also, eating healthy foods will give your body the tools it needs to produce a healthy breast milk supply. One big bonus is that you should lose your pregnancy weight without too much effort!
A mom's breast capacity: "A woman's storage capacity isn't related to her breast size, but to the amount of functional glandular tissue she has," says Nancy Hurst, Ph.d., R.N., I.B.C.L.C., director of women's support services at Texas Children's Hospital in Houston. Some women have greater milk-storage capacity, and their babies may be able to go longer between feedings without affecting the volume of milk; women with smaller "containers" may suffer in terms of supply if their breasts aren't emptied more often.
Uneven production of milk: According to Michele Hakakha, M.D,. most women have one breast that produces more milk than the other (especially if she has had surgery on her breasts like implants, large biopsies, or reductions). Similarly, in the early phases of breastfeeding, some babies prefer one breast over the other, making the less-used breast not produce as much milk. If you are just starting to breastfeed your newborn, Hakakha recommends feeding on both sides evenly and then trying to pump in-between feedings, particularly on the side that is making less milk, to increase demand.
Boosting production: Sometimes women truly aren't making enough milk and need to boost production. The standard advice is to simply nurse more often, or even add some pumping sessions into your day. This signals your body that there's a greater demand, and so it will increase the low milk supply. Beyond that, there are some herbal remedies that work for some women, such as teas and supplements made with the herb fenugreek. (Fenugreek should not be taken during pregnancy.) The prescription medication Reglan can also increase milk supply in most women.
Skipping feedings: Management problems, which are the most likely and treatable causes of low milk supply, often involve having an abundant supply at the outset that then dwindles, says pediatrician Marianne Neifert, M.D., co-founder of the Academy of Breastfeeding Medicine and author of Great Expectations: The Essential Guide to Breastfeeding (Sterling). "The most common scenario is that the milk comes in but doesn't get well drained," she says. "If milk isn't removed from a woman's breasts frequently and effectively, she's already behind the eight ball by the end of the first week." For the first four to six weeks, your newborn should be nursing as often has every two hours around the clock. After that, you may be able to drop some nighttime feedings so that your child sleeps for four to seven hours at a stretch. However, until then, or if your baby is sleeping more than four hours during the day, wake him up to breastfeed.
Overfeeding: Another common pitfall is trying to provide more milk than is necessary because an infant is being overfed. Some mothers who have an oversupply might be able to consistently pump enough milk to overfeed a baby, but most will not. Most babies can drain a bottle so fast that their stomach doesn't have time to tell their brain that they are full. An infant's maximum stomach capacity is only five ounces, and most breastfed babies only need three to four ounces in a bottle to meet their nutritional needs. Unlike formula, breast milk changes with the baby, and your little one's ability to digest and absorb nutrients from your milk also changes. Because of this, your infant does not need to take in a larger quantity of breast milk as he gets older. If your infant is consistently drinking more than four ounces of milk in a bottle, then it's time to begin paced feedings to allow time for your infant's stomach to tell his brain that it's full.
Not drinking enough liquids: Your body needs a lot of water to make milk—and to keep you healthy as your recover from childbirth. Drink water all day long, as well as healthy beverages such as milk and juice. Drink sugary sodas and caffeinated drinks such as coffee in moderation, since they may not keep you as well hydrated.
Dieting: A breastfeeding mother needs roughly the same number of extra calories as a pregnant woman. You're still "eating for two," which means an extra 300 to 500 calories a day, or about the amount in a container of yogurt, a cup of cereal, and a piece of fruit. Dieting, or cutting back calories, is the opposite of what you need to do—you can hurt your breast milk supply and make yourself feel run down as well.
Stress and worry: Unfortunately, worrying can sometimes lead to a low milk supply. Nursing is both a physical and a psychological thing—if you can stay relaxed, think about the happy aspects of parenthood and your new baby, and remain confident about breastfeeding, you boost your chances of success.
An ineffective latch: If a baby doesn't have a good "docking" with the breast, he may not be able to stimulate and drain the breast effectively.
A premature baby: Preemies can be particularly ineffective at removing enough milk when breastfeeding because they tire easily and have immature feeding skills.
Health issues: Approximately 4 percent of women have primary causes of low milk supply that are more difficult to treat, including such medical issues as breast and hormonal problems. "Previous breast surgeries, insufficient mammary tissue, and thyroid or other hormonal disorders are some of the more common causes," Neifert says. "A woman who has difficulties during delivery, such as very heavy bleeding, can also have problems." So may a woman with a severe infection or high blood pressure.
Environmental toxins: A woman's surroundings may affect her milk supply. A small study conducted in 2006 found that daughters of women who grew up in a pesticide-contaminated agricultural valley of Mexico had a much higher incidence of insufficient mammary tissue than those living on a hilltop in the same area."We're seeing a dramatic increase in the number of women who have primary problems, possibly because of environmental contaminants," says Diana West, I.B.C.L.C., a co-author of The Breastfeeding Mother's Guide to Making More Milk (McGraw-hill). "Lactation consultants around the world are reporting increases in the numbers of women who can't produce full milk supplies."
Underlying fertility problems: "Interventions are allowing people to get pregnant when they wouldn't otherwise, causing babies to be born to women who might not have fully functional reproductive systems," West says. "For example, many women with PCOS (polycystic ovary syndrome, a condition that can cause ovulation problems) have less functional milk-making tissue."
Returning to work or school: Working outside the home can present a unique set of challenges to the breastfeeding mother. While an electric breast pump is an indispensable tool to the working mother, it isn't perfect. Breast pumps can't draw milk from the breast as effectively as a baby. However, to maintain your milk supply during any separation, expressing milk is a must. They key is making time to pump, even when you have a busy schedule.
Starting your period again: For some women, their menstrual cycle returns within three months postpartum, and for others, eighteen months postpartum. When a woman's menstrual cycle returns, this typically signals the beginning of hormone-mediated milk supply changes throughout the month. Most mothers report that one to two days before the onset of their period as well as the first two to three days of their period, their milk supply drops. In addition to a drop in supply, the hormones related to menstruation also cause changes in the milk's taste. This drop in milk supply is normal and transient. Typically, a mother will still make enough milk to nourish her child effectively but your babies nursing habits and schedule might change a bit during this time.
Unsure if your newborn is really drinking enough? Check to see if he's:
Wetting 8 to 12 diapers a day. Not sure? Today's diapers are super absorbent! Place a piece of toilet tissue in the diaper and you'll be able to tell if it's gotten wet.
Acting satisfied after a meal. It's logical enough! If baby looks content or even happily drunk after breastfeeding, you can be sure he's got a full tummy.
Gaining a half-ounce to an ounce a day in weight. If you don't have a baby scale at home, don't worry. Your pediatrician will gauge baby's weight at your well-baby appointments.
If you suspect you have low milk supply, see a lactation consultant as soon as possible. (To find one, visit the International Lactation Consultant association at ilca.org.) She can identify risk factors, evaluate how much your infant drinks during a breastfeeding session, and start you on a pumping regimen to improve milk drainage. There's no blanket fix; treatment must be individualized.
That said, many lactation consultants follow a typical course of action. The first step is to increase milk removal, which often involves a combination of nursing and pumping. Next, a lactation consultant might recommend herbs, such as fenugreek, malunggay, goat's rue or shatavari, to help boost your supply. Some might also recommend prescription medications, such as domperidone. Says West, "Domperidone has been shown to be highly safe for long-term use at the levels we recommend for nursing mothers and is used throughout the world to effectively and safely increase milk production."
Experts say that with the right approach, you should be able to boost your milk supply—especially if you catch the problem early. "Almost everyone can make more milk," West says. "It may not be enough to sustain your baby, so you might still need to supplement, but that's OK. You need to celebrate what you can do and see your breasts as being half full."