Lorna C. Aliperti, APRN, IBCLC
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Not Enough Milk?

Increasing Your Milk Supply

  1. Milk production works on the same principle as muscle building–use it or lose it. The primary determining factor in milk supply is the amount of milk your baby removes by nursing and/or the amount removed by your pumping.
  2. A sudden decrease in a previously good supply may be caused by a plugged duct. Information on how to manage this problem may be found at Plugged Ducts.
  3. Pumping can increase your milk supply by increasing milk removal. Research has shown that thoroughly emptying the breast, rather than frequency of milk removal is the important factor in milk production. Even though many people believe the baby is more effective than a pump at emptying the breast, most remove only 2/3 of the available milk during a feeding, and there are usually “leftovers”. One of the fastest ways to increase supply is to pump for 5-10 minutes after each nursing.
  4. Power Pumping is popular with some moms. They pick one hour for three days in a row and pump for ten minutes, rest for ten minutes, pump for ten minutes, rest for ten, etc. This can jump start an effort to increase supply.
  5. Fenugreek is probably the best known and most used herbal remedy for low milk production. The dosage is 2-4 capsules three to four times a day. Capsules generally contain 500-600 mg. Nature’s Way brand fenugreek is often recommended. Side effects include a maple syrup odor to sweat and urine, loose stools, and occasional hypoglycemia so you should take it with meals. Women with an allergy to peanuts should not take fenugreek. Most women find they have a noticeable increase in supply in a few days.
  6. Oatmeal is a supply booster according to many. A bowl a day is suggested. One working mother says, “I make up a big batch of oatmeal raisin cookies, and by the time they’re gone—2 to 3 days—my supply is back up again.” If you would finish the cookies in one day this may not be the best choice for you.
  7. Nettle is another herb that is frequently used in products made to support lactation. It is thought to primarily provide nutritional support and is considered non-toxic. Three to four cups of the tea (which is often combined with raspberry leaf) are suggested.
  8. Parsley, sage, lemon balm, oregano, peppermint and spearmint are herbs which are said to decrease milk supply (in large amounts). Some lactation consultants have reported that they have more than the usual number of calls about low milk supply after Thanksgiving, and this has been attributed to the sage which is typically a seasoning used in turkey stuffing.
  9. A prescription medication, Reglan (metoclopromide) is often given to mothers with inadequate milk supply . It is usually prescribed for nausea and vomiting, but as a side effect it increases prolactin, the hormone needed for milk production. The dose is usually 30-45 mg. per day. This medication is usually given for 2-4 weeks, and then the dose is tapered down. Side effects are not usually severe, but can include nervousness, fatigue, depression or gastric upset in the mother. Depression is considered to be of most concern, and women with a history of depression should probably avoid this medication. There are no reports of problems in the infants of mothers taking this drug.
  10. Domperidone (motilium) is a medication available outside the U.S. (Canada and Mexico) which is recommended by the majority of breastfeeding authorities for serious supply problems. It works much like Reglan, but does not cross the blood/brain barrier, so fatigue, depression and nervousness are said to be less of a concern. No infant problems have been reported, and it is approved by the American Academy of Pediatrics for use in breastfeeding women.
  11. Fennel is an herb frequently recommended for increasing milk production. The dosage is 1 capsule 3 times a day or 2ml. of the tincture 3 times a day. This is another plant in the daisy family, so those allergic to daisies should avoid it. No reported effects on infants. Fennel is often an ingredient in teas made to help milk production.
  12. Goat’s Rue, available from Motherlove is thought to be a particularly effective galactagogue and is being increasingly recommended.

Some mothers worry that their baby is not getting enough “hindmilk” or that their milk is not “rich” enough. This is not true. Research has shown that the only variable so far correlated with infant growth is the volume of milk consumed, not the fat content of the mother’s milk.

Sources:

Ruth Lawrence, Breastfeeding: A Guide for the Medical Profession

Jack Newman, The Ultimate Breastfeeding Book of Answers

Thomas Hale, Ph.D., Medications and Mother’s Milk

Mitoulas et al. Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation.<\i> British Journal of Nutrition. 88(1):29-37, 2002 Jul.

Mitoulas et al. Infant intake of fatty acids from human milk over the first year of lactation. British Journal of Nutrition. 90(5):979-86, 2003 Nov.

Butte NF et al. Human milk intake and growth in exclusively breastfed infants. J Pediatrics 1984: 104: 187-95.

Cregan M & Hartmann PE. Computerized Breast Measurement from Conception to weaning: Clinical Implications. J Human Lact 15(2): 89-96.

  • Dear Lorna, This is a very belated thank you, but the timing seems appropriate. On Monday my daughter and I will achieve a major milestone – 6 months of successful breastfeeding. It was very important to me to breastfeed for at least 6 months, but when my daughter was 7 weeks old, I was in so much pain that I did not think we would be able to achieve this goal. Fortunately, that is when Dr. Cahill recommended that I call you. The protocol and encouragement you provided allowed me to continue to breastfeed – and to grow to love it! Now I think I will even continue to breastfeed for another 6 months! Thank you so much for your help. You are a gifted practitioner! Suzanna Pollak