First, it's important to assess if you're truly dealing with a low milk supply. Sometimes mothers can perceive normal breastfeeding patterns and/or baby behavior as an inadequate milk supply. If you determine that you really do have a low supply, consult with a lactation consultant to determine the "why" behind it so that you can get to work fixing the problem and prevent it from occuring again. In the meantime...

There are several positive steps you can take if you decide that your milk supply is low. If possible, plan to set aside a few days, perhaps a weekend, to spend doing little else but working to increase your milk production. Following the steps listed below, most moms notice an increase in supply within 24-72 hours. If you're pumping and just finding it harder to keep up with your baby's milk needs, although your baby seems fine when he nurses, the following will also apply.

• Nurse or pump frequently. Plan to nurse at least every 1 1/2 to 2 hours during the day and at least every 3 hours at night even if you must awaken your baby. Time your feedings from the beginning of one to the beginning of another. If your baby is available to nurse, this is preferable to pumping as he will better stimulate your breasts to produce more milk.

• Allow the baby to nurse on each side until he pulls off himself or goes to sleep.

• Offer both breasts at each feeding.

• Although nursing is preferable, if the baby cannot nurse directly at the breast, use a hospital-grade electric pump for double pumping instead (such as the Lactina or Pump In Style). Double pumping has been shown to increase Prolactin levels. Prolactin is the hormone which stimulates milk production. Pump for 10-15 minutes per session. Longer sessions have not been proven to be any more beneficial at increasing supply.

• Along with nursing, you may want to add another pumping session or two sometime during your day. You also may want to add a few extra minutes (5-10) of pumping after the baby has finished nursing.

• Allow the baby to meet all of his sucking needs at the breast. Avoid any bottles or pacifiers during this time. Your baby's need to suck ensures that he spends adequate time at the breast to stimulate your supply.

• Avoid supplements including solid food, water, juice, and formula. Adding these will result in your baby nursing less often and you getting less stimulation. You can be sure that your baby is getting enough by counting his wet diapers and bowel movements. See "Is My Baby Getting Enough?"

• If your baby requires a supplement for medical reasons, consider using a nursing supplementer at your breast so that you can continue to receive crucial BABY stimulation.

• Snack often on foods rich in protein and calcium.

• Drink enough to satisfy your thirst. Forcing fluids is not necessary and may have the opposite effect. Any type of fluid is satisfactory.

• Rest as much as you can. Consider taking the baby to bed with you for the time period. The rest will benefit you and the close skin-to-skin contact may encourage him to nurse more often.

• Some mothers have found that the herb, Fenugreek, is helpful for increasing milk supply. It works best when combined with increased frequency of nursing and/or pumping. You can find it at your local health food store or nutrition store. The dosage is 2-4 capsules 3 times a day. Most moms notice an increase in supply after using it 1-3 days. It is safe for your baby. While taking it you may notice that your perspiration and urine smell like maple syrup as Fenugreek is used to give artificial Maple syrup its odor. Some moms report diarrhea while taking it that quickly resolves once they stop taking it. If you suffer from asthma, your symptoms may become worse with the Fenugreek. Dosages higher than the recommended one given above may result in hypoglycemia in some mothers. If pregnant, you should NOT use Fenugreek as it may cause uterine contractions. Many moms use it for a quick boost to their supplies. Others have used it long-term with no problems. Other herbs often recommended for increasing milk supply are Blessed Thistle and Alfalfa. For some mothers a combination of herbs seems to work better than one herb alone. You may use the Fenugreek, Blessed Thistle, and Alfalfa in combination if you choose.

• If the above measures do not cause a significant increase in your supply, you may want to ask your doctor about Reglan (Metoclopramide), a prescription drug available in the US and sometimes prescribed for low milk supply. Reglan is most effective at doses of 10-15 mg 3 times a day and should not be used for any longer than 2-4 weeks. If you have a history of depression, Reglan should be avoided due to its potential side effects of depression and mood swings. If you live outside the US in a country where the drug Domperidone (Motilium) is approved, it may also be used for low supply and seems to have far fewer side effects than Reglan. The dosage suggested for increasing milk supply is 10-20 mg 3-4 times a day. Domperidone can be compounded by a pharmacist with a prescription in the United States. It can also be obtained in its completed form without a prescription from countries outside the United States. Ordering it in this fashion is legal and considered safe. For more information on obtaining Domperidone, visit this page. Both Domperidone and Reglan can be used with any of the herbs mentioned above.

Written by Becky Flora, BSed, IBCLC

Last revision: May 28, 2003

Sources:

La Leche League's, "The Breastfeeding Answer Book" (1997) by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC

"The Nursing Mother's Guide to Weaning" (1994) by Kathleen Huggins, R.N., M.S. and Linda Ziedrich

"Medications and Mothers' Milk" (1999) by Thomas Hale, Ph.D.

More info at other sites:

"Increasing Low Milk Supply" - Determine here if your supply is really low and read about methods to increase it if it is.

"Herbal Remedies for Increasing Milk Supply"

"Domperidone"