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Home , Low milk supply, Weaning

February 2019 INFORMATIONAL HANDOUT INCREASING SUPPLY by Bonne Dunham, RN, IBCLC, Corporate Services

Most , at some point I N T H I S I S S U E during their UNDERSTANDING MILK journey, will have concerns PRODUCTION about their milk production IS MY BABY GETTING for one reason or another ENOUGH MILK?

A common concern that SIGNS THAT YOUR BABY MAY NOT BE GETTING mothers have is ‘Will I have ENOUGH

enough milk for my baby?’ WHY MIGHT MY MILK SUPPLY BE LOW?

TIPS FOR INCREASING SUPPLY

Corporate Lactation Services REFERENCES CORPORATE LACTATION SERVICES P A G E 2 UNDERSTANDING MILK rather than ounces. It is straw colored, perhaps with a tint of orange. PRODUCTION This perception of is When your baby is put to and the most common reason mothers allowed to feed frequently, on cue, give for early or and at least every 2-3 hours (or 8-12 supplementation. Understanding milk times a day, including the middle of production, baby’s needs for the night.) the milk will start to nourishment, typical newborn transition from to mature behavior and effective milk removal milk around the third or fourth day. from the can really boost a The milk will appear thinner and whiter ’s confidence with than the colostrum. breastfeeding and dispel quite a bit of Milk removal is the primary factor in the misconceptions that may lead to P H O T O B Y M A R T I N R . S M I T H building and maintaining a milk earlier than necessary weaning. supply. Bringing baby to breast 8-12 Learning breastfeeding and baby times a day, and effectively removing basics will not only boost your milk, in each 24-hour period, confidence, it will also help you to stimulates the production of a plentiful know the difference behind true low supply of milk. But your milk must be milk supply and a misperception removed in order to signal your body about low milk supply that is rooted in to make more milk. lack of confidence and worry. Basic Facts About Milk When your baby breastfeeds less, or you get less stimulation and milk Production removal from your breasts, the body Your breasts start to make colostrum responds by cutting back on milk about halfway through the production. Milk production is a supply and continue through the few first and demand situation. days of breastfeeding. This production is driven by hormones associated with pregnancy. Colostrum is the first milk that your baby will receive when breastfeeding and is high in carbohydrates, protein and antibodies. It is easily digestible and is the perfect first food for your baby. It comes out of the breasts in smaller amounts than most people think. It is measurable by teaspoons

CORPORATE LACTATION SERVICES P A G E 3 IS MY BABY GETTING By day 4 has three or more ample (quarter size or larger) stools that are ENOUGH MILK? yellow or turning lighter in color, towards yellow. A stool at every Below is a list of markers that can feeding is not unusual. Stools can be help you to determine whether or not your baby is ‘getting enough.’ Along loose and runny. with learning these signs that can let Your baby has pale, diluted urine. you know whether or not you are on Your baby continues to have at least the right track for milk production, it three stools in each 24-hour period is recommended that you schedule until he or she is about 5 or 6 weeks ‘well-baby checks’ with your baby’s old. Once babies cross that 6 week pediatrician. These visits commonly threshold, bowel movement patterns occur 48 hours after discharge from may change and baby may go less P H O T O B Y M A R T I N R . S M I T H the hospital, at 2 weeks postpartum, often, but the bowel movements and 1 month, 2 months and every 2-3 the tummy are still soft. Some babies months until your baby’s second have one big ‘mudslide’ every few birthday. The weight-checks and days. If bowel movements are hard, reporting on what you are seeing in like pellets or gravel, this means that your baby for output and behavior your baby has constipation and your will be a big piece in the knowing baby’s doctor should be consulted. whether or not your baby is ‘getting Your baby routinely breastfeeds at enough milk.’ least 8-12 times in each 24-hour period. Baby’s feedings may not be Anytime that you are spaced exactly at regular intervals, but concerned about your you can expect to be breastfeeding baby’s well-being is a your baby every 1-3 hours or so. Your baby regains birthweight by 10 to good time to check in 14 days after . with the pediatrician. If Your baby gains 4-8 ounces a week, or you are concerned about on average, about 1 oz per day in the your milk supply, reach early weeks and months. out to your lactation Your baby has active and alert periods throughout the day. consultant for help and Your baby is content between feeding, guidance. usually rests for 1-2 hours, wakes on By day 4 your baby has at least six his or her own and signals to wet in each 24-hour period. breastfeed again. CORPORATE LACTATION SERVICES P A G E 4 between active swallowing vs. fluttery SIGNS THAT BABY MAY sucking that is non-nutritive. Just NOT BE GETTING ENOUGH because a baby is ‘constantly’ at the breast does not always mean that your Above was a list of markers that tells baby is removing milk. you if your baby IS getting enough, but it might be helpful to have a few if your baby is not gaining weight, ideas of what it might look like if your losing weight, or not back to birth- baby is NOT getting enough. You weight around two weeks postpartum. may need help to identify whether your baby is getting enough or not. WHY MIGHT MY MILK Your baby’s pediatrician or a SUPPLY BE LOW? are professionals Ineffective milk removal from the who can help you determine this, so P H O T O B Y M A R T I N R . S M I T H breast is the leading cause of a low if you have a question or concern, milk supply. Some of the reasons for reach out! ineffective milk removal are below. Contact your baby’s doctor if you see the following Not putting your baby to breast (or pumping often enough if you are signs: exclusively pumping). When milk is your baby cries constantly and is allowed to remain in the breast for difficult to console even with feedings. long periods of time (more than 4-6 if your baby has dark, concentrated hours) it signals to the body to slow urine with an orange or red tint to it. down milk production. jaundice: a yellow or orange coloring of the skin. Not allowing your baby to get the most possible drainage on a breast during a if your baby is not having any bowel feed. This can happen when mothers movements. do ‘timed feedings.’ For example, 10 if your baby is still having dark minutes on one side and 10 minutes meconium stools by day 4/5. on the other breast. This technique if your breasts don’t feel full. may result in leaving milk still in a breast. It might take some time to if your baby seems to be ‘using you as learn ‘when to switch breasts’ but a pacifier’ and is constantly at the getting the most possible drainage on breast without seeming satisfied after a breast before switching to the next is a feed. When baby is at the breast the goal. The more milk that is you will want to learn the difference removed = more milk produced! This CORPORATE LACTATION SERVICES P A G E 5 WHY MIGHT MY MILK will top-off a breastfeed with an ounce or two of formula. This may result in SUPPLY BE LOW? (CONT) your baby asking for less breastmilk is also true if you are exclusively because they are full on formula. pumping your breast. Pumping your breasts for 15-20 minutes and using Bottle feeding: Whether you plan to massage of your breast can ensure feed breastmilk by bottle or formula, that you are removing enough milk to you will want to pump/express milk tell your body to make more milk. from your breasts during the time that Please also see our “Exclusive your baby is receiving a bottle, to keep Pumping” handout for details. your milk supply up. Some Scheduled feeding: When babies are give baby a bottle ‘to give mom a fed on a schedule, this can interfere break’ but if you are hoping to keep with the supP HpOlTyO BaY nMdA R TdI Ne Rm. SaM InT Hd cycle of your supply going, you will want to milk production. Your baby will be remove milk from your breasts having many growth spurts and it is whenever your baby is taking a bottle. hard to predict when they will occur. As well, some babies will develop a Keep up with your baby’s growth preference for bottles because they demands by nursing on cue. don’t have to work at milk removal as hard or in the same way as breast- Offering only one breast per feed at feeding. This preference may lead to most breastfeeding sessions can problems with and sucking result in a decreased milk production properly when at the breast. over time. Offering one breast per feed may be ok if your milk supply is Pacifier use: much like bottles, use of well-established or abundant and pacifiers can also affect baby’s latch. your baby is gaining well. As well, over-use of a pacifier can Poor latch: If a baby is poorly latched greatly reduce the amount of time that and not able to effectively remove your baby spends at breast, which may milk this may result in low milk supply. cause a drop in your milk supply. Supplementing with formula: some- Feeding cues may be missed when times it is necessary to supplement a your baby is using a pacifier. baby. But unnecessary supplementing Occasionally, maternal health can lead to a decreased milk supply. concerns will be a factor in decreased Formula is very filling and more milk supply. Please see the section difficult to digest than breastmilk. below on ‘When to contact a health Occasionally, parents who are ‘not professional’ for a more complete list sure if their baby is getting enough’ CORPORATE LACTATION SERVICES P A G E 6 SOME REASONS FOR TIPS FOR INCREASING INEFFECTIVE MILK YOUR SUPPLY REMOVAL (CONT) Breastfeed on cue: at least 8-12 times a day (or more!). If you are exclusively of what these health concerns could pumping, then removing milk with your be. pump at least 8-12 times a day is If your baby was born preterm recommended to help with increasing (before 32 weeks) or even late and maintaining milk supply. preterm (between 32-36 weeks) it Be sure that you baby is properly may take some time for your baby to latched. Speak with or have a visit fully develop the skills for with a lactation consultant to go over breastfeeding, while the brain is still your latch and breastfeeding rhythms developing P‘oH OnT O tBhY eM AoR TuI Nt sR .i SdMeI T Hof the to see if there are any areas that can womb’. It may appear as if some of be improved. these babies have a good latch, but their ‘suck, swallow, breathe’ pattern Drain each breast thoroughly before may yet be effective enough for milk switching and offering the next breast. removal. Many mothers who have Don’t allow long periods (greater than babies who are born early will use a 5 hours) without milk removal. in conjunction with Gently massage your breast before a breastfeeding until proper feed/pump. This helps to ‘wake up’ the breastfeeding skills are developed. milk producing glands. You can also Hormonal : Most methods massage or compress your breast of contraception that women use is during a feed or pump to help with not considered to be harmful to their greater milk removal. If you are using breastfed children, but some forms, a pump to express milk or increase namely those containing , can your supply, here is a great video that be very harmful to milk supply. Be shows how to use your hands when sure to let your primary care provider you pump. know that you are breastfeeding when Rest and relaxation: reducing tension choosing a form of contraception. during the times that you are Are you perhaps pregnant again or breastfeeding can help the milk flow. getting your menstrual cycle back? Prepare a cup of tea for yourself, put This can impact your milk supply. on soothing music or take a few deep breaths. What relaxes you? CORPORATE LACTATION SERVICES P A G E 7

You may need to slow down the : A is a extra-curricular tasks/outings in your substance that can increase breastmilk life to place some focus on spending production in nursing mothers. An some uninterrupted time with your herbal galactagogue is a remedy or baby to concentrate on increasing supplement that can be found in your feedings or getting extra various forms; capsules, teas, stimulation on your breasts. Get help tinctures or powders that can be added with your tasks or housework while to smoothies. These herbal you do this. supplements may be just one herb or a combination of herbs depending on Hold your baby skin-to-skin: this will your need or which product you help to elicit feeding instincts in your purchase. It is a good idea to consult baby and he PlpH O TyOo BuY M tAoR T IlNa Rt.c ShM I TaH t first with a knowledgeable herbalist and/or cue. your health care provider to see if Pump your breasts for 5-10 minutes galactagogues are a good choice for directly after a breastfeeding session you. For a complete list of herbs and for extra milk removal. If you still their specific uses please click here. feel fullness in your breast after a feed, or if you have a sleepy baby or Replace pump parts: if you are using a a baby with a poor latch, you will pump for your milk removal than you want to consider doing this a few will want to be replacing your pump times a day (or more) until your parts from time to time. Worn-out supply and breastfeeding get on pump parts decrease the performance track. of the pump. If you exclusively pump or express more than 4 times a day Adding an extra pumping session to with a pump, you will want to consider your regular breastfeeding sessions replacing the tiny rubber membranes may help with milk production. You or duck valve (depending on what type will want to discuss the timing of of pump you have) once a month (or these extra pumping sessions with replace every 2-3 months if only using your lactation consultant. pump once or twice a day). It’s If you are using a pump for milk important to check periodically for a removal, be sure to have the correct decrease in the elasticity or warping of sized breast flange. Using one that is this part. If you have a pump that has too large or too small can affect milk a ‘backflow protector’ you will want to removal. replace this part every 3-6 months depending on use. CORPORATE LACTATION SERVICES P A G E 8

Power-pumping is a technique using Acupuncture: this age-old healing the pump to get extra stimulation/ modality, whereby very small needles milk removal between regular are placed in the skin (very shallow) breastfeeding or pumping sessions. on certain ‘points’ along the body and There are a variety of ways to power- have been shown to help with pump: Pick a one- or two-hour increasing milk supply and flow. window of time for on-and-off Acupressure: Very similar to the pumping. It doesn’t have to be acupuncture, however, instead of a perfect, but you will want to pump for needle, the application of pressure 15 minutes, take a 15 min break, from thumbs or fingertips to points on then pump again for 15 minutes and the body for therapeutic effects. so on. You may not see much milk being expresPsH OeTdO BtYo MwA RaT IrNd Rs. S MthI T eH end of Speak with your doctor about your your time-frame, but please know options for testing certain hormones in that this extra stimulation does boost your body that could be affecting your your milk producing hormones. ability to produce enough milk. An imbalance in any of the following Are you properly hydrated and hormones could be a contributor to getting enough calories to support your challenges: thyroid, , the hard work of producing milk? It is insulin, testosterone, hemoglobin and recommended that breastfeeding hematocrit. mom’s drink at least eight to twelve 8-ounces glasses of water a day. If you have tried many of these options Drink to thirst and eat to hunger! to see if your body will respond Producing milk takes a lot of energy naturally and have not seen the results and a good source of energy can be you are looking for, you may consider had from high quality foods, eaten in some lactation-enhancing their most natural state. (Whole pharmaceutical drugs that may foods. Less processed, sugary increase your milk supply. There are a foods). Also consider continuing handful of prescription drugs that are taking your prenatal vitamins as long used to increase milk supply: as you are still breastfeeding. Metoclopramide (Reglan), Speak with your lactation consultant (Motilium) and Sulpride to see if a hospital grade breast (Eglonyl, Dolmatil, Sulpitil, Sulparex, pump might be a good option for you. Equemote). How do they work? Your These pumps have a stronger motor body requires an appropriate level of and are often more effective and the hormone prolactin in order produce efficient at milk removal. milk. A low level of prolactin can be CORPORATE LACTATION SERVICES P A G E 9 associated with low milk production. If you have concerns that There is another hormone, called your baby is not getting dopamine, which inhibits the presence of prolactin. These enough milk, please pharmaceutical drugs act to block or contact your lactation reduce dopamine levels in your body, consultant or your baby’s with the hopeful effect of raising the prolactin levels and thus increasing pediatrician to help you milk supply. These drugs are not with this concern. effective for all women, especially if prolactin levels are already normal or CONTACT US! high. You can speak with your primary care provider about your Call 1-888-818-5653 options P H O T O B Y M A R T I N R . S M I T H My Lactation Consultants Name and telephone extension is:

Please note, that even with the greatest of efforts and a perfect latch, there are a handful of mothers who may struggle with milk production. Certain maternal medical issues may interfere with milk production. Please speak to your REFERENCES healthcare provider about this if you struggle to produce milk and have Lauwers, J., Swisher, A. Counseling any of the following medical the Nursing Mother:A Lactation conditions: hormonal imbalances Consultant’s Guide, 6 th ed. such as polycystic ovarian syndrome Burlington, MA:Jones & Bartlett or infertility, thyroid complications, Learning:2016. -sugar dysregulation, Wambach. Riordan, Breastfeeding and anemia/iron issues, breast surgery, Human Lactation 5th ed. Burlington, mammary glandular insufficiency, MA. Jones& Bartlett Learning 2016. retained placenta, theca lutein cyst, Breastfeeding Nutrition – Tips for experienced a postpartum Moms. Mayo Clinic. April 2018. hemorrhage, hormonal birth control Galactogogues – Herbs That Increase use, heavy smoking or alcohol use. Breastmilk Supply. 2019.