With the right information and support, most breastfeeding mothers will make plenty of breast milk and their babies will be contented and thrive. However, good breastfeeding support is not always available and there can be a variety of factors that might lead to a mother finding she has a low milk supply. If a mother doesn’t have enough milk to satisfy her baby, there are several ways to make more breast milk. A breastfeeding specialist can be a helpful partner to identify the most likely reasons for a low milk supply and to discuss a personalised care plan to maximise a mother’s breast milk.
This article looks at how milk production works and how to use this information to increase breast milk. If your baby is not getting enough milk or not gaining enough weight, supplements may be needed to keep your baby well fed until your milk supply increases.
How milk production works
Breast milk is made “on demand”. As long as milk is taken from the breasts (by a baby or a pump) more milk will be made in the breast to replace it.
- A full breast has slower milk production. As soon as a breast is full it sends a message to the breast or “milk making factory” to slow production.
- An empty breast has faster milk production. As soon as a breast is empty, the milk factory speeds up production.
It follows that MORE BREASTFEEDS equal MORE MILK because the more often the breasts are emptied the more milk will be made. However, this system depends on effective milk removal through a good latch (the way baby attaches to the breast), good positioning and plenty of frequent feeds. If your baby isn’t draining the breasts well, your milk supply will not be fully stimulated. A good breast pump can help with breast drainage while you work on improving latch and positioning with the help of a lactation consultant.
How to make more breast milk
Sometimes making more breast milk is just a matter of improving positioning or offering both breasts per feed instead of one. Sometimes it is not quite as straightforward. If your milk supply doesn’t improve after trying the suggestions below, contact your IBCLC lactation consultant for more personalised information based on your medical history.
#1 A good latch and position
With a good latch your baby can stimulate the breast properly to release milk, and the more milk that is released, the more will be made to replace it. A good latch is one that has lots of breast tissue in the mouth not just a nipple. Positioning is also important so that your baby can get a good mouthful of breast, be comfortable at the breast and feel stable. When your baby is latched well and getting breast milk you will either hear him swallowing, or see the pause in his suck while he swallows. Breastfeeding is not supposed to hurt and pain or sore nipples indicate something is wrong. See Latching Tips and Why Does Breastfeeding Hurt? for further tips to improve latch and an explanation of how latching can help with increasing milk supply.
#2 Frequent feeds
Emptying the breast frequently is another key to stimulating your milk supply, therefore waiting a set time so that your breasts “fill up” between feeds will NOT be helpful. Healthy newborn babies typically want to feed every couple of hours or more. Sucking fists or fingers, moving their head from side to side with an open mouth or starting to fuss are all signs that a baby is hungry (hunger cues). Encouraging your baby to feed as often as they need will help your milk supply. Breastfeeding in clusters i.e. more frequent breastfeeds at certain times of the day are perfectly normal. The closer together breastfeeds are, the higher the fat content of all the breast milk and the more milk your breasts will make.
Sleepy baby or ineffective feeds
If your baby is very sleepy or has not been getting enough milk for a while, it may be necessary to wake your baby to remind him to feed. Remind a sleepy baby to feed at least every two hours during the day and every four hours at night. Watch for the baby who looks as if they are breastfeeding but closer inspection reveals they are asleep at the breast, or making light fluttery jaw movements as if they are dreaming about breastfeeding but without swallowing—see #3 and #4 below and read more in Flutter Sucking and Comfort Nursing.
#3 Monitor swallowing and active feeding
Letting your baby be the one to end the feed normally ensures he has had enough milk. If he has filled his tummy, he may fall asleep after 10-30 minutes of active sucking and swallowing (rough guide). His hands and face will be relaxed and he will let go of the breast himself. However, watch for the baby who is “hanging out at the bar but not buying any drinks”. He may stay latched for an hour or more but close inspection shows he is not actively sucking and not swallowing milk. This baby may fall asleep with his hands clenched in tight fists and may have a worried expression. In this case, after breastfeeding from both breasts for 20-30 minutes with compressions (#4), your time will be better managed by pumping and topping him up with breast milk (or formula if needed), rather than sitting on the sofa for long periods with a baby who isn’t drinking and isn’t gaining weight.
#4 Use breast compressions
Breast compression is the name given for applying massage and steady pressure or compression to the breast during a breastfeed to simulate another let down (release) of milk. If your baby falls asleep after less than ten minutes swallowing, or, when your baby stops actively sucking and swallowing, gentle breast compressions can increase milk flow which starts baby sucking again and so further stimulates the milk supply. This works better to keep a baby actively sucking than blowing on baby or tickling toes. For more information see What is Breast Compression?
#5 Offer both breasts per feed
Letting your baby finish each side at his own pace and offering both breasts at each feed is a way to increase a milk supply. After your baby has finished the first breast with breast compressions, offer the second breast and repeat, using breast compressions again when sucking slows on this breast. Keeping to one breast per feed is a way to reduce a milk supply.
If your baby keeps falling asleep while feeding, a technique called “switch nursing” may help keep his interest and encourage active feeding. Change (or switch!) breasts when baby’s sucking slows down and he swallows less often. Switch nursing is also explained in One Breast or Two Per Feed?
Foremilk and hindmilk
One common cause of a low milk supply is when a mother has been told to stay on one breast for blocks of time to “get to the hindmilk”. Hindmilk is the name for the milk towards the end of a feed which has a higher fat content. This is very poor advice for the mother who doesn’t have much milk. Keeping to one breast per feed or for a period of time is a way to reduce your milk supply. See Forget about Foremilk and Hindmilk for more information.
#6 Pumping or hand expressing
Pumping or hand expression will be invaluable if your baby is not latching at all, if you want to pump so you can store breast milk, or if your baby is not draining the breasts properly. A good pump can increase your milk supply all on its own, simply by thoroughly emptying the breasts at each pumping session. For many pumping tips, including how often to pump and how long to pump for, see How to Increase Milk Supply When Pumping. Research has shown that breast massage during pumping and hand expressing after a pumping session to remove the remaining milk can help milk supply significantly1.
It may not always be necessary to pump, especially if you are working with a lactation consultant and have improved positioning and feed frequency and are now using breast compressions. Every mother-baby pair is different so be guided by your IBCLC’s individualised care plan.
Spending time holding your baby skin-to-skin or with you both lightly dressed has many benefits for you and your breastfed baby including spotting early feeding cues, stimulating hormones needed to make milk and helping your baby gain weight simply by your baby being where he feels safest and expends least energy—in your arms.
#8 Avoid pacifiers (dummies) and delaying feeds
Dummies can cause a baby to miss feeds or go longer between feeds if their hunger cues are stifled with an empty teat. A pacifier can also affect a baby’s latch and suck because a pacifier teat is very different to a breast. See Pacifier, Dummy or Soother—Yes or No? for more information. When all your baby’s sucking is at the breast it will boost his milk intake. See He Can’t be Hungry. He Just Ate! to understand how babies gain weight.
#9 Night feeds are important
A baby can take as much as 30% of their calories at night so night feeds are very important if your baby is not gaining weight. Some mothers whose babies sleep through the night early—yet who don’t gain much weight have found it can help to set an alarm to schedule a feed in the night.
For a summary of popular galactagogues see What is a Galactagogue? And for more reading see The Breastfeeding Mother’s Guide to Making More Milk.
galactagogues can’t compensate for a milk supply problem if milk removal is not sufficiently frequent and effective. Identifying and addressing all contributing factors to your low production first will give you the best shot at success. Then galactagogues may help speed up the process.
#11 Body work
If any of the important nerves involved in milk let down are functionally impaired, or if any of the mother’s spinal vertebrae are misaligned, body work or manual therapy may be of interest to some mothers with milk production issues2.
#12 Acupuncture or acupressure
Acupuncture has been used in China for low milk supply for two thousand years with specific acupuncture points reputed to be associated with raising prolactin levels so increasing milk supply. For more reading on this subject and references see Acupuncture and Acupressure (lowmilksupply.org).
Supplementing your baby
If your baby’s weight is a concern, it is important to keep your baby well fed until your milk supply improves and your little one is able to take enough breast milk. Topping up with expressed breast milk or formula if needed after (or before) several day time breastfeeds will have less impact on your breastfeeding relationship than replacing whole breastfeeds with bottles. The volume of supplement used each day is an indication of how much more breast milk is needed to establish a full milk supply. You can work towards making this amount of breast milk with the ideas above.
Should I offer solids early?
In most cases the answer to poor weight gain is not to start solids early but to work on your breast milk supply with an breastfeeding specialist using the ideas above. If additional calories are still needed, donor milk or formula may be indicated. However, after four to five months of age, Canadian paediatrician Jack Newman and breastfeeding author Maureen Minchin have written about how starting selected high quality solids may be preferable to topping up with formula, since formula and using a bottle have their own downside and risk such as an early end to breastfeeding and implications for long term health. Working with your IBCLC lactation consultant and health professionals will help you decide on the best course of action for your baby. See Starting Solid Foods for more information.
Breast milk is made by supply and demand. When a pump or baby removes milk from a breast, more breast milk is made. This principle depends on good breast drainage which in turn depends on a good latch, frequent breastfeeds or a good pump. There are many ways that a mother can increase her milk supply but sometimes there can be medical causes hindering a full milk supply. An IBCLC lactation consultant can help a mother identify the reasons for her low milk supply and suggest a care plan tailored for her and her baby to make more breast milk.