Most women at some time during the breastfeeding experience question how to increase or maintain breast milk supply. The short answer is that breastfeeding is a complete “supply and demand” experience. The body is an amazing machine; if you feed a lot (that is, breastfeed a lot), it will make a lot. How else can we explain women that make enough to feed twins or triplets? So to make more, you have to feed more. As simple as that sounds, there are a few tricks to try.

Timing

The key time to establish a good milk supply is at the beginning. Frequent, effective feeding will really drive your milk to come in. You must stimulate the milk to come in. This is ideally done within the first few hours after birth. If your baby isn’t a great feeder, has problems, or is otherwise unable to eat (e.g., a premie in the NICU), you can “trick” your body after birth into making lots of milk by pumping. Typical newborns feed every 1-3 hrs for 20 or so minutes. If you are going to pump, you must do so as often as a baby would feed. If you want to make milk for twins, you must feed/pump twice as much.

Pumping

Sometimes, when a mom experiences a dwindling milk supply or experiences a problem (e.g., mom or baby got sick) that affects her milk supply during the breastfeeding experience, I will recommend something I call power pumping. Once again, it is the concept of trying to trick your body into making more milk. Know in advance that it is a lot of work/time commitment and doesn’t always work. This is how to do it: pump an extra time for every time your baby eats. Take for example a baby that feeds every 3 hours. First, breastfeed your baby. About an hour later, pump both sides of your breasts (the key is to pump for 3 minutes beyond when there isn’t any more milk coming out, to get any remaining hind milk). Then two hours after that, feed your baby again. The cycle just repeats itself. I typically recommend doing this for 24-48 hours. If your breasts will respond to extra stimulation, you will see an increase in the amount of pumped milk throughout the power pumping.

Drugs

Drugs or medications can increase or decrease milk supply. The most common medications that lactating women unknowingly take which can decrease milk supply include: combination birth control pills (it is usually the estrogen component that creates problems) and antihistamines/allergy medications (esp. those with pseudoephedrine). As for which drugs increase milk supply, there is a drug called Reglan (a.k.a., metoclopramide) that is sometimes used. However, the drug does have a black box warning on it, so I tend not to recommend it. There are also a few other drugs (not commonly accessible in the U.S., so I will not elaborate here). Some women have success with an herb called Fenugreek. If I were to use an herb, this is probably the one I would use (it has a good safety profile and is fairly effective). There are other herbs of note like alfalfa and blessed thistle (I have less experience with them and the safety profile is a bit less established).

Taking Care of Mom

Probably the most important aspect of milk production is appropriate care of the woman producing the milk. Lack of sleep, stress, and not eating well (doesn’t this sound like all new moms) can all contribute to less milk supply. I acknowledge that it is easier said than done, but try to get sufficient sleep. Eat well (especially high-protein foods). Consume enough calories (moms eager to lose baby weight may have strict diets that inhibit their body’s ability to make a good milk supply). Drink lots of water. Decrease your stress load. Stay healthy. All of these things will increase your milk supply.

Age of The Baby

Most babies start solid foods around 6 months of age. Since breast milk production is a supply and demand thing, most babies “demand” less milk as they eats solids. Consequently, most women gradually start to make less milk. You can help offset this effect by having other care givers feed more solid foods when you are not around, so you can breastfeed more when you are around.

Relax

Ultimately, relax. If you don’t make enough milk to feed your baby, it is ok. Many women have this “all or nothing” approach to breastfeeding. The truth is, any amount of breast milk you can give your baby is good. Certainly, something is better than nothing. Do what you can and use formula for the rest. It’s ok, you’re doing great.