So, you have low supply?
My first question to you…
Why do you think you have low supply?
Low supply is a common fear amongst breastfeeding women. The number of women with adequate milk production who believe they are not making enough milk is so common, it literally has a name:
Perceived Low Supply
Low pumping output is commonly mentioned as an indicator amongst women with supply concerns. While this may seem like definitive evidence, pumping output is NOT A PREDICTOR OF SUPPLY.
So how do we determine if we have low supply? We ask baby! If baby is not meeting these milestones, you may have true low supply concerns.
Very few women are truly unable to make milk. There are a number of situations such as certain hormonal imbalances, insufficient glandular development, or a history of breast surgery/trauma that may truly inhibit some woman from breastfeeding. Even some of these situations can be mitigated. For the average breastfeeding women, there are several common root causes for low supply that can be dealt with once they are identified.
Lets assume you do have low supply. Now lets talk about what you can you do to boost your production.
1. Figure out the reason your supply dipped
Breastfeeding is all about supply and demand.
If your breasts once made milk, they can make more milk.
‘The key is figuring out why supply has dipped in the first place. Check out this post to see if one of these 10 Common Reasons for Low Supply fits you. If none of these reasons seem to fit or if you are unsure, you should have a board certified lactation consultant come out and evaluate you and your baby during a feed. Many consultants take health insurance. Check with your insurance provider to see if your visit is covered!
For those of you who do not live in my neck of the woods, I offer phone consults to discuss any lactation concerns and will help you formulate a plan. We can discuss your low supply concerns and make and I will send you a wealth of resources and a detailed plan of action to help boost your supply. You can contact me HERE or read more about my SERVICES.
2. Feed the baby
Because breastfeeding is all about supply and demand, one of the best ways to boost supply quickly is to feed the baby… A LOT. Many working moms will see a dip in their supply as they progress through the workweek. This is because baby is at the breast less frequently and they are unable to pump as often as they would have been feeding baby at home.
Over the weekend, have a breastfeeding staycation. Let baby be on and off the breast on demand all day. This can mean every 1-1/2-2hrs baby is feeding. The constant stimulation and empting of the breast will send signals to make more milk! Skin to skin time actually increases oxytocin release. The more time mother and infant spend skin to skin, the more often they breastfeed. So snuggle up together and feed, Feed, FEED.
Ensure baby is being an active participant. The key is EMPTYING the breast. You should be offering both breasts each feed. Another technique is switching breast every time baby looses interest or begins to fall asleep. This can mean switching sides three or more times during feed to keep baby alert and feeding. Using hand compression to massage the breasts while baby is feeding is another helpful method of further empting the breast and keeping baby interested.
3. Good latch
A healthy latch is really sthe first step to establishing supply. If there is early latch dysfunction for any reason (preterm infant, tongue tie, flat nipples, sleepy baby, etc.), pumping and hand expression will need to be employed to keep supply healthy while baby grows and learns. This can take time depending on the reason for feeding difficulty. If there are issues with latch, I strongly encourage follow up with a board certified lactation consultant to help you work through these issues.
What makes a good latch? It should be juicy, it should be sustaining, and it should be pain free.
This means the baby should have a nice wide latch taking in areola as well as nipple. Lips should be flanged out and not tucked in. Baby will suck in active busts with pauses for swallows.
Once baby really gets on and pulls the nipple up into the roof of the mouth, they should be able to maintain the latch for extended periods. Initially, some infants will make several attempts (coming on and off the breast) before establishing a sustained latch. This is fine. What is not ideal is a baby that comes on and off frequently throughout the feed. This baby is having trouble sustaining a latch. Some baby’s are really good fakers. They have what can appear like a juicy latch and seem to be busily sucking away. They usually quickly loose interest at the breast and doze off because they are not really eating. A quick trick to test if baby is truly latched is to give a gentle pull of the breast from baby. If the nipple slips right out of baby’s mouth, the latch was shallow and not sustaining. If suction is maintained, baby has a good hold of the nipple and has managed to pull it up into the roof of the mouth.
This is important. Sometimes, the early stages of breastfeeding can cause some nipple pain and trauma for moms as their nipples cope with transitioning into a more “active” role. It is not normal for breastfeeding to be painful after the early days and it is not realistic to plan a sustained breastfeeding relationship if it hurts the mother. Beyond the pain for mom, it is usually a red flag for another issue that may ultimately be compromising supply (such as tongue tie). Some babies are able to compensate for being unable to create a juicy sustained latch and their methods are often painful and can cause nipple breakdown for the mother.
Some of these latch issues resolve with practice and time as baby grows and matures. Others may need intervention from a trained professional that can coach mom and baby how achieve a health latch.
How do I get a good latch?
How do we get a juicy, sustaining, pain free latch? There are lots of tips I could give you but here are the highlights. Make sure your baby is opening wide BEFORE you give the nipple. Tickle your baby’s lips with the tip of your nipple until you get a wide mouth ready to latch. If your baby is persistent trying to slurp in your nipple with a shallow latch… practice practice practice. Keep pushing for wider without letting baby get too frustrated. It can be a bit of a tight rope to walk, but if you persistently try for a deeper latch… you will notice improvement.
When your baby opens wide for that wide latch, you want to take that breast and plop the nipple right on top of babies tongue. By getting the nipple deep and on top of the tongue, you have done all the ground work for baby to get a deep latch. Hold your breast and baby stead while the baby negotiates getting the latch. It is helpful if your baby’s nose and your nipple are lined up. If baby is too high, it is difficult to get the nipple on top of babies tongue.
Hold your breast like a sandwich
What does that mean? You should be using sandwich hold while supporting your breast to help baby get a nice juicy bite. You need to maintain the sandwich hold while baby is working on getting the latch. It may take a couple of attempts before baby succeeds. Once you feel your baby get into a nice deep suck pattern, test the “sustainability” and then you can let go. For more detail about sandwich hold, click HERE.
Some babies, may need you to maintain the sandwich hole throughout the feed during the first few weeks. If you baby has a great latch but then keeps popping off, try supporting the latch for the hold feed. If you have an older baby that requires you to use sandwich hold for the whole feed, you may want to have an IBCLC come and evaluate for tongue tie and take a closer look at your baby’s latch.
4. Hand expression and Hands on pumping
This is such an important skill that every breastfeeding mother should know. While more research is needed to totally quantitate the benefits of hand expression, a few studies have begun to demonstrate it’s significance. A 2010 study examined mothers who were separated from their infant’s in the first 48 hours postpartum. They were taught hand expression and instructed to alternate with pumping every three hours. Hand expression yielded more than double the output.
Many mother’s pumping in the first few days of their infant’s life will get nothing. I routinely tell mothers in the hospital who need to pump for various reasons to not be discouraged if they get absolutely nothing initially. Yet, we know that part of establishing supply is empting the breast, not just manual stimulation.
Hand expression has been shown to be a more efficient means of extracting colostrum and has been demonstrated to influence later supply. It has been shown to be extremely beneficial to mothers of premies who are trying to establish their supply solely through pumping. I think hand expression is a widely underused tool that all breastfeeding mothers should be taught. Beyond ensuring better intake in the first few days of life, routine hand expression in the first three days postpartum can help moms establish a healthy supply from the get go.
HANDS ON PUMPING
HOP involves using manual breast massage while utilizing an electric breast pump to increase output. A 2009 study showed mothers using hands on pumping increased daily output by 48% despite pumping less time than the control group. A second study further demonstrated that mothers who used hands on pumping had higher fat content in their expressed milk. Manual massage and compression combined with the suction force of an electric breast pump is more efficient at completely empting the breast and extracting the fatty hind milk. By further empting the breast, we are boosting supply!
This technique is especially important for mothers who are working or find themselves pumping for extended periods of time. Electric breast pumps are not as efficient and removing breastmilk as infants. Employing hands on pumping is an important technique to maximize your pump sessions. For more information about getting MORE MILK from pumping, check out THIS POST.
5. Pump it up!
Pumping can be a powerful tool for increasing supply. How much milk you make is all about SUPPLY AND DEMAND. The more milk baby eats AND the more milk you pump, the more your breast will make. I have written a pretty comprehensive series on pumping that walks you through techniques to maximize your output. For a more in depth look at pumping , read PUMP MORE MILK, and the rest of the pumping series.
After you read about how to maximize your pumping output, next you can start using a technique called power pumping. Power pumping is a pumping technique used to mimic baby cluster feeding at the breast. Cluster feeding (and power pumping) results in repeatedly emptying the breast which jacks up your supply and demand curve. This technique is really helpful when you have a dip in supply. Some moms experience a dip when they return to work… Power Pumping to the Rescue! Best results are seen when power pumping is used for at least two to three consecutive days.
I highly recommend using some heat to help maximize your output (and supply) while power pumping. Heat has been shown to increase efficacy of milk removal from the breast. Warming dilates the milk ducts allowing for quicker and more efficient removal of milk. Mothers who use warmed breast shields report feeling more relaxed and comfortable during pumping sessions. As we know from our last header, comfort and relaxation have effects on milk ejection and only further support the benefits of using heat while pumping.
My absolute favorite hot pack is Lil Buds. Lil Buds are all natural breast comfort packs that can be heated or cooled for treatment of engorgement, clogged ducts or mastitis. They are also super handy to wear while breastfeeding and pumping because they fit snuggly in your nursing bra. You can read all about them HERE or purchase them direct HERE. Be sure to use the special discount code BORN&FED only available to my readers. Enter the code at check out and receive 10% off your Lil’ Bud order.
I know a lot of you are reading this list and thinking there is not a lot of information about increasing low supply. That is because most women do not have low supply, they need to boost supply. The best way to boost supply is through the body’s natural supply and demand mechanisms. Drinking more water, eating oatmeal, or whipping up a batch of lactation cookies have almost no research supporting its validity. In fact, most research points to herbal and food galactagogues having mostly a placebo effect. More research is needed to assess the effectiveness of medications such as X as and their use for mothers with but the general consensus is if you want to get more milk…empty the breast more.
The use of medications as galactogues
Did I forget Galactogogues (substances that increase milk production)? Nope. They didn’t make the list. More soon… I felt they warranted their own blog post.
Don’t Forget your Breast Pump Bag!
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Anderson, P. O., PharmD. (2013). Journal of Human Lactation. Galactogogue Bandwagon. 29(1), 7-10. doi:10.1177/0890334412469300
Medici, T. A. (2011). ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion (First Revision January 2011). Breastfeeding Medicine,6(1), 41-49. doi:10.1089/bfm.2011.9998
Morton, J., MD, FABM. (2012). Journal of Human Lactation. The Importance of Hands,28(3), 276-277. doi:10.1177/0890334412444930
Morton, J., Hall, J. Y., Wong, R. J., Thairu, L., Benitz, W. E., & Rhine, W. D. (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology,29(11), 757-764. doi:10.1038/jp.2009.87
Ohyama, M, Watabe, H, Hayasaka, Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int. 2010;52:39-43.
Widdows, ST, Lowenfeld, MF. A study of the composition of human milk. The influence of the method of extraction on the fat percentage. Biochem J. 1933;27:1400-1410.
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