Breast-feeding and your milk supply

A number of factors influence your milk supply; the two most important are how often you breast-feed and how well your breast is emptied. The hormone that regulates milk production (prolactin) is stimulated by breast-feeding, so the more frequently you feed your baby and empty your breasts, the more milk your body produces. Initially, your milk supply increases in the first few days as you feed your baby.

Your baby is likely getting enough milk when he or she:

• Has 6 to 8 wet cloth diapers every 24 hours. If you use ultra-absorbant disposable diapers, you may change closer to 4 to 6 wet diapers in this same period.
• Settles well after breast-feeding.
• Awakens every 1 to 3 hours to feed.

It is normal for a breast-feeding baby to lose up to 10% of his or her body weight and then gain it back by 2 weeks of age. After this initial weight loss, your baby will most likely gain weight steadily, at a rate of about 0.5oz to 1oz a day in the first few months.

Signs of poor eating are less reliable indicators of milk supply. Problems such as refusing the breast or frequent crying may not be related to low milk supply. Your doctor or lactation consultant can help you evaluate and solve these problems.

True milk insufficiency is rare. However, it takes time to establish your milk supply. When your milk supply does not seem to be adequate for your baby, try:

• Breast-feeding more often. Feed your baby on demand, which means whenever he or she wants to eat. Newborns need to breast-feed at least 10 to 12 times in a 24-hour period. Wake your newborn if it has been more than 2 hours since the last feeding. During growth spurts, your baby may seem very hungry. More frequent feedings will increase your milk supply, usually within 2 to 4 days.
• Breast-feeding for a longer period at each feeding.
• Feeding on one breast until it is empty, before changing to the other side.
• Helping your baby latch on properly.
• Improving your let-down reflex.
• Avoiding tobacco, excessive caffeine (more than 3 caffeinated drinks a day), and certain medications. If you plan to take birth control pills, talk to your health professional to determine when you should start.
• Getting enough rest, drinking plenty of water, and eating a balanced diet.

Your health professional or lactation consultant can help you determine whether you have a problem with milk supply and help you solve it.

Alternative remedies for low milk supply

Some women are advised to try herbal remedies to increase milk supply, such as fenugreek, fennel, or various herbal teas. However, do not use any of these remedies without first consulting your health professional. The effect of herbal remedies on milk supply has not been well studied. Some experts advise that some herbs (including fenugreek, fennel, comfrey leaf, and borage) may have negative effects on the baby. Also, allergic reactions can occur in the mother or the baby.

Although domperidone is available in some countries to treat gastric disorders, it is a medication that is not approved for any use in the United States. However, some breast-feeding women obtain this medication and take it to increase their milk supply. This medication increases milk supply by stimulating the production of the hormone prolactin. The U.S. Food and Drug Administration (FDA) has issued warnings for breast-feeding women to not take domperidone because of its potential dangerous side effects (such as irregular heartbeat and sudden death). Also, the drug has unknown effects on the breast-feeding infant.¹

Citations

1. U.S Food and Drug Administration (2004). FDA warns against women using unapproved drug, domperidone, to increase milk production. FDA Talk Paper T04-17. Available online: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01292.html.