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Increasing My Milk Supply??

Posted by on Jul. 25, 2010 at 4:39 PM
  • 3 Replies

Hey Mamas!

I think I have messed up and let my milk supply diminish some.  I've had a hectic week and have not got to nurse or pump on my regular schedule.  Is there any way I can get my supply back up to par with my baby?  I've heard to nurse or pump every 2 hours..is that true?  And how long should each pumping/feeding session last?  My LO usually eats every 3 or so hours, so should I nurse her on both sides for however long she wants and then pump for a bit after she's done?  Or should I just feed her my stored milk whenever she's hungry and pump every 2 hours?  UGH.......I'm so lost!  I just know that I want to BF (EBF for that matter!) and I don't want to lose my supply totally!

I've been nursing DD on both sides until she pulls away, but she still seems hungry so I give her a bottle w/ breastmilk.  I just fear that with my supply going down, I'll run out of my stored up milk quickly.

Thanks so much in advance for your help!

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by on Jul. 25, 2010 at 4:39 PM
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Replies (1-3):
tabi_cat1023
by Group Admin -Tabitha on Jul. 25, 2010 at 5:12 PM

JUST nurse no bottles, baby is used to the fast flow of the bottle and giving that bottle will make matter worse..just nurse if baby is hungry baby can nurse more milk is always there just slowed

kyriesmommy13
by on Jul. 25, 2010 at 5:14 PM

 

Increasing Low Milk Supply

By Kelly Bonyata, BS, IBCLC

Is your milk supply really low?

First of all, is your milk supply really low? Often, mothers think that their milk supply is low when it really isn't. If your baby is gaining weight well on breastmilk alone, then you do not have a problem with milk supply.

It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are not valid ways to determine if you have enough milk for your baby.

What if you're not quite sure about baby's current weight gain (perhaps baby hasn't had a weight check lately)? If baby is having an adequate number of wet and dirty diapers then the following things do NOT mean that you have a low milk supply:

  • Your baby nurses frequently. Breastmilk is digested quickly (usually in 1.5-2 hours), so breastfed babies need to eat more often than formula-fed babies. Many babies have a strong need to suck. Also, babies often need continuous contact with mom in order to feel secure. All these things are normal, and you cannot spoil your baby by meeting these needs.
  • Your baby suddenly increases the frequency and/or length of nursings. This is often a growth spurt. The baby nurses more (this usually lasts a few days to a week), which increases your milk supply. Don't offer baby supplements when this happens: supplementing will inform your body that the baby doesn't need the extra milk, and your supply will drop.
  • Your baby nurses more often and is fussy in the evening.
  • Your baby doesn't nurse as long as she did previously. As babies get older and better at nursing, they become more efficient at extracting milk.
  • Your baby is fussy. Many babies have a fussy time of day - often in the evening. Some babies are fussy much of the time. This can have many reasons, and sometimes the fussiness goes away before you find the reason.
  • Your baby guzzles down a bottle of formula or expressed milk after nursing. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop (see below).
  • Your breasts don't leak milk, or only leak a little, or stop leaking. Leaking has nothing to do with your milk supply. It often stops after your milk supply has adjusted to your baby's needs.
  • Your breasts suddenly seem softer. Again, this normally happens after your milk supply has adjusted to your baby's needs.
  • You never feel a let-down sensation, or it doesn't seem as strong as before. Some women never feel a let-down. This has nothing to do with milk supply.
  • You get very little or no milk when you pump. The amount of milk that you can pump is not an accurate measure of your milk supply. A baby with a healthy suck milks your breast much more efficiently than any pump. Also, pumping is an acquired skill (different than nursing), and can be very dependent on the type of pump. Some women who have abundant milk supplies are unable to get any milk when they pump. In addition, it is very common and normal for pumping output to decrease over time.

See also Is my baby getting enough milk?

 

Who to contact if you suspect low milk supply

If you're concerned about your milk supply, it will be very helpful to get in touch with a La Leche League Leader or a board certified lactation consultant. If your baby is not gaining weight or is losing weight, you need to keep in close contact with her doctor, since it's possible that a medical condition can cause this. Supplementing may be medically necessary for babies who are losing weight until your milk supply increases. If supplementing is medically necessary, the best thing to supplement your baby with is your own pumped milk.

 

Potential causes of low milk supply

These things can cause or contribute to a low milk supply:

  • Supplementing. Nursing is a supply & demand process. Milk is produced as your baby nurses, and the amount that she nurses lets your body know how much milk is required. Every bottle (of formula, juice or water) that your baby gets means that your body gets the signal to produce that much less milk.
  • Nipple confusion. A bottle requires a different type of sucking than nursing, and it is easier for your baby to extract milk from a bottle. As a result, giving a bottle can either cause your baby to have problems sucking properly at the breast, or can result in baby preferring the constant faster flow of the bottle.
  • Pacifiers. Pacifiers can cause nipple confusion. They can also significantly reduce the amount of time your baby spends at the breast, which may cause your milk supply to drop.
  • Nipple shields can lead to nipple confusion. They can also reduce the stimulation to your nipple or interfere with milk transfer, which can interfere with the supply-demand cycle.
  • Scheduled feedings interfere with the supply & demand cycle of milk production and can lead to a reduced supply, sometimes several months later rather than immediately. Nurse your baby whenever she is hungry.
  • Sleepy baby. For the first few weeks, some babies are very sleepy and only demand to nurse infrequently and for short periods. Until baby wakes up and begins to demand regular nursing, nurse baby at least every two hours during the day and at least every 4 hours at night to establish your milk supply.
  • Cutting short the length of nursings. Stopping a feeding before your baby ends the feeding herself can interfere with the supply-demand cycle. Also, your milk increases in fat content later into a feeding, which helps baby gain weight and last longer between feedings.
  • Offering only one breast per feeding. This is fine if your milk supply is well-established and your baby is gaining weight well. If you're trying to increase your milk supply, let baby finish the first side, then offer the second side.
  • Health or anatomical problems with baby can prevent baby from removing milk adequately from the breast, thus decreasing milk supply.

See Reasons for Low Milk Supply and Hidden Hindrances to a Healthy Milk Supply from more information on things that can decrease milk supply.

 

Increasing your milk supply

Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

  • Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.
  • Nurse frequently, and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.
  • Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).
  • Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
  • Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to manage breastmilk intake. This can be particularly helpful for sleepy or distractible babies.
  • Avoid pacifiers and bottles. All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).
  • Give baby only breastmilk. Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.
  • Take care of mom. Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.
  • Consider pumping. Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
  • Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.

 

Page last modified: 03/29/2010
Written: 05/13/1998

http://www.kellymom.com/bf/supply/low-supply.html

 

kyriesmommy13
by on Jul. 25, 2010 at 5:16 PM

 

I'm not pumping enough milk. What can I do?

By Kelly Bonyata, BS, IBCLC

Introduction

Milk supply normally varies somewhat throughout the day and over weeks and months. As long as baby is allowed to nurse on cue, your milk supply will accomodate baby's needs. However, when mom is pumping part-time or full-time, pumping output can become an issue due to a few factors:

  • The ability to measure how much milk you are pumping makes any decrease in pumping output more obvious and more worrying, even if it's a normal variation.
  • Pumping moms generally need to pump x amount of milk for baby for a particular day, and it can be quite stressful when mom does not pump this amount.
  • No pump can remove milk from the breast as well as an effectively nursing baby, so pumping does not maintain milk supply as well as a nursing baby. Because of this, the greater the percentage of baby's nourishment provided by pumping (rather than direct breastfeeding), the greater the possibility that mom may have to work harder to maintain supply.

What is normal when it comes to pumping output and changes in pumping output?

Most moms who are nursing full-time are able to pump around 1/2 to 2 ounces total (for both breasts) per pumping session. Moms who pump more milk per session may have an oversupply of milk, or may respond better than average to the pump, or may have been able to increase pump output with practice. Many moms think that they should be able to pump 4-8 ounces per pumping session, but even 4 ounces is an unusually large pumping output.

It is quite normal to need to pump 2-3 times to get enough milk for one feeding for baby (remember that the pump cannot get as much milk as a baby who nurses effectively).

Many moms are able to pump more milk per session when they are separated from baby. Milk pumped when you are nursing full-time is "extra" milk -- over and beyond what baby needs. Don't get discouraged if you are trying to build up a freezer stash when nursing full time and don't get much milk per pumping session -- this is perfectly normal and expected.

It is very common to have more milk than baby needs in the early weeks, which regulates down to baby's needs over the first few weeks or months. When your milk supply regulates (this change may occur either gradually or rather suddenly), it is normal for pumping output to decrease. For moms who have oversupply, this change often occurs later (6-9+ months postpartum rather than 6-12 weeks).

It is normal for pumping output to vary from session to session and day to day. Having an occasional low volume day is not unusual.

During a growth spurt, don't be surprised if baby drinks more expressed milk than usual, making it harder for mom to provide enough expressed milk. Growth spurts are temporary - try increasing nursing and adding a pumping session or two at home until the growth spurt is over.

Menstruation or ovulation can result in a temporary drop in milk supply. You might also notice cyclical dips in milk supply before your period returns, as your body begins the return to fertility. Hormonal changes also cause milk supply to decrease during pregnancy.

Remember that the amount of milk that you pump is not a measure of your milk supply!

 

What can cause a decrease in pumping output?

First, consider the possibility that baby is being overfed when you're apart. If this is the case, you may actually not need to be expressing as much milk as is being requested. This is certainly not always the case, but it is not at all uncommon. See How much expressed milk will my baby need? for additional information.

When you do need to pump more milk, the first thing to check is your pump:

  • Are you using an appropriate pump for the amount of pumping that you do?
  • How old is your pump? If you have an older electric pump (particularly older than a year), or if you are pumping more often than the pump was designed for, the motor may be wearing out.
  • Many times a decrease in pumping output is because pump parts need to be replaced. Have you checked your pump and replaced any parts that are worn or that haven't been replaced in the last 3-6 months?
  • Do you have a type of pump (like the Avent Isis) that benefits from occasionally boiling the boilable parts?
  • Switching to a larger pump flange makes a difference in pumping comfort and/or output for some moms. See Choosing a Correctly-Fitted Breastshield for more information.

Supply-demand cycle:

  • Have you reduced the number of pumping or nursing sessions recently, or cut back on nursing/pumping in other ways? Milk production is a demand-supply process. More nursing/pumping results in a greater milk supply. If you consistently decrease nursing or pumping for several days, your overall milk supply will decrease and you can expect to see a decrease in pumped amounts.
  • Has baby started solids recently? As baby eats more solids and takes in less milk, overall milk supply naturally decreases and you may see a decrease in pumping output. You may not notice a change in nursing pattern, as some babies nurse just as often, but take in less milk during those sessions. If baby started solids early (before around 6 months) or is eating lots of solids early on, you are more likely to notice a drop in supply. A very gradual start to solids around 6 months or later is less likely to affect milk supply.

Hormonal causes of decreased milk supply:

  • Have you started hormonal birth control recently? Hormonal birth control, particularly that containing estrogen, can significantly decrease milk supply.
  • Are you expecting either ovulation or your period soon, or has it recently started?
  • Are you pregnant?

Taking care of mom:

  • Have you started a strict diet? Are you getting enough calories? Snacking during the day on healthy, protein-rich foods may be helpful.
  • Are you drinking to thirst? Some moms, particularly when they are at work, will get busy and forget to drink enough fluids.
  • Are you getting enough rest? This can be hard to do when you have a baby. Try to go to bed a little earlier and to take a nap each day on your days off. Consider co-sleeping so you can get more sleep. Just a little added rest may make a big difference.
  • Have you been under an unusually large amount of stress? Stress can affect let-down and pumping output.
  • Have you been sick? Illness, especially if you have a fever, mastitis or get dehydrated, can result in a temporary decrease in milk supply. Some medications can also decrease milk supply (hormonal birth control, pseudoephedrine, ethanol/alcoholic beverages, bromocriptine, ergotamine, cabergoline).

See also Hidden Hindrances to a Healthy Milk Supply

 

How can I increase pumping output?

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

Increasing frequency

  • Nurse more often when you are with your baby.
  • Are you pumping frequently enough? Is there any way you can add a pumping session at work? If necessary, when pumping times are very limited, adding even a short 5 minute pumping session is better than not pumping at all.
  • Add a pumping session or two outside of work hours or on the weekend. Try pumping after baby nurses, or pump one side while baby nurses on the other side. You might also try pumping while baby is napping, at night, or when baby goes longer than usual between nursings.
  • Does your baby complain about slower milk flow when you pump between nursings? If so, try single pumping between nursings, instead of double pumping. Although single pumping is not as effective for increasing milk supply, this leaves one breast more full, so the milk will flow more quickly. See also these tips for babies who want a faster milk flow.
  • Try cluster pumping, instead of a regular nursing/pumping session. Sit down with your baby and your pump, and nurse and pump every half-hour to hour for several hours.
  • Some moms find it helpful to do a 2-3 day long power pump every couple of weeks to "super charge" their milk supply. This is simply a nursing vacation with pumping added in. On these days, get lots of rest, nurse very frequently and pump after as many nursing sessions as possible.

Removing more milk from the breasts

  • Are you pumping long enough? When pumping to increase milk supply, it's recommended that you (double) pump for at least 15 minutes; to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. If you don't always have time to pump this long, remember that adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.
  • Use a good double pump. Double pumping generally results in better pumping output and is better for maintaining milk supply. Pump quality can make a huge difference in pumping output, and different moms have better results with different pumps. However, some moms with abundant milk supplies do not respond well to pumping (even using the best of pumps) and do not get much milk when pumping. These moms may get better results using manual expression.
  • Use breast massage (see "Assisting the Milk Ejection Reflex" toward the bottom of the link) and breast compression.
  • If your pump has a soft shield or shield insert available (for example, the Medela SoftFit breastshield or the Avent "Petal" massager insert), then try using the pump with and without it. Some moms have also found that they can use the Avent "Petal" massager inserts with other brands of pumps (for example, Medela or Ameda). Some moms get better results with the softer shield; some get better results without it.
  • Switching to a larger pump flange increases pumping output for some moms.

Galactagogues

  • Many working and pumping moms have found that eating oatmeal is very helpful for increasing pumping output. It can also be helpful to snack on protein-rich foods during the day and to have something to drink every time you sit down to pump or nurse.
  • Many moms have gotten good results using fenugreek or other herbs to increase supply, either on a short- or long-term basis. This is most effective when combined with increased nursing/pumping.

 

Other things to try

The following things are useful for maximizing nursing and minimizing the amount of expressed milk that baby needs while you are away.

Nurse right before you leave baby and immediately after you return from work. Make sure your care provider does not feed baby right before you are due to return.

Has your baby started solids? If so, have your care provider offer all (or most) solids, and only (or mainly) breastfeed when you are with baby. By doing this, baby may need less milk when you are apart (due to the solids) and will nurse more when you are together. This can both help your supply (more nursing) and decrease the amount of pumped milk you need to provide.

Encourage baby to "reverse cycle" - reverse cycling is when baby nurses frequently when mom and baby are together (usually at night) and takes little milk when mom & baby are separated.

 

Page last modified: 03/30/2010
Written: 05/02/03

http://www.kellymom.com/bf/pumping/pumping_decrease.html


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