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Remedies for Low Milk Production

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Are you having trouble with your milk supply? If so, don't give up on breastfeeding! Here are some tips to help you boost your supply.

Did you know that low milk supply issues, whether real or perceived, is one of the most common reasons moms give up on breastfeeding? If you are having trouble with your milk supply, the first action to take is to consult a local lactation consultant. Many times mothers believe their milk production is inadequate when this is not the case.

During a consultation, the lactation professional will weigh your baby before and after the feeding to approximate the amount taken during this feeding. Sometimes, this is all that is needed to ease maternal anxieties related to milk production. 

Low milk production issues can arise for a variety of reasons. Mechanical issues related to breastfeeding, such as incorrect latch, ineffective milk removal, and infrequent feedings and/or short breastfeeding duration, can affect milk supply. Physiological issues, such as a retained placenta, insufficient glandular tissue, or conditions such as polycystic ovarian syndrome, can also negatively affect milk production. The type of birth control you are using can also decrease your milk supply. This is why consulting a lactation consultant is of utmost importance.
 
Ensuring adequate and frequent milk removal is key to maintaining a good supply. Skin-to-skin contact, breast massage, and pumping are all effective techniques to help increase your milk supply. Therapies such as acupuncture can be effective treatments to boost milk supply.
 
Breast Compression
 
Breast compression aides in increasing milk production by helping to drain the breast. Utilize breast compression during feeds and/or pumping. Here is Dr. Jack Newman's step-by-step instructions for performing breast compression:
  1. Hold the baby with one arm.
  2. Support your breast with the other hand, encircling it by placing your thumb on one side of the breast (thumb on the upper side of the breast is easiest), your other fingers on the other, close to the chest wall.
  3. Watch for the baby’s drinking, (see videos at nbci.ca ) though there is no need to be obsessive about catching every suck. The baby gets substantial amounts of milk when he is drinking with an “open mouth wide—pause—then close mouth” type of suck.
  4. When the baby is nibbling at the breast and no longer drinking with the “open mouth wide—pause—then close mouth” type of suck, compress the breast to increase the internal pressure of the whole breast. Do not roll your fingers along the breast toward the baby, just squeeze and hold. Not so hard that it hurts and try not to change the shape of the areola (the darker part of the breast near the baby’s mouth). With the compression, the baby should start drinking again with the “open mouth wide—pause—then close mouth” type of suck. Use compression while the baby is sucking but not drinking!
  5. Keep the pressure up until the baby is just sucking without drinking even with the compression, and then release the pressure. Release the pressure if baby stops sucking or if the baby goes back to sucking without drinking. Often the baby will stop sucking altogether when the pressure is released, but will start again shortly as milk starts to flow again. If the baby does not stop sucking with the release of pressure, wait a short time before compressing again.
  6. The reason for releasing the pressure is to allow your hand to rest, and to allow milk to start flowing to the baby again. The baby, if he stops sucking when you release the pressure, will start sucking again when he starts to taste milk.
  7. When the baby starts sucking again, he may drink (“open mouth wide—pause—then close mouth” type of suck). If not, compress again as above.
  8. Continue on the first side until the baby does not drink even with the compression. You should allow the baby to stay on the side for a short time longer, as you may occasionally get another letdown reflex (milk ejection reflex) and the baby will start drinking again, on his own. If the baby no longer drinks, however, allow him to come off or take him off the breast.
  9. If the baby wants more, offer the other side and repeat the process.
  10. You may wish, unless you have sore nipples, to switch sides back and forth in this way several times.
  11. Work on improving the baby’s latch.
  12. Remember, compress as the baby sucks but does not drink. Wait for baby to initiate the sucking; it is best not to compress while baby has stopped sucking altogether.
 
Pumping
 
A hospital-grade double electric pump can be a very helpful tool for increasing your milk supply and can often be rented by the day, week, or month. Contact a local hospital, lactation consultant, or breastfeeding boutique to find a rental station near you. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) also provides breast pumps to low-income mothers eligible to receive WIC. Contact your local WIC office for more information on this program.
 
To help boost your milk supply, be sure that you are feeding your baby or pumping frequently (eight to twelve times in a 24 hour period) and draining both breasts at every feeding/pumping session. Hand expressing or pumping after each feeding for approximately 5-15 minutes will help to stimulate milk production and will ensure breasts are fully drained. Do not skip feedings. 
 
Begin pumping by setting your pump to a rapid cycle speed and at a low suction level. Once your milk has let down, reduce the pumping speed and increase the suction level. Adjust your pump to your maximum comfortable vacuum and ensure that the pump flanges fit your breast correctly. It is estimated that over 50% of moms will need another flange size than the one provided in the standard accessory kit and that 75% of moms will need a larger flange size two weeks after pumping has started1. How do you know if your breast shield is the right size? Watch your breast during a pumping session and look for the following:  
  • Space is visible around your nipple when inserted into the breast shield. 
  • Your nipple should not rub against the side of the flange 
  • Your nipple should move freely within the tunnel.
Adding breast massage while pumping has been shown to increase daily milk volume by approximately 48%. This is known as "hands on pumping." Here is a great informative video with step-by-step instructions for "hands on pumping": Maximizing Milk Production with Hands On Pumping. Dr. Jane Morton's steps for hands-on pumping are:
  1. Massage both breast.
  2. Double pump and set the pump at the maximum suction level that is comfortable for you.
  3. When the sprays of milk subside, stop pumping and massage your breasts again.
  4. Single pump and/or hand express both breasts to ensure complete breast drainage.
  5. Alternate breasts and be sure to pay attention to the outer margins of the breast.
"Power-pumping" can be used to jump-start your milk production. This technique mimics a baby feeding frequently and tricks the body into making large quantities of milk. Here's how to power-pump:
  1. Pump for 10-12 minutes.
  2. Turn the pump off and rest for 10-12 minutes.
  3. Repeat Step 1 & 2 for one hour once a day.
  4. It can take a week for your milk volume to increase, so be patient and don't get discouraged.
 
Galactogogues

 

             Organic Milkmaid Tea

Organic Milkmaid Tea
Galactogogues are agents such as medications and herbs which stimulate breast milk production. Be sure to check with your doctor before taking any medication or before starting any herbal supplementation.
 
Herbs:
  • Fenugreeka spice frequently used in Middle Eastern and African cooking, is the most commonly used herbal galactogogue among clinicians. Fenugreek can be taken in tea or capsule form and can be found at your local health store. Currently, there are no scientific studies that prove fenugreek increases milk supply. The FDA has said that fenugreek is safe but should not be used during pregnancy. Most clinicians recommend taking three fenugreek capsules three times a day. Fenugreek supplements usually stimulate milk production within 24-72 hours.  Some women may be extra sensitive to the effects of fenugreek and may only need one capsule two-three times a day while others may need to add another galactogogue such as blessed thistle to increase milk production. Once milk supply is re-established, fenugreek supplementations can be discontinued. Fenugreek may cause a maple-syrup odor to mom and baby’s sweat and urine and may cause diarrhea, gassiness, and fussiness. Fenugreek may also lower your blood sugar and may cause allergies in people with history of asthma.
  • Blessed thistle (Cnicus Benedictus), a Mediterrean herb having anti-bacterial and anti-inflammatory properties, is another herbal galactogogue. Blessed thistle may contain some levels of alcohol and may cause an allergic reaction in individuals allergic to ragweed. Usual dosage is three capsules three times a day or 20 drops of the tincture three times a day. Fenugreek and blessed thistle work well when taken together.
  • Fennel seed (Foeniculum vulgare), another popular herb used in Mediterrean cooking, can be used to boost breast milk production and has been used to ease colic. Recommended dose is 5-7 grams of seed per day as a tea. Fennel is believed to be estregenic and may reduce milk supply.
  • Goat's Rue (Galega officinalis) comes from the same family as fenugreek. Recommended dosage is 1 teaspoon of dried herb steeped in 1 cup of water twice a day or 1-2 mL of tincture three times a day.
  • Other herbal galactogogues include: Milk Thistle, Caraway Seeds, Lemo Balm, Chastetree Berry, Raspberry Leaf, and Stinging Nettle.
Medications:
 
If continuing to have low milk production, speak with your physician about prescribing Reglan (metoclopramide) or Motilium (domperidone).  Domperidone is considered superior to metoclopramide since it has fewer side effects and does not cross into the brain tissue.
 
Below are some resources for mothers experiencing low milk supply:
 
Don't forget to take care of yourself during this time. Rest when you can, keep hydrated, eat nutritiously, and take some time to relax.

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Referenced:
1.  Texas Department of State Health Services Nutritional Services and Texas Association of Local WIC Directors. Lactation Counseling and Problem Solving Syllabus, pg 41. Attended January 2011.

Sources:
Academy of Breastfeeding Medicine. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion (First Revision January 2011). BREASTFEEDING MEDICINE: Volume 6, Number 1, 2011.
Dr. Jack Newman. Breast Compression
LactMed: Blessed Thistle
LactMed: Domperidone
LactMed: Fennel
LactMed: Fenugreek
LactMed: Goat's Rue
LactMed: Metoclopramide
Hale, T. (2010). Medications and Mothers' Milk (14th Edition). Hale Publishing: Texas.
Higgins, K (2005). The Nursing Mother's Companion (20th edition). Boston: The Harvard Communications Press.
Walker, M (2011). Breastfeeding Management for the Clinician (2 edition). Boston: Jones and Bartlett Publishers.
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