Concerns about milk supply top the list of new-parent worries. Almost everyone who breastfeeds wonders, at some point, if they are making enough milk. The principles behind milk production are simple, yet our individual bodies, babies, and lives are not. This post is meant to cover the basics of milk supply and production. You may also want to read about the other side of the equation: the signs your baby is getting enough to eat.
If you have questions or concerns about your milk supply or how much milk your baby is getting from the breast, I cannot emphasize enough how important it is to visit an International Board Certified Lactation Consultant (IBCLC) for individualized assessment and guidance.
Milk production essentially has two stages—the first days and weeks after birth when you’re working to establish and build a milk supply, and the time after you’ve established your milk supply during which you need to maintain it. Two things are crucial to both building and maintaining your milk supply: frequent and thorough removal of milk from your breasts.
Give me frequent stimulation or give me preprogrammed cell death (involution)
Breasts need frequent stimulation whether you’ve given birth or are inducing lactation. Technically, breastfeeding or pumping 8 times in 24 hours is sufficient for building milk supply. However, more is better, and breastfeeding or pumping 10 or 12 times per day should, theoretically, yield a higher milk supply.
Milk removal at night is important and can make the difference between plentiful and not enough milk. Newborn babies, whether they’re fed by breast or bottle, should not be sleeping longer than 3 hours in a stretch and, ideally, your breasts will not rest that long, either. Prolactin is a hormone essential to milk production. Its levels in your body is higher at night, so your milk production capacity is greater then.
One way to help ensure that you’re calibrating your milk supply to your individual baby’s (or babies’) needs is to feed your baby when you notice feeding cues. This applies to newborns, who eat very frequently, and older infants, who often (but not always) eat less frequently. When you watch your baby’s cues, you’ll be providing them with the food, drink, comfort, and closeness they need when they need it.
The very early days after birth are essential to establishing milk supply and the more milk removal—whether by breastfeeding, hand expression, or pumping—in the first few days, the more milk you will have overall. (One study found a large difference between pumping output at 8 weeks between mothers who pumped or pumped and used hand expression.) Your milk supply continues to increase over the first several weeks to match your baby’s increasing needs, and, by 4 to 6 weeks, you should be making as much milk as you’ll be making until your baby starts solid foods—around 25 to 30 ounces per day.
Remove it, and remove it well
Breastfeeding or pumping must also be effective. Milk supply is calibrated partly by a substance called feedback inhibitor of lactation (FIL). When milk sits in the breast, this polypeptide encourages milk production to slow down to help avoid harm that can come from uncontrolled milk production (such as plugged ducts and mastitis). Plus, breastfeeding takes a lot of resources, and if milk isn’t needed, those resources would be better used elsewhere. In short, if milk isn’t being removed adequately, whether due to infrequent milk removal or ineffective milk removal, you will make less milk.
One of the big causes of ineffective breastfeeding is a latch that needs improvement. Often, a baby’s latch can be improved with simple positioning. Sometimes, it’s more complicated. One large red flag of a latch issue is sore nipples. They may be outright painful, bleeding, cracked, blistered, or bruised. Or it may just be uncomfortable to breastfeed. If you have pain with breastfeeding that isn’t improving with more practice on your own, find help sooner rather than later. A comfortable latch is a latch that is effective.
There are tricks to pumping well, too. Hands-on pumping makes pumping more effective. Ensuring that your flanges are sized properly can help, too, as can making sure your pump is working effectively.
But how can you TELL? I want numbers!
Like I mentioned earlier, the mechanics are simple but our babies and bodies may not be. Sometimes we want more data for our own piece of mind; sometimes we need more data to figure out how to apply interventions such as supplementation. There are times when it’s not enough to say “breastfeed frequently and make sure your baby is breastfeeding well,” because there are other issues at play. IBCLCs have other tools in their toolboxes to help tease out causes and effects, and to point the way toward solutions.
One technique that can provide further data is a test-weight feeding (also called a weighted feed). This is when, basically, you weigh a baby, breastfeed the baby, and weigh the baby again. When you consider things such as the age of the baby, gestational age at birth, whether this feeding was “good” or “bad” or “okay,” visual and audible signs of a good latch, etc., you can begin to flesh out the big picture. It’s important that test-weight feedings are done with a sensitive scale and by a person who has enough training and knowledge to interpret what they’re seeing.
Can pumping tell you if you’re making enough milk? Sort of. Pumping doesn’t tell you exactly how much milk you’re capable of producing or how much your baby is drinking from the breast. Babies who are breastfeeding well are better at extracting milk than pumps are, although the key word there is “well.” If a baby is not breastfeeding well, she may not be getting what you’re making. It’s common to have a well-fed breastfed baby and a low pumping output. There are many reasons why your pumping output might be low that don’t have anything to do with your milk supply.
That said, what you can express by hand or by pump can provide clues as to milk production. An IBCLC can help you unravel the mysteries of your milk supply by taking many factors into account, including the age of your baby, how much baby ate at the breast, how much milk you can express after a feeding, weight gain, and diaper output.
When your milk production is low
If you suspect that your milk supply is low, contact an IBCLC who can help assess you, your baby, and your milk supply. Without figuring out the root of the problem, the problem will not be fixed. For this reason, galactagogues should not be used as a first resort. While there is some evidence that they work at least some of the time, there are potential risks, and the largest benefit comes from using them along with good management of breastfeeding.
There are, unfortunately, no magic drinks, foods, herbs, or pills. Addressing the frequency and effectiveness of milk removal is essential to making the most of your ability to make milk.