Exclusive breastfeeding is recommended for the first 6 months of a baby's life and continued breastfeeding for at least 1 year of age adding in complementary foods after 6 months of age. The World Health Organization recommends breastfeeding up to 2 years of age and longer if mutually desired.(1)
There are many reasons parents might experience a bump in the road and have to supplement with donor milk or formula. Before eliminating formula or donor milk, you will need to increase your milk supply so you will be able to provide the appropriate amount of milk to your baby while reducing or stopping supplement feedings.
Where to begin
Identify what led to the use of supplements. The answer will help you plan the best way for you to increase your milk supply.
If your baby had latching difficulties and was not able to remove milk well causing a decrease in your supply, get in touch with an IBCLC for how to help your baby improve their feeding skills. Once you increase your supply, if your baby is not able to effectively remove milk because of unresolved latch and feeding challenges, milk production may decrease again despite your hard work.
Milk supply is driven by hormones after your baby is born. In the first few weeks postpartum, everytime your baby nurses, it gives information to the body about how much milk needs to continue to be made for your little one. Milk supply regulates based on that feedback and milk production follows the rules of supply and demand.
Strategies for increasing milk supply at your breast/chest
- Nurse more - offering to nurse more often will keep prolactin levels higher because each time your baby nurses and removes milk, it tells the body to make more milk. You will still need to continue supplementing until your supply begins to increase and you can safely begin to reduce the amount of formula being given and replacing it with nursing sessions. Using a tool like a supplemental nursing system ensures your baby will get the amount of food they need but every feeding is at your chest which means more stimulation for increasing milk production.
- Skin to skin - being skin to skin with your baby does a lot to boost your supply. Oxytocin is known as the love hormone, the bonding hormone and is the one responsible for milk release. Oxytocin is released during skin to skin contact, warmth and as soon as your baby begins to suck while breastfeeding. In fact, even just thinking about your baby or smelling the scent of your baby on their blanket can release oxytocin and trigger the milk ejection reflex.(2) When oxytocin is released, it causes the myoepithelial cells in the breast to contract and squeeze milk from the alveoli into the ducts and toward the nipple.(3)
- Wear your baby - Wearing your baby facilitates bonding with your baby and baby’s who are worn cry less and regulate easier being held close to your body. It is shown that babywearing increases the amount of time a baby nurses which can help increase and maintain milk supply as well as lead to longer total breastfeeding durations.(4)
- Nursing holiday - Take a “vacation” with your baby. Spend the entire day or a weekend, in bed, mostly skin to skin, relaxing and nursing with your baby. Nurse, rest and nourish your body with nutrient dense food and repeat.
- Middle of the night - It is biologically normal for babies to nurse during the night. It just so happens that the hormone, prolactin, responsible for making milk is naturally highest during the night between 2-5am. When you sleep with your baby in contact with you, you and your baby may wake more to feed, naturally responding to each other.(5) Safe co-sleeping parent and babies wake more often during the night but get more quality sleep.(6) Babies get about 20% of their calories from milk during the night.
Strategies for increasing milk supply with pumping
- Flange size and pump parts - The right tools to get the most milk is important. Having the correct flange size will make pumping more comfortable and remove more milk while pumping. Make sure to follow the recommendations for replacing pump parts to make sure they are all in their best working order.
- Massage your chest before you begin to pump - Prepare your breasts by gently stroking or massaging. Moving the tissue around gets milk moving and ready to flow more easily when you begin to pump. Touch should be gentle and as soft as you would stroke your baby’s face. Oxytocin is released during touch so you may begin to leak a little milk as your supply increases. Breast massage can help manage any stuck milk and help increase your overall supply.(7)
- Heat - Using a heat pack, like the Breast-Ease, encourages milk output and the milk ejection reflex or let down.(8) Apply heat before and during your pumping session.
- Breast compressions - using your hands during pumping to compress your breast/chest tissue can help move milk through the ducts. You will get more milk out with this hands on technique.
- Hand express at the end of each pump session - Ending with hand expression removes more milk and can boost your production. Many people respond better to hand expression than they do to pumping and it is a valuable skill for all lactating parents to know.
- Power pump - Replace or add one hour of “cluster feeding” with your pump. Power pumping is a method of alternating pumping and resting for a total of one hour. You can experiment to find intervals of time that work best for you or follow a pattern on the pump for 10 minutes and rest for 10 minutes and repeat until you have reached one hour of time. By resting in between and then beginning to pump, you are stimulating your milk ejection reflex more often as well as signaling prolactin. Some people notice results from power pumping in just a couple days, while other people do not see results for closer to a week.
- Increase total amount of pumping sessions - Add another session of pumping into your day or overnight. Most people need between 8-10 milk removals minimum to maintain their milk supply. If you are trying to increase your supply, pumping more frequently and during the middle of the night sends the message that your baby is taking more milk and the demand for more milk will trigger more milk production.
- Middle of the night - Going too long between milk being removed will slow down milk production. Prolactin’s circadian rhythm follows a pattern of being highest during the night and very early morning hours and lower later in the day. Going too long at night between milk removals signals to slow production and affects your next day's supply. Find ways that you can pump your milk during the night and still get your rest. Setting up a nighttime pump station with everything you need right beside you will make those sessions not as disruptive.
More help for boosting supply
- Galactogogues - There are many foods and herbs that support lactation and milk supply. Include a variety of whole foods in your diet and avoid processed foods. Some foods that help boost nutrition and increase milk supply include leafy green vegetables, oats, raw nuts and seeds, seaweed, chia seeds, beans and lentils.
- Supplements - herbs and herb blends are a great way to help increase your milk supply as you address underlying issues and make dietary changes that support overall health. Which supplement you take will depend on your unique health history. Some herbs like fennel and anise in Lechita and Liquid Gold can help improve digestive health. Moringa and nettles in Milkapalooza and Cash Cow are nutritional powerhouses and can improve vitamin and mineral status. Black cumin seed in Pump Princess, can increase insulin sensitivity and breast milk refill rate.
- Avoid pacifiers - Instead of using a pacifier, let your baby nurse every time they want to suck including for comfort. Every time your baby removes milk, it signals more milk to fill the cells. Using pacifiers interferes with the number of times a baby breastfeeds. It is normal for babies to nurse for some shorter periods of time during the day and other times for a longer, more full feeding. Breastfeeding meets the needs for calories, but is about much more than just calories including being comforted, helping a baby to fall asleep and attachment so it makes sense that they may ask to nurse many times day and night.
- Find a local or online support group to connect with others. It always feels good to share experiences with others in the same situation and talk about what is working, what is not and to know you are not alone in this journey.
Footnotes:
- https://www.bfmed.org/assets/DOCUMENTS/abm-position-breastfeeding.pdf
- https://www.ncbi.nlm.nih.gov/books/NBK148970/#:~:text=The%20oxytocin%20reflex%20is%20also,to%20get%20the%20milk%20easily.
- https://www.infantjournal.co.uk/pdf/inf_054_ers.pdf
- https://pubmed.ncbi.nlm.nih.gov/22734604/
- https://cosleeping.nd.edu/assets/135560/emph_2014_mckenna_nightwaking_copy.pdf
- https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007
- https://pubmed.ncbi.nlm.nih.gov/31135656/
- https://www.researchgate.net/publication/221712891_Does_Warming_the_Breasts_Affect_the_Amount_of_Breastmilk_Production
Resources:
https://www.legendairymilk.com/blogs/news/power-pumping?_pos=1&_sid=aff74b0e4&_ss=r
https://www.legendairymilk.com/blogs/news/feher-pumping-challenge?_pos=2&_sid=aff74b0e4&_ss=r
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