How to increase milk supply

There are 3 main reasons why breasts may not make enough milk:

Infrequent or ineffective removal of milk

Hormone or hormone receptor issues

Anatomical problems including insufficient tissue and breast surgery.

1.Infrequentand ineffective removal.It is recommended that a baby breastfeed within the first half hour to hourafter birth andthen on demand (usually every 2 to 3 hours), including during the night. This is often aproblem I the hospital settings.

 

There are also cases where the baby breastfeeds frequently, but the removal is noteffective

Sleepy babies

Baby with a weak suck ( premature)

Babies with anatomical issues such as a tongue tie.These babies may not be able to stimulate the breast and remove milk effectively. If milkis not removed from the breast, the production will begin to decrease.2.Hormonal and Hormone receptor issues.Certain hormonal problems may leadto lower milk production.

These include

Polycystic Ovarian Syndrome

Insulin resistance

ThyroidDysfunction

Increased Testosterone levels

Prolactinoma

Pituitary tumors

Pituitary insufficiencies

Growth Hormone deficiencies

Late onset Congenital Adrenal HyperplasiaThe following conditions may cause hormonal changes that lead to poor milk production

Pre–eclapmsia

Severe blood loss

Abrupt blood pressure changes during or after birth3.

Anatomical Problems of the breast:

Insufficient Glandular tissue/Hypoplasia. Breasts did not mature completely duringpubertyDuctal Outlet Obstruction: Alveolar cells make enough milk but milk cannot exit.Women become engorged and milkcan’tbe removed by baby pump or hand

Breast reduction Surgery

Breast Augmentation

4.Medication can lower milk supply:

Sedating antihistamines like diphenhydramine

Pseudoephedrine

Estrogen

Estrogen vaginal cream

Bromocriptine.

CabergolineSigns of ineffective breastfeeding and low supply:

Infant weight loss more that 7% at day 3–4

Continued weight loss after post birth day 3

Regained birth weight ant day 10 to 14

No audible swallowing

Lessthat < 6 wet diapers

< 3 stools per day after day 4

Infant restless/irritable or very lethargic

Minimal/no breast changes by day 5 after delivery

Persistent/ Increasingly sore nipplesWhatelsecan interfere with your supply?

Wrong shallow latch

Notdraining the breasts frequently

Watching the clock and not baby

Giving top–ups

Smoking can decrease breast milk

Herbs like sage and mint

Starting a hormonal contraceptive

Using meds like antihistamines and flu meds

Alcohol

Another pregnancy

Dummies insteadof feedingGeneral business above the normal activityOvertirednessEating disorder’sNot drinking enough fluidsBreast surgeryStrategies to increase milk supply:Milk removal = more stimulation = more milk production1. Provideadequate infant nutrition if there is no weight gain or anomalies that prevents optimalfeeding:Introduce a complementary rather than a supplementary feed ofexpressedbreast milkor formula if no breast milk is available.Make use of supplementary nursing systems to help maximise stimulation of the breastand to encourage baby to suck on the breast.Feed the baby expressed breast milk via cup or syringe or make use of paced bottle asan alternative if unable to breastfeedNipple shield can be helpfulto facilitate a better latch and improve breastfeedingTest weighs after feeds to establish the intake of breast milk.

Follow the baby up frequently to ensure good weight gain.2.Maintain the milk supply.Help the mother to maintain milk supply if shecannot feed the baby or the baby has lowweight gain by making use of hand expressing, massage or an electric breast pump.Express frequently by hand or use a good hospital grade or double electric breast pumpuntil the problem is sorted out.Feed the baby expressed breast milk via cup or syringe or make use of paced bottlefeeding,3.Maximize breast stimulation and complete breast emptying:a.Breastfeed on demand:8–12 feeds a dayFrequent unlimitedfeeds will stimulate milksynthesis and increasesupply.Do not time the feeds. Le baby finish the one breast before moving to the second breastRespond to feeding cues and no set routines.Avoid the use dummies to replace a feed or extend gaps between feeding.Wake the sleepy baby(especially if baby isjaundiced or premature)for feeds. Make sure babyfeeds at least8–10 times a day.b.Switch nursing:feed on both sidesStart feeding on one breast and if baby falls asleep or stops sucking switch to the second breastand again to the first one.Frequent emptying of the breast will stimulate the milk supply as well as switching will help thesleepy baby to be more wakeful and take in more milk.c.Empty and drain the breasts well after feeds;Too full breasts that are not drained frequently can cause the feedback inhibitory system toslow down milk synthesis and reduce the supply.Hand express or use a pump to drain the breasts well after every feed even if only smallamounts can be expressedd.Monitorforswallowing and active feeding.Infants can spend along time on the breast doing NNS and not removing any milk. They fallasleep and it can be confused with good feeding.Watch out for signs of active Nutritive sucking and deep jaw movements and signs ofswallowing.The breast will feel softer after a feedif the baby fed well.e.Breast compressions:Compressing the breast when baby is sucking but not drinking will help to increase the supplyand help to continue the milk flow when baby is only sucking. It will stimulate the let–downreflex and encourage baby to feedBreast compressions are helpful if your baby is lethargic or jaundiced or has a low muscle toneand uncoordinated SSB cycles (premature infants).f.Breast massage prior and during feedsMassage your breasts before and during a feed. Cup the breast with your hand and massagetoward the nipple with your thumb.

 

Massage will stimulate the let–down reflex as well as increase the caloric intake of hind milk. Itwill also stimulate oxytocin tobe released.g.Power pumpingPower pumping at least 2 times a day willhelp with stimulation of milk supply. Pump for 3 cyclesfor 10 to 15 minutes or until milk stops flowing and rest 10 to 20 minutes in–between thesecycles.Do power pumping for a day or two until milk supply is back to normalh.Skin to skin contactSkin to skin contact will relax both mom and baby, regulates babies vital signs and blood sugarandstimulates baby to breastfeed.2.Take care of yourself:a.Restand reassurance.Take a nap in theafternoons with the baby. Prolactin hormone increases during restMake sure that baby feeds at night. Prolactin hormone is produced during sleepTake time of and just focus on feeding resting and eating for a day or two.Accept some help. An expressed breast milk bottle given by the dad can help the sleepdeprived mother. Use the supplement with caution. Regular supplements can down regulate thesupply.b.Realistic expectations:Babies need frequent small feeds because of their small stomach capacities.c.Follow good diet.Eat regularly and drink enough fluids. Hydration will improve milk supply.Take a lactation nutritional supplement if you do not have a good appetite or do not have timeto prepare a balanced meal.