What Can I Do About My Low Milk Supply? May 9, 2014 13:07
Written By Michelle Roth, BA, LCCE, IBCLC
One of the top reasons women wean their babies before intending is thinking that their milk supplies are low (McCarter‐Spaulding & Kearney 2001; Gatti 2008; Kent, Prime & Garbin 2012; Kent, et. al. 2013; Neifert & Bunik 2013). While there are cases where women cannot produce enough milk for their babies, more often the problem is in expectations about breastfeeding patterns and what’s normal for a breastfed baby.
Sometimes around 10 days and then again around the 4-6 week mark, women think they have “lost their milk” because their breasts don’t feel as full or their milk is no longer leaking copiously. Changes around these times, however, are normal fluctuations in the way your body makes milk. They are likely signs that your initial engorgement has subsided and your milk supply has evened out to perfectly match your baby’s needs (Mohrbacher 2010; Kent, et. al. 2013).
Women who feel their milk supply is insufficient often base this perception on infant behavior – a baby who seems unsatisfied, who wants to nurse often, who is fussy or unsettled, etc. Though these behaviors can have many causes, women tend to blame their own bodies for not producing enough milk (Mohrbacher 2010). In addition, use of formula before hospital discharge is often wrongly instituted for “insufficient milk supply” at a time when moms aren’t yet making much milk (as nature intended!). While their bodies are, in fact, working right, they are led to believe something is wrong. And this perception sticks with them causing them to wean early (Gatti 2008). In addition, McCarter-Spaulding and Kearney (2001) found “mothers who perceive that they have the skills and competence to parent a young infant also perceive that they have an adequate breast milk supply” and vice versa. If a mom isn’t confident in her abilities, she may think her milk supply is low whether that’s truly the case or not.
So, milk supply issues – whether real or perceived - can impact how long a baby is breastfed. The solution is to help these moms feel confident in their milk supply. Working to increase milk supply will help those who are truly experiencing a dip in output, and may aid those who perceive a low supply feel more self-assured in their ability to breastfeed. Consider these tips for increasing milk supply:
- Nurse more! The more stimulation your breasts get, the more milk you will make. And the baby is better at prompting this than any pump on the market. You need to be sure, however, that your baby is transferring milk well. Do you hear your baby swallowing after every one or two sucks early in the feeding and less frequently as the feeding progresses? This may sound like a soft “kah” sound, or may look like a pause in the middle of a suck. Do your breasts feel full before a feeding and softer when your baby has finished? These are good signs that your baby is transferring milk. Is your baby falling asleep at the breast soon after starting a feeding? These babies need to be encouraged to keep going.
Newborns will nurse every 1-2 hours, but even older babies may nurse often. Has your baby stopped nursing so often? Is he skipping feedings? Are you getting busy during the day or using a pacifier and missing some feeding cues? Has your baby started “sleeping through the night”? These can all lead to a decrease in supply. Try a “nursing vacation” – spend the weekend tucked in bed with your baby and nurse as often as possible.
- Pump: Using a quality electric breast pump can help to stimulate supply. Keep in mind that pumps and pumping supplies can wear over time, so be sure yours is in top shape for the best results. Also, some brands are better than others at removing milk, so do some research before purchasing a pump.
Some women choose a few times a day, and consistently pump at those times. Other moms pump on one side while baby nurses on the other. Or you can try pumping for 5-10 minutes after every nursing session. The key to getting a good yield of milk when pumping is the ability to elicit milk ejections. If you have difficulty letting-down to a pump, you will get less milk. Two let-downs are sufficient, and three or four are even better. (Mohrbacher 2010). Use all of your best relaxation techniques: relax your muscles, breathe deeply, think about your baby, listen to a recording of your baby crying, smell something baby has slept in, do whatever it takes to condition yourself to let-down to the pump.
Also, doing breast massage before and during a pumping session (sometimes called “hands-on pumping”) can increase the amount of milk you are able to remove, and may give your nerves more stimulation resulting in an increase in production (Mohrbacher 2012).
- Consider herbal galactagogues: A galactagogue is a substance that can increase production of breastmilk. Different substances have different mechanisms, but they should all be used in conjunction with increased nursing or pumping, or reserved for use until after other methods have failed to produce the desired results (Mohrbacher 2010).
Fenugreek (Trigonella foenum-graecum L.) is an herb used in many cultures to increase milk supply. The recommended dosage is 1800mg three times a day. Supply generally increases 24-72 hours of beginning the supplement; but for some women, it can take as long as one to two weeks. Use caution with this supplement if you have a history of allergies, asthma, hypoglycemia, or diabetes, and do not use if you are taking blood-thinning medications.
The effects of fenugreek are improved when combined with the herb blessed thistle (Cnicus benedictus). Adding 3 capsules of blessed thistle 3 times per day along with fenugreek improve output.
Both fenugreek and blessed thistle seem to be the most effective if used in the first few weeks after birth. Other herbs (including marshmallow root, goat’s rue, alfalfa, fennel, spirulina, raspberry leaf, brewer’s yeast, and shatavari) and some foods (for instance, oatmeal) have milk-enhancing properties, so adding them to your diet may boost your milk production. Keep in mind, though, these substances won’t do much if you aren’t nursing or pumping often.
- Discuss medications with your healthcare provider: Prescription medications that act as galactagogues are sometimes warranted when all else has failed. Domperidone is the medication most likely to be effective in increasing milk supply, and the least likely to cause untoward effects for mom or baby. It has been used successfully in many parts of the world; however, use in the US is restricted. Reglan (metoclopramide) is another drug that helps to increase milk production. This drug should not be used by anyone with a history of depression or anxiety as it can increase the severity of these symptoms, and can even cause these symptoms in someone without a prior history. Use of Reglan should be considered with caution (Mohrbacher 2010; Zuppa 2010).
Any time you are dealing with a dip in supply, you should consider working with someone knowledgeable about breastfeeding, such as a board certified lactation consultant (IBCLC) or trained peer counselor. Sometimes just having that support is all you need to persevere through difficulties with supply. Any amount of breastmilk your baby gets is a gift – but maximizing your production so you can continue to nurse is well worth the effort, for you and for your baby.
Gatti, L. (2008). Maternal perceptions of insufficient milk supply in breastfeeding. Journal of Nursing Scholarship, 40(4), 355-363.
Kent JC, Hepworth AR, Sherriff JL, Cox DB, Mitoulas LR, Hartmann PE. (2013). Longitudinal Changes in Breastfeeding Patterns from 1 to 6 Months of Lactation. Breastfeeding Medicine 8(4), 401-7
Kent, J. C., Prime, D. K., & Garbin, C. P. (2012). Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(1), 114-121.
McCarter‐Spaulding, D. E., & Kearney, M. H. (2001). Parenting Self‐Efficacy and Perception of Insufficient Breast Milk. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 30(5), 515-522.
Mohrbacher, N. (2012). To Pump More Milk, Use Hands-On Pumping. http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html [Accessed March 30, 2014].
Mohrbacher, N. (2010). Breastfeeding Answers Made Simple. Amarillo, TX: Hale.
Neifert M & Bunik M. (2013). Overcoming clinical barriers to exclusive breastfeeding. Pediatric Clinics of North America, 60(1), 115-145.
Zuppa, A. A., Sindico, P., Orchi, C., Carducci, C., Cardiello, V., Catenazzi, P., ... & Catenazzi, P. (2010). Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. Journal of Pharmacy & Pharmaceutical Sciences, 13(2), 162-174.
Heard of Moringa? It's an herb that helps milk supply. June 9, 2013 00:00
For any new mother who wants to do the best for her baby, breastfeeding can easily provide many benefits. However, some women have problems producing enough milk throughout the breastfeeding years. There can be causes for low milk supply such as being under stress or having some types of hormonal imbalances. Other causes can be having duct milk damage from previous surgeries, smoking, or even getting pregnant again while nursing. When these possible causes can be ruled out, Moringa can be an option to help increase breast milk flow.
The Moringa tree was first referenced around 2000 B.C. when it was used by people in Northern India. It was believed the tree had medicinal benefits and was able to prevent over 300 diseases. This tree was also used for various reason by the Greeks, Romans, and Egyptians as both protection from the hot sun and as a lotion. Maurian warriors of India ate the leaves believing they had the power to increase their strength and stamina.
Although the Moringa tree is native to the Northern part of India, it is now found in many areas of the world including Central and South America, Africa and Asia in tropical and sub-tropical climates. This tree can grow up to 12 meters high and has drooping branches on which there are small leaves that contain an incredible powerhouse of vitamins and minerals. It grows best in sandy or dry soil with bright sunshine, but cannot tolerate excessive flooding or soil with little drainage. The tree needs little water, making it a valuable commodity in drier climates.
The Moringa tree has many uses including: food for humans and forage for livestock, medicine, dye, water purification, and can also help to increase flow of breast milk in lactating women, as has been proven in studies. The leaves of the tree are full of vitamins and minerals which contain:
* 7 times the Vitamin C content of oranges
* 4 times the calcium content of milk
* 4 times the vitamin content of carrots
* 3 times the potassium content of bananas
* 2 times the protein found in yogurt
The Academy of Breastfeeding Medicine Protocol Committee did a study to find out how Moringa effects the rate of milk flow in lactating mothers. Two groups of mothers were given breast pumps and asked to pump every four hours. One group was given the supplement and the other was not. The mothers in the study were asked to write down how much milk was produced each time they pumped over a three day period. The results came back showing that the mothers who had used the Moringa supplement produced more milk overall than those mothers who didn’t use the supplement.
In another such study, the same results were found. Mothers were asked to measure their breast milk production on the third, seventh, and fourteenth day of production. Although all mothers had about the same results on the third day, the mothers taking a Moringa supplement had increased production on the seventh and fourteenth days when compared to those who didn’t take a supplement. These promising results will most likely lead to even more studies showing the efficacy of the supplement on lactating women.
For any mother who struggles with not producing enough milk, the Moringa supplement may be just what she and her baby needs. There are no ill side effects and a good variety of vitamins and minerals come from it. According to both studies done, it may be beneficial for a mother to begin taking the supplement as soon as she gives birth, enabling her milk flow to increase by the third day after birth.
With permission from Hilary Jacobson, here's a great comprehensive lactogenic list of foods from her book, Mother Food for Breastfeeding Mothers...
Lactogenic foods support lactation for many reasons. Eating sufficient calories and getting an abundant supply of nutrients is helpful in itself for lactation, but these foods also contain substances that interact with and support the chemistry of lactation. These substances include phytoestrogen, natural plant sedatives, plant sterols and saponins, and tryptophan, among others. In addition, a rich supply of minerals and a good balance of fats ensure that the mother’s cells and nerves are functioning at an optimal level.
Fennel can be eaten raw or cooked, for instance, steamed, or sautéed in butter and then simmered in a bit of water. Fennel seed is well-known as an herb to increase milk production. The vegetable, containing the same pharmacologically active volatile oils, acts as a gentler support.
Carrot, Beet, Yam
These reddish vegetables are full of beta-carotene, needed in extra amounts during lactation. Carrot seed has been used as a galactagogue, and the vegetable, also containing the volatile oils and phytoestrogen, acts as a gentler support. The beet is a wonderful source of minerals and iron. Taking raw beet can help alleviate iron deficiency. These vegetables are naturally sweet, and they support the liver.
Dark Green Leafy Vegetables
Dark green vegetables are a potent source of minerals, vitamins and enzymes, as well as phytoestrogen that support lactation. Dandelion and stinging nettle leaves are diuretic, and can help reduce edema during pregnancy and after birth. They can be plucked from your garden in early spring and eaten whole, chopped into salad, or used to make tea. Stinging nettle can be harvested for salad or cooked as spinach. In your market, you'll find arugula, beet leaves, kale, Swiss chard, spinach, chicory, collard greens and others.
Grains and Legumes
Grains and legumes have a long history as galactagogues. The most commonly used grains include oats, millet, barley and rice. Oats are the most widely used lactogenic food in the US. Legumes to include in your diet are chickpea, mung beans and lentils.
Nuts that support milk supply include almonds, cashews, and macadamia nuts. As much as possible, eat raw nuts, not roasted or salted. The taste of raw nuts will grow on you.
Oils and fats
Healthy fats play a vital role in cellular and neural metabolism. The kinds of fats a mother eats will influence the composition of fats in her milk. Please see the article “Dietary Tips for Pregnancy and the Postpartum” for more information.
The renowned expert in fats, Mary G. Enig, suggests that mothers get regular and substantial dosages of butter and coconut oil. In addition, use cold-pressed virgin olive oil, and take equal amounts of cold-pressed sesame oil and flaxseed oil in salads.
One way to balance the fats is to dribble a quarter teaspoon of olive oil, flaxseed oil, sesame oil, and a thin slab of butter over meals. Be sure to eliminate unhealthy fats such as partially hydrogenated vegetable oils and transfatty acids from your diet, as these will also enter your milk.
In addition, be sure to have a source for essential fatty acids. For more information, see “Dietary Tips.”
Lactogenic beverages include getting enough plain water to hydrate the body, drinking commercial lactation teas, non-alcoholic beer, ginger ale, Rivella, and natural herbal root-beers from your health food store. Check out coffee substitutes based on the lactogenic grain barley, such as CARO, Roma, Caffix, Pero or Dandy Blend. These imitation coffees usually also contain chicory or dandelion, plus malt—ingredients that are all lactogenic. A recipe for "Barley Water," a potent lactogenic beverage, is at the bottom of this article.
Garlic is famous for its medical benefits, and has a long history as a galactagogue.
In one study, babies were seen to latch on better, suckle more actively, and drink more milk when the mother had garlic prior to nursing(2). If you do not wish to eat garlic, try adding a capsule of garlic extract to a meal eaten about an hour before breastfeeding.
If you would like to introduce garlic to your diet, and are not used to eating garlic, introduce it very slowly and observe your baby’s reaction. Take only 1 – 2 cloves per day. These can be chopped or pressed through a garlic press into any food after it has finished cooking. Try it in vegetables, rice, grains, pulses, salad sauce, spaghetti sauce, or other sauce.
Our culture does not encourage eating garlic, and many people do not tolerate garlic well (or onions, another food which is traditionally lactogenic). For this reason, garlic is not recommended by the American Herbal Product’s Association while breastfeeding except under the guidance of a qualified herbalist. However, if you do tolerate garlic there is no reason that you should not benefit from it. Take garlic in moderation as do mothers all over the world.
Caution: Do not combine with anticoagulants, as garlic has blood-thinning actions.
Danger: Babies and small children should never be given garlic in any form, whether fresh, dry, powdered or in capsules, to chew, swallow, eat or suck on. Garlic is highly caustic to delicate body tissues, and rubbing it in one’s nose or eyes could be painful and dangerous. Babies will benefit from the garlic a mother eats, and that reaches him through her milk.
Ginger is helpful for the letdown and milk flow. Some mothers benefit from drinking ginger ale. Even commercial ginger ale is flavored with “natural flavoring” that is real ginger.
Warning: Do not use ginger or ginger ale in the early postpartum if there was significant blood loss during birth. Do not take ginger immediately after birth due to danger of hemorrhaging.
Caution: Ginger tends to compound and increase the effects of medication being taken. Talk to your doctor if you are taking medication, especially diabetic, blood-thinning, or heart medicine.
Sources: You can find ginger at your local grocery store. Check out stores that sell Asian foods, health food stores, and on line.
Spices in your kitchen can be used to support milk production. Try adding marjoram and basil to your meals, and anise, dill or caraway. Black pepper, taken in moderation, is helpful.
This powdered yellow root gives curry its yellow color and basic flavor. A potent anti-inflammatory and antioxidant, turmeric is being studied in connection with the prevention of Alzheimer’s disease, rheumatism, and cancer. Turmeric has lactogenic properties and can also be taken to help prevent inflammatory conditions. One half teaspoon of turmeric a day may help prevent inflammation in the breasts.
Caution: Some herbalists warn that pregnant women should not use turmeric if they are at risk for miscarriage.
Oats (Avena Sativa)
The humble oat is one of our most nutritious foods, and contains proteins, vitamins, minerals and trace elements that nourish the nerves, support the metabolism of fats, and uplift the spirit. In traditional medicine, both the seed and the leaf—called oat-straw—are taken. Oats are prescribed as a nervine tonic in the treatment of nervous exhaustion. In Europe, women traditionally take oats after birth. Oats are taken today in the US to increase milk production, both as food and as a supplement. Like other galactagogues, oats are antidepressant, antispasmodic, and they increase perspiration.
Allergy: Occasional. Persons sensitive to gluten in wheat are frequently able to tolerate oats.
Dosage and Preparation:
Taking large dosages of oats is helpful in kick-starting milk production.
Oatmeal can be taken for breakfast or an afternoon snack.
Oat-straw is especially rich in minerals. It is available as capsules or as an ingredient in so-called “green-drinks.” Take as indicated on the package.
Fluid extract: 3 – 5 ml (15 – 35 drops), three times a day.
Nutritional and Brewer's Yeast
Nutritional or brewer’s yeast frequently leads to a significant boosts in a mothers’ milk supply. Mothers sometimes say that they feel much more energetic and emotionally balanced while taking yeast. This may signal a lack of essential nutrients in their diet, in particular, chromium, vitamin B complex, and especially vitamin B12, found in some brands of fortified nutritional yeast. Brewer’s and nutritional yeast also contain protein and good levels of phytoestrogen.
Allergy: Persons who are allergic to yeast should avoid these products.
Side-effects: Occasionally, mothers or babies become gassy, more so with brewer’s yeast than nutritional yeast. To be on the safe side, start with a small dosage and slowly increase.
Sources: Vegetarian stores and health food stores.
Green foods are reputed to increase the fat content of breastmilk. Some mothers supplement with chlorophyll. So-called "green drinks" can be very helpful. Their ingredients include barley-grass, alfalfa leaf, spirulina, corellas, kelp, oat-straw and other herbs with lactogenic and medicinal properties.
Caution: Chlorella, a common ingredient in commercial green-drinks, is used by medical specialists to chelate (remove) heavy metals from the body, especially mercury. If not taken at the correct dosage, chlorella can lead to an increase of mercury in the bloodstream and probably in a mother’s milk as well. It is wise to choose green-drinks that only contain a low percent of chlorella.
Sources: Super markets, health food stores, online.
Green papaya is taken as a galactagogue across Asia. It is a superb source of enzymes, vitamins, and minerals, including vitamins C, A, B, and E. Green papaya is the unripe fruit, and it needs to be simmered until soft. Green papaya can also be taken in supplement form.
Allergy: Persons allergic to latex may be allergic to papaya and other fruit.
Caution: Persons taking Warfarin should consult with their doctor before taking papaya supplements.
Large, black sesame seeds are used to increase milk production across Asia. Husked, light-colored sesame seeds are also effective and easier to digest. Sesame seed "butter" known as Tahini can be found in health food stores. Sesame is our most potent vegetable source of calcium!
Allergy: Allergy to sesame is becoming more common.
Spirulina is a non-toxic variety of blue-green algae. It has been farmed in lakes and ponds as a food source for thousands of years. It is valued for its proteins, enzymes, minerals, vitamins, chlorophyll, and essential fatty acids. Spirulina's nutrients are easily absorbed, even when a person’s digestion is not up to par.
It is important that spirulina be cultivated on a farm that is not located in waters that are contaminated, in particular with heavy metals. It is also advisable not to use spirulina that has been genetically ‘improved.’ Spirulina and other “green foods” may increase the fat-content of breastmilk.
Note: It is not wise to rely on spirulina as a source of B12.
Barley-water is used medicinally to treat colds, intestinal problems (both constipation and diarrhea) and liver disorders. It was recorded in Greek medicine two thousand years ago as a galactagogue. Taken for a week or two, it often helps mothers with chronic low milk supply. Make a pot in the morning and drink it throughout the day, warming each cup and sweetening it with a natural sweetener as desired.
Barley-water can be made with whole grain or pearl barley. Barley flakes can also be used, though these have been processed and are possibly less potent than the whole or pearled grain.
Breastfeeding Aids: Herbs and Milk Supply January 5, 2013 00:10
Mothers who are nursing for the first time are often concerned about the amount of milk they produce. Some mothers worry that they don’t produce enough to satisfy their baby while others wonder what to do with all their extra milk. In addition to including lactogenic (milk-producing foods) in a well-balanced diet, sometimes the use of herbs can also help to boost and maintain an abundant milk supply. A lot of mothers worry about taking supplements that might harm their infant. Simple remedies available at home or at most health food stores can help put these worries to rest.
Mothers need only look as far as the kitchen sink to help keep their milk flowing. It is easy to become dehydrated when breastfeeding a hungry newborn. A nursing mother needs to be aware of her thirst and consciously drink water throughout the day to replace the liquid the baby draws from her. Simply staying hydrated will help milk production.
Nursing mothers have used herbs for centuries and they are usually considered safe alternatives that can help nursing mothers keep up their milk production. As always, consult a health care professional before taking any new supplement. Using the wrong herbs or using herbs in the wrong way can cause undesirable side effects.
Galactagogues are herbs that are used to increase the milk supply. These herbal remedies may come in a liquid tincture, tea or pill form. Mothers may need to take these natural aids for up to two weeks to see an affect.
Relaxing with a cup of warm tea can be soothing and help ease milk letdown. Chamomile tea is said to have a calming affect while red raspberry tea can stimulate milk production. Fenugreek is perhaps the most well known galactagogue. It is taken alone or in combination with other herbs to increase milk supply. Taking Fenugreek can result in a slight maple odor in the urine. Caraway, Blessed Thistle, and Brewer’s yeast can also be used to boost milk supply. Aniseed can aid in milk production and promote healthy digestion.
If herbs don’t seem to increase milk production, try using a breast pump for 5-10 minutes after the baby is finished feeding. This additional stimulation will help mothers produce more milk. Mothers can save the pumped milk, store it in the freezer, and have plenty of milk for their baby when return to work.
Mothers who have an overabundance of milk or choose to stop breastfeeding may also seek an herbal aid. Sage is the herb of choice for mothers who wish to decrease or stop their milk supply. Taking sage is reported to help dry up a mother’s milk. Sage can be drunk in tea form or consumed in a liquid tincture available from health food stores.
Most nursing mothers will find they have sufficient milk to feed their new babies. For those who feel they need a little help, natural remedies can provide safe, attainable answers.