When we discuss increasing milk supply it is important to first know how your milk supply works. So let’s start from the very beginning!
Your body actually starts to produce breastmilk in pregnancy. Yup, you heard that right; during pregnancy! Around 16-20 weeks in pregnancy your breasts start to prepare for baby. You may have noticed tenderness, enlargement, sensitivity and darker areolas. All of these changes help your body to prepare to make breastmilk for your baby!
So how is this milk made you may ask? Breastmilk is made in tiny grape-like clusters called alveoli. You first start making colostrum which is a type of breastmilk (yes, colostrum IS breastmilk). This milk is dubbed “liquid gold” due to its yellow hue and antibody support. Colustrum is higher in protein, Vitamins A, E and K as well as antibodies compared to mature milk.
After you deliver baby, you also deliver your placenta. The removal of the placenta is what starts the cascade of hormonal events that drive your milk supply in the beginning. The hormones progesterone and estrogen suddenly drop after the placenta is delivered and at that same time the milk making hormone, prolactin increases. The rise in prolactin tells your body to make milk!
As said above, the first milk you have is called colostrum. This is enough to feed baby until your “real” milk comes in. This “real” milk is actually called transitional milk because you still are making colostrum! You will make colostrum for the first 2-4 weeks and that is mixed with mature milk. Your mature milk will then take over as the colostrum fades away.
After your mature milk comes in, your milk supply then depends mainly on milk removal. What does that mean? In short, your breastmilk is a supply and demand process. In most cases, the more milk removed equals more milk made. Unfortunately, the opposite is also true.
Think of your breasts like an automatic ice machine. If your ice bucket is FULL it isn’t going to make more ice. There is simply not enough room BUT if the ice machine senses that ice has been removed; the ice machine begins making more ice.
Your breasts work similarly to ice machines in this way due to a small whey protein called FIL. Now, who the heck is FIL and what does he have to do with lactation?
FIL stands for;
FIL is responsible for SLOWING milk production when the breasts are too FULL but also FIL is responsible for INCREASING the milk production when the breasts are LESS FULL.
I know, I know this sounds counterintuitive. But let’s face it… if we don’t use it then we lose it. FIL is the reason for that. The body isn’t going to make more milk if the milk isn’t being removed.
Meaning: More milk removed = more milk made!
So… What about low milk supply? To answer that question, let’s first discuss what a normal milk supply is. The average amount of breastmilk intake for a baby one to six months is 25 oz per day. If we divide that by 8-12 feedings/pumping session then that gives us roughly 2-3 oz per time. It is important to note that this is for a session meaning BOTH breasts.
If you are pumping, it is also important to remember that the pump is no indication of your milk supply. Let me say that again, the pump is not what your baby can do if your baby is nursing efficiently.
If you are stressing over milk supply, remember this; every mama responds to a pump differently. If you are having trouble with milk output, it is important to work with a LC to get to the root of the problem. It could be a simple flange fitting, or maybe adding in massage and heat to help remove the milk with the pump. It could be your pump parts needing to be changed or a different pump entirely. All pump brands work in a slightly different manner so it could be that the particular pump isn’t working for your body.
Or it could be that there’s no issue at all! A lot of mamas come to me with this thought that they need to be pumping 6-8+ ounces per 2-3 hour pumping session and that’s just simply not accurate!
The pump is a machine. It is just that, a machine. It is not a baby. Am I thankful for pumps? ABSOLUTELY. But they aren’t a human. They come pretty close but they just aren’t a baby.
This is especially important to remember if your baby is in the NICU or if you are away from baby. Pumps literally just suck. While your baby uses their jaw and cheek muscles to help pull the milk with their sucking. That is why it is important to use hand massage, touch/massage as well as looking at pictures/video of your baby to elicit the milk letdown reflex. Removing milk is SO much more than just the suck. It is also about hormones including the stress hormone called cortisol!
On the other hand, not every baby can remove milk EFFICIENTLY. Therefore the pump could remove milk better than baby could. This can be due to a number of reasons like poor latch, oral ties, prematurity, jaundice and even illness/sickness.
So what if I am not pumping? How do I know if I have an adequate milk supply? This is where we look at your baby! As I discussed in the Breastfeeding 101 for New Moms blog; the following are ways we can see if your baby is getting enough milk and therefore your body is making enough milk. It is important to remember, if you feel like you are struggling with milk supply or breastfeeding – discuss with your baby’s provider and get with a lactation consultant.
⭐️ 𝗗𝗶𝗮𝗽𝗲𝗿 𝗼𝘂𝘁𝗽𝘂𝘁 – What goes in ➡️must come out! As a newborn your baby should be having lots of diaper output. Baby should have between 5-6+ wet diapers every 24 hours. In the beginning, your baby’s output will correspond with the days of life. So 1 pee, 1 poo on the first day and so on (check out my post on this in my “early days” highlight!
⭐️ 𝗔𝘂𝗱𝗶𝗯𝗹𝗲 𝘀𝘄𝗮𝗹𝗹𝗼𝘄𝘀 – you should be able to hear (and see) your baby swallowing. Swallows will sound like a soft “caaa” sound. You should see good jaw and cheek movement as well as their throat moving when they swallow.
⭐️ 𝗕𝗮𝗯𝘆 𝗵𝗮𝘃𝗶𝗻𝗴 𝗰𝗼𝗻𝘁𝗲𝗻𝘁 𝗔𝗡𝗗 𝗮𝘄𝗮𝗸𝗲 𝗽𝗲𝗿𝗶𝗼𝗱𝘀 𝗯𝗲𝘁𝘄𝗲𝗲𝗻 𝗳𝗲𝗲𝗱𝗶𝗻𝗴𝘀 – This is a big one. Yes, your newborn will sleep but your newborn should also have good awake periods throughout the day. Besides when baby cluster feeds (see my post about this), your baby should GENERALLY be content between feedings. If you notice your baby is having a tough time waking up for feedings, be sure to talk to your ped AND a LC!
⭐️ 𝗕𝗿𝗲𝗮𝘀𝘁𝘀 𝗳𝗲𝗲𝗹𝗶𝗻𝗴 𝘀𝗼𝗳𝘁𝗲𝗿 𝗮𝗳𝘁𝗲𝗿 𝗳𝗲𝗲𝗱𝗶𝗻𝗴𝘀- Are you really a breastfeeding mom if you don’t grab your boobs several times a day? Your breasts will likely feel a little more firm before a feeding and after should feel lighter and softer. BUT remember, as time goes on and your supply regulates you may lose this “fuller” feeling. (see post on this)
⭐️ 𝗪𝗲𝗶𝗴𝗵𝘁 𝗴𝗮𝗶𝗻 𝗮𝗻𝗱 𝗺𝗲𝗲𝘁𝗶𝗻𝗴 𝗱𝗲𝘃𝗲𝗹𝗼𝗽𝗺𝗲𝗻𝘁𝗮𝗹 𝗺𝗶𝗹𝗲𝘀𝘁𝗼𝗻𝗲𝘀 – Initially your newborn will lose a little weight right after birth. Normal weight loss is up to 10% of birth weight. After your milk comes in, your baby should be back up to birth weight by 10-14 days. From then, normal weight gain is 4-7oz per week until 4 months old. It is also important to watch developmental milestones as well as weight.
And finally, what are some examples of things that cause low milk supply besides supply vs demand? Breast surgery including breast implants as well as reduction, thyroid problems, history of infertility, polycystic ovarian syndrome (PCOS) and insufficient glandular tissue (IGT). It is important to remember that any of these examples are not a be-all end-all. If you do have any of these, be sure to work closely with a lactation consultant.