Helping Your Supply  

These are not tips for those of you trying to establish milk supply, unless we've talked about it first.  I'm putting this info up for moms trying to increase the amount they pump at work, or other scenarios where the supply had been OK and now has been dwindling. 

Before we use these medications/supplements, we have to make sure the latch is effective, we're using breast compression, we've tried pumping after feedings to increase breast stimulation, and that there isn't some other reason the supply has dwindled, like increased stress, poor diet, lack of sleep (meaning, you aren't taking care of yourself) starting on a hormone- containing birth control pill (estrogen or progesterone),  thyroid problems, pregnancy, oversupply, pseudoephedrine cold medications (or any other medication for that matter.)  One reason to have your supply drop off is pregnancy.  That's an easy test to check and one place to start.

Usually, the supply is lower because you and the baby are sleeping longer at night and not getting as much stimulation at the breast. If the baby is sleeping longer and you want to maintain your milk supply, you need to get up at night and pump. The whole breastfeeding system is set up to shut down, so your baby takes lack of stimulation at the breast as a sign that they don’t need to make as much milk. Removing milk at night, as much as it hurts to miss sleep, will help teach your body that you aren’t ready to stop yet.  And that stimulation also helps as a natural form of birth control. If you continue to remove milk every 4 hours at night and allow unlimited access to breastfeeding during the day, and your baby is under 6 months of age, and you have not gotten your period, you are practicing Lactational amenorrhea, a natural form of birth control because of breastfeeding. But, you have to meet all those criteria. 

Another reason is oxytocin. Oxytocin is the love hormone” because it is released under many circumstances, such as orgasm, childbirth and breastfeeding. It is responsible for your milk ejection reflex (your “let down) because it stimulates the small muscles surrounding the milk-producing alveoli to contract and therefore release milk. It is a hormone that is exquisitely sensitive to stress. So, if you have returned to work, are having school –related stress, are having issues at home or are just plain stressed for any reason, oxytocin does not work well. It makes sense: if you are having a baby in front of a tiger (yes, a tiger, again), you wouldn’t want the hormone that helps with childbirth working so that you can give birth in front of a predator. Nor would you want to breastfeed in front of one. Tigers come in many forms. Rid yourself of yours, and your production increases.

If you are pumping at work, you need a relaxing environment. Some people suggest looking at pictures of your baby. That just made me feel guilty. I shopped for shoes and am quite happy to share my favorite sites with those that feel their oxytocin levels would increase with that activity. What you can’t do is pump under stress. I have pumping rules.

Plus, you make more milk than you need in the early weeks, and then you and the baby get your rhythm and your supply (ideally, some keep making lots of milk) regulates to meet the baby’s needs. As your supply regulates, many women, who had a freezer full of milk at 2 months, are dipping into the stored supply at 4 months, especially if we have return to work.  Everybody gets nervous when that happens, but we do expect, with growth, the baby will need more milk. That doesn’t mean we like thawing stored milk-- I saw every thawed frozen bag as a sign of failure.  Really-- thank goodness I married a psychiatrist.

We are really in a  race to 6 months.  At 6 months, your baby can have foods and up to about 4 ounces of water. That means whoever is watching the baby has new options and the pressure to produce and produce will decrease. I have taken care of some wonderful women who may not have had enough milk to exclusively feed a 3 month old, but have more than enough for a 6 month old (and beyond)  because we have these other options.

Remember to take care of yourself: drink until your thirst is quenched but not more than that: too much water decreases supply. Sleep when you can, have a messy house, and be gentle with yourself. This isn’t easy and while we are making strides towards accommodations in the workplace, we have so much more to do. Do the best you can and make it to 6 months. I, for one, am in awe of the efforts that the women I meet have given to make breastfeeding work.

There are herbal supplements, but the literature is scant and does not support that these work. I would guess that they do, but not for the population in general. There may be special subgroups who respond. There is likely a large placebo effect as well, meaning that just taking something helps your supply.  So, if you think it’ll work, it might work. Oxytocin just wants happiness.  Who am I to crush the happiness of a placebo effect?

Since the mammary gland is a part of the endocrine system there are many hormone changes that may affect milk production. Before you start these, a visit with a lactation expert is important because we many have a much easier solution, or a solution that impacts your health, like insulin resistance, obesity, hypertension, anxiety, depression, thyroid illness and medication side effects that we need to treat differently than these supplements. The longer you delay asking for help, the more impact on your supply. Please ask for help. There are an army of people out there waiting to help you.

You will see that the Academy of Breastfeeding Medicine’s Protocol on Galactologues focuses on maternal and baby factors, the latch and other non-pharmacologic ways of increasing milk supply.  I am including some of the rememdies I get asked about frequently, but I hardly ever use these. I want to focus on maternal health and well-being and any problems the baby might be having.

Fenugreek:  This is a non-prescription herbal supplement that increases milk supply by decreasing an inhibitor (follow that?) of prolactin. It may also decrease blood sugar.  Fenugreek can make you smell like maple syrup and can upset your stomach. The starting dosage is 1 or 2 600-625 mg capsules every day for a few days.  If you have no stomach upset, then bump up the dose to 3 capsules three to four times a day.  In my experience, Fenugreek helps those mothers who have insulin resistance issues more than other mothers.

Goat’s Rue: may help those with insufficient glandular tissue.

Oats: are good for you. Take care of yourself and your oxytocin rises. I know of no other mechanism by which this works.

Mother’s milk tea: You need to drink a lot of this to help your supply.

Beer: This is an excellent summary of the history of beer as a way to increase milk supply. Short story: yes, it may help increase supply but it has to be Guinness. It’s a double-edged sword though as alcohol can decrease oxytocin. This isn’t in my professional list of ways to increase supply, but I am including it here because I get a lot of questions about it.

Domperidone:  This one, in my experience, works well, especially if you are already making milk; for women who have had issues establishing a supply, I have not has as much success. You need a prescription to obtain it in the US and it is getting harder and harder to obtain in the US due to regulations on compounding pharmacies. In fact, I currently do not have a way to prescribe Domperidone in Wisconsin.  I continue to think that it is a much safer and more useful medication than its cousin, Reglan (below), which is sometimes offered as an alternative.  

This is only available by prescription. The usual dose is 10 mg 3-4 times a day and it needs about 7-10 days or so to kick in. Domperidone is not currently covered by insurance. I cannot write for prescriptions to be filled overseas. At this point, I am out of luck prescribing this.

Reglan (metaclopromide) Reglan is a cousin of Domperidone and has a similar mechanism of action. They are both primarily used to help with gastric motility and reflux and their ability to increase prolactin is a side effect. Increasing Prolactin increases milk supply. Reglan is covered by insurance, but the side effect are many, including depression, fatigue and dystonic reactions, all because Reglan crosses into the brain. Domperidone does not, which is why I hope we get the legalities with the medication taken care of soon.

Bottom line: the causes of low supply are plentiful and you should talk to a lactation specialist to create a plan that will work for you.

Updated Feb, 2016

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