Decreased milk production

Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic and Program Patient handout

There are many medical and non-medical ways of increasing milk production. It is never “too late” to increase milk production if you are willing to seek help and put in some effort.

How can I tell if I don’t have enough milk?

Decreased milk production means that your baby needs more milk than you can produce.

Signs that your baby is getting enough milk:

There is one wet diaper for each day of life until day 6 → then 6 or more heavy wet diapers in 24 hours.
Stools are soft and yellow from day 5 of life onwards (only if exclusively breastfeeding).
Baby is alert, wakes up on his/her own to feed, and is satisfied after feeds.
Baby is back to birth weight by day 10-14 of life, after possibly losing 7-10% of its initial weight.
Baby gains 20 to 30 g/day during the first 3-4 months of life, then 15-20 g/day after that.
Your breasts are fuller before feeds, and softer after feeds.

These signs are not written in stone, and it is important to follow-up regularly with your health care provider to ensure that your infant is growing and developing well.

Important: the amount of breastmilk that you are able to pump does not always show how much milk you truly have. Your baby will almost always be able to get more milk out of your breasts than a breast pump will be able pump out.

How to increase breastmilk production without pills:

First of all, make sure your baby has a good latch and that you have no pain while nursing. A good latch will help your baby get more milk, and will also better stimulate the breasts to produce milk.
Breastfeed often (8-14 times in 24 hrs) and try to drain the breasts at every feed, so that they feel soft afterwards.
Place the infant directly skin-to-skin to help increase milk supply, during and in between feeds.
Pump or manually express your milk after feeds to increase milk production by stimulating your breasts more. Even as little as 5 minutes of pumping after feeds can make a big difference. If the baby is not at the breast at every feed, then you may need to pump for longer, and more often. For babies who are not at the breast at all, you will need to pump at least 6 times in 24 hours or as many times as the baby feeds to keep up your milk supply.
You may be shown how to do “breast compressions”, which are 5-second squeezes of the breast while your baby is feeding, to encourage milk flow.
Switch nursing is another term you might hear about. This means switching the baby from one breast to the other rapidly (perhaps after a few minutes) so as to stimulate your let-down reflex. You may end up feeding in the following way: right breast for 5 min, then left breast for 5 min, then right breast again for 5 min, then left breast again for 5 min, etc.

Supplementation:

What if I need to supplement?

If you need to supplement for any reason, remember that this does not mean that you have failed at breastfeeding, and it may only be temporary.

The best way to supplement is by using your own pumped milk. If that is not available, donor milk is the second best option. The third option for supplemention is infant formula. It is best to avoid powdered formula as it is not sterile.

There are many ways to supplement your baby, including:

Using a lactation device or tubing at the breast.
Cup-feeding.
Finger-feeding with a tube.
Bottle-feeding.
Dropper or syringe-feeding.

Avoiding the use of a bottle may help in making sure your baby latches well onto the breast. Please speak to a lactation professional to see which of these methods is right for you.

How to store breastmilk:

Breastmilk is very valuable, so it is important to store every drop for later use. For healthy term infants, freshly expressed breastmilk can be stored in the following ways (Academy of Breastfeeding Medicine Guidelines):

At room temperature (up to 25°C or 77°F) for 6 to 8 hours.
In an insulated cooler bag with ice pack for 24 hours.
In the refrigerator (4°C or 39°F) for up to 5 days.
In a freezer compartment inside the refrigerator (-15°C or 5°F) for 2 weeks.
In a freezer located above the refrigerator (-18°C or 0°F) for 3 to 6 months.
In a chest or upright freezer (-20°C or -4°F) for 12 months.

The information contained in this patient handout is a suggestion only, and is not a substitute for consultation with a health professional or lactation specialist. This handout is the property of the author(s) and the Goldfarb Breastfeeding Clinic. No part of this handout can be changed or modified without permission from the author and the Goldfarb Breastfeeding Clinic. This handout may be copied and distributed without further permission on the condition that it is not used in any context in which the International Code for the Marketing of Breastmilk Substitutes is violated. For more information, please contact the Goldfarb Breastfeeding Clinic, Herzl Family Practice Centre, SMBD Jewish General Hospital, Montreal, Quebec, Canada. © 2009