What is it?
Research suggests that the primary driver of milk production is the effectiveness and frequency of feeding, expression and pumping. However, there are other factors, such as food and medicine, that can have an impact on supply.
How common is it?
Most women become concerned about production and supply at some point during their breastfeeding experience.
What can I do about it?
Breastfeed or pump often and effectively — for smaller babies (under 7 pounds), every 2 to 2 1/2 hours, larger babies (over 8 pounds) every 2 1/2 to 3 hours. The physical act of a baby suckling or pumping is part of what activates the supply of milk and subsequent production. Prolactin and oxytocin are the hero hormones that govern milk supply and flow. Oxytocin stimulates the "let down" reflex, which starts the flow of milk and prompts the body to keep milk flowing. Both hormones are stimulated by an infant suckling at the nipple, or the act of pumping.
Emptying each breast of its milk by nursing the baby on both sides signals the body to keep making more milk, which is why full feeds — which leave your breasts feeling significantly less full — are a key component of healthy milk supply.
At seven to 10 days postpartum, adequate milk supply is considered to be 16 ounces per day.
Here are signs that you are producing enough milk:
- Breasts should be softer after each feeding — particularly close to the areola
- Your other breast leaks or drips as the baby nurses
- You leak or feel tingling just before breastfeeding, then relieved afterward
- You can hear the baby swallowing or gulping while feeding
- You see milk residue on lips or tongue — or dribbles in the corner of mouth — when your baby comes off the breast
- The baby produces four to six wet diapers and multiple stools in a 24-hour period
- The baby is relaxed (though awake) after nursing
- The baby's belly looks distended and full after nursing
- Your baby is gaining the recommended .7 to 1 ounce per day, and is back at their birth weight by day 10-14
Here are signs that your milk production is low:
- Your breasts do not feel full of milk (feeling softer and less hard is normal once regular breastfeeding is established; this is a significantly "empty" feeling)
- Your baby appears fussy while feeding and after nursing is complete
- Your baby is lethargic and not interested in waking for feeds
- Less than four to six wet diapers per day
- Your baby is not meeting the recommended weight gain goals
- Difficulty with your baby’s latch. If your baby isn’t effectively latching to the breast with a full, deep latch (where the entire areola enters the baby’s mouth), it may mean that they are not able to efficiently empty the breast of milk
These foods are generally good for milk production
Some foods and herbs have been reported to help support milk supply. These are often referred to as galactogogues from the Greek galacta, which means milk. A few commonly used foods and herbs are:
Oats also contain polysaccharide, and they’re also a good source of iron which can help with (remember, low iron can decrease milk production). Added bonus: oatmeal is generally a healthy thing to eat.
A galactagogue is a food, herb or drug that increases milk production. Fenugreek is an herb that has the most evidence behind it. One very small randomized control trial of 66 women who drank fenugreek tea showed promising results: increased milk production and babies who gained weight more rapidly. Other herbs that are recommended for amping up milk production include shatavari, goat's rue, milk thistle, and malunggay (also known as moringa).
While herbs are natural, they should be used with the guidance of a lactation consultant, OB-GYN or midwife to ensure they are safe for you. It’s worth noting that all of these herbs should be avoided by pregnant women (fenugreek specifically has been shown to lead to uterine contractions; the others are not recognized as safe by the FDA), and those with an allergy to chickpeas or with thyroid conditions should avoid fenugreek. Moreover, thyroid complications — hyperthyroidism and hypothyroidism — are common during pregnancy, and fenugreek has been shown to impact thyroid function. Always consult with a medical professional to ensure any herbal supplement is right for you.
Studies have linked polysaccharide (a type of carbohydrate in barley hops) with an increase in prolactin, the hormone that helps increase milk production. This is likely why many new parents are told to drink Guinness, a dark Irish beer, but studies have shown that alcohol consumption inhibits milk production.
Other healthy foods
Certain foods such as apricots, asparagus, beet greens, carrots, dandelion greens, green beans, peas, pecans, sweet potatoes and watercress have been anecdotally known to increase milk production.
These foods may inhibit milk production
The common myth is that drinking helps boost milk production, but alcohol actually inhibits the milk ejection reflex, leading to a temporary decrease in production. If supply is a concern for you, abstain from drinking temporarily.
While there is little research on herbal effects on lactation broadly, it is believed that parsley, sage and mint (spearmint and peppermint) reduce milk production, which can be helpful during the weaning process.
Antihistamines may cause a reduction in prolactin, which is the hormone governing milk production. However they may not have an effect on breast milk production where lactation is established, and when doses are low.
Progesterone works to interfere with prolactin, the hormone that stimulates milk production, by blocking the receptors within the breast, thereby decreasing milk production. Estrogen similarly impacts prolactin and milk production. That said, speak to a lactation consultant or OB-GYN to discuss whether something may be right for you.
Over-the-counter medications with pseudoephedrine
Small research studies and experts suggest that over-the-counter medications with pseudoephedrine (such as Sudafed) interfere with breast milk production.
What can I do about it?
Ultimately, hormones dictate initial milk production, but skin-to-skin contact and frequent breastfeeding (or simply expressing milk often) during the first few days postpartum have been linked with increases in milk production since they stimulate the production of lactation hormones. If you’re worried you’re not producing enough milk, talk to a lactation consultant as soon as possible.
When should I be worried?
It can be concerning to have questions about your milk supply. If you are following the standard suggested frequency of feeding (10-12 times per day or every two to three hours) and you notice a decrease of breast fullness at feedings, or that your baby is showing signs of fussiness, talking to your doctor or midwife, or consulting a lactation consultant can offer some clarity and support on how to troubleshoot the issue.