Evidence-Based Ways to Increase Lactation Production
Adequate nutrition, hydration, and frequent breast emptying (at least 6 times daily) are the most effective evidence-based strategies to increase lactation production. 1
Nutritional Requirements for Optimal Lactation
Energy and Macronutrients
- Caloric needs: Lactating women require an additional 500 kcal/day above pre-pregnancy requirements 1
- Typical requirement: Additional 2,000-2,100 kJ (approximately 500 kcal) per day
- Energy intake should contain at least 20% fat to maintain adequate milk fat content 1
Protein Requirements
- First 6 months of lactation: 19 g/day additional protein
- After 6 months: 13 g/day additional protein 1
Hydration
- Increase water intake by approximately 700 mL/day above normal requirements
- Total adequate intake: 2.7 L/day (compared to 2.0 L/day for non-lactating women) 1
Specific Strategies to Increase Milk Production
Breast Emptying Techniques
- Pumping frequency: Maintain ≥6 pumping sessions per day for optimal milk production 2
- Studies show mothers who pump ≥6 times daily have significantly higher milk output than those who pump less frequently
- Hospital-grade breast pumps produce more milk than hand expression 2
Nutritional Supplements
- Essential fatty acids: Add 100-200 mg of preformed DHA during lactation 1
- Total recommended intake: 250 mg EPA plus DHA daily, with additional 100-200 mg DHA
Medications (Galactogogues)
- Metoclopramide: First-line pharmacologic galactogogue with documented efficacy and safety 3
- Domperidone: Alternative option that crosses the blood-brain barrier and enters breast milk to a lesser extent than metoclopramide 3
Dietary Recommendations
Food Groups
- Vegetables: >7 servings/day
- Fruit: 2 servings/day
- Grains/cereals: 2 servings/day
- Milk, yogurt, cheese: 2 servings/day
- Lean meats, poultry, fish, eggs, nuts, seeds, legumes: 2 servings/day 1
Micronutrients
- Vitamin D: 10 mg daily supplement recommended throughout lactation 1
- Iodine: Ensure adequate intake (150 mg daily) 1
- Iron and folic acid: Continue supplementation for 3 months after birth 1
Seafood Recommendations
- Consume 8-12 ounces of seafood weekly for improved infant outcomes
- Limit white (albacore) tuna to 6 ounces/week
- Avoid tilefish, shark, swordfish, and king mackerel due to mercury content 1
Practical Implementation
Establishing Milk Supply
- Early milk production thresholds that predict successful full lactation:
- Day 6: 350 g/day
- Day 8: 500 g/day
- Day 14: Close to 750 g/day 2
Preventing Common Issues
- Evening snack: Include an evening snack to prevent overnight ketosis 1
- Pre/during feeding snack: For insulin-treated diabetic mothers, eat a carbohydrate-containing snack before or during breastfeeding to prevent hypoglycemia 1
Monitoring Success
- Track daily milk output
- Predictive thresholds for achieving full lactation (>750 g/day by day 42):
- Day 7 output >406.8 g/day (68.2% sensitivity, 100% specificity)
- Day 14 output >518.0 g/day (81.8% sensitivity, 100% specificity) 2
Special Considerations
Weight Loss During Lactation
- Energy intake of 1,800 kcal/day typically meets nutritional requirements for lactation while allowing gradual weight loss of 1-2 lb/month 1
- Overweight women can safely lose up to 2 kg/month without affecting milk volume 1
Environmental Factors
- Avoid smoking, which is associated with reduced milk production 1
- Minimize exposure to environmental chemicals that may affect lactation duration 1
Remember that successful lactation is both a physiological process and a learned behavior. While these evidence-based strategies can help increase milk production, consistent application and monitoring are essential for optimal outcomes.