How to Increase Milk Production
The most effective strategy to increase milk production is frequent breastfeeding or milk expression (at least 8-10 times per 24 hours) with thorough breast drainage, as milk production operates on a supply-and-demand mechanism where removal frequency directly drives production. 1, 2
Core Principles of Milk Production
Milk production is fundamentally controlled by infant demand rather than maternal capacity—a mother's actual production capability may be several-fold higher than what she typically produces. 3 Understanding this principle is critical: most mothers who perceive insufficient milk supply actually have adequate production capacity but need optimization of milk removal. 2
Immediate Actions to Optimize Milk Supply
Increase feeding frequency to at least 8-10 times per 24 hours with on-demand feeding rather than scheduled intervals, which decreases newborn weight loss, reduces need for supplements, and prevents hyperbilirubinemia. 1
Ensure thorough breast drainage at each feeding session, as incomplete emptying signals the breast to reduce production while complete drainage stimulates increased synthesis. 2
Implement continuous rooming-in to facilitate frequent, exclusive breastfeeding without separation from the infant. 1
Initiate early skin-to-skin contact immediately after delivery, which decreases hypoglycemia risk and supports earlier lactogenesis II (copious milk production typically occurring by day 3-4 postpartum). 1
For Mothers of Premature/VLBW Infants
Begin milk expression within the first hour after delivery if direct breastfeeding is not possible—this timing is critical, as benefits of "within 6 hours" initiation disappear unless expression begins within the first 60 minutes. 4
Facilitate early, frequent milk expression through hospital protocols to establish full milk supply for very low birth weight infants, as mother's milk reduces necrotizing enterocolitis, late-onset sepsis, chronic lung disease, and improves neurodevelopment. 1
What Does NOT Work
Ineffective Interventions to Avoid
Extra fluid intake beyond physiological needs does not improve milk production—advising mothers to drink excessive fluids is unsupported by evidence and should not be recommended. 5
Lactation cookies containing "galactagogues" (oatmeal, brewer's yeast, flax seeds, fenugreek) show no effect on objective milk production rates, perceived milk supply, or breastfeeding self-efficacy in a 2023 randomized controlled trial, representing unnecessary financial burden and false hope. 6
Pharmacological Options (Galactagogues)
When non-pharmacological optimization has been maximized and insufficient milk persists:
Domperidone can be used as a galactagogue and may increase milk supply when taken orally, though it is primarily indicated for gastrointestinal conditions. 1 Due to first-pass hepatic metabolism, levels in milk remain low, making it compatible with breastfeeding. 1
Metoclopramide is also used as a galactagogue and may increase milk supply while being compatible with breastfeeding. 1
Consult LactMed database (National Library of Medicine) for comprehensive medication safety information, as most maternal medications are compatible with breastfeeding. 1
Common Pitfalls to Avoid
Do not recommend supplements before optimizing breastfeeding technique and frequency—supplementation should only occur when medically necessary or after technique optimization fails. 1
Avoid test weighing (weighing infant before/after feeds) as a measure of milk production in term infants, as this practice lacks precision and is no longer routinely recommended. 5
Recognize that normal breastfeeding frequencies, suckling times, and amounts are highly variable—counsel mothers that perceived insufficiency often reflects normal variation rather than true inadequacy. 2
Address modifiable risk factors: smoking/vaping reduces milk production and shortens lactation duration (advise cessation or timing immediately after breastfeeding to minimize infant exposure); moderate alcohol consumption (up to 1 standard drink/day with 2-hour wait before nursing) does not affect breastfeeding duration. 1
Support Infrastructure
Ensure access to skilled lactation support in maternity facilities and outpatient settings, as breastfeeding-supportive hospital practices (WHO Ten Steps) are associated with higher exclusive breastfeeding rates at discharge and 8 weeks postpartum. 1
Provide breast pump access if prolonged separation occurs to prevent mastitis and maintain supply. 1
Link with community breastfeeding resources for ongoing support beyond hospital discharge. 1