How can I improve my breast milk production?

How to Improve Breast Milk Production

The most effective strategy to improve breast milk production is to increase breastfeeding or milk expression frequency to 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

Immediate Actions to Optimize Milk Supply

Frequency and Technique

• Breastfeed or express milk 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 continuous rooming-in to facilitate frequent, exclusive breastfeeding without separation from the infant 1
• Implement 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
• Verify proper infant latch and effective breast emptying, as inadequate breast drainage is the most common cause of perceived insufficient milk supply 2

Critical Pitfall

Do not introduce formula supplementation before optimizing breastfeeding technique and frequency—supplementation should only occur when medically necessary or after technique optimization fails 1, 2

Nutritional Optimization for Milk Production

Caloric and Macronutrient Requirements

• Consume an additional 500 kcal/day above pre-pregnancy needs during the first 6 months of exclusive breastfeeding, as milk production requires approximately 670 kcal/day 3, 4
• Never consume less than 1,800 kcal/day, as this is the minimum threshold for maintaining adequate milk production 3, 5
• Ensure at least 20% of total energy intake comes from fat, as inadequate fat intake may affect the fat content of breast milk 4, 3
• Increase protein intake by 19 g/day during the first 6 months, and 13 g/day after 6 months beyond baseline requirements 4

Hydration

• Consume 2.7 liters of water daily (700 mL more than non-lactating women) 3, 4
• Note that extra fluids beyond physiological needs do not improve breast milk production based on available evidence 6

Essential Micronutrients That Support Lactation

• Continue iron and folic acid supplementation for 3 months postpartum, as recommended by WHO 4, 3
• Take vitamin D supplement (10 mcg daily) throughout breastfeeding, as maternal diet directly affects milk vitamin D content 4, 3
• Ensure adequate iodine intake (250 mcg daily) through iodized salt and seafood 4, 3
• Consume 250 mg EPA/DHA daily plus additional 100-200 mg DHA during lactation to compensate for oxidative losses and infant accumulation 4

Food-Based Strategy

• Consume 7 servings of vegetables daily (emphasize green leafy vegetables) and 2 servings of fruits 3
• Include 2 servings of dairy products daily and 2 servings of protein-rich foods (pulses, legumes, lean meats) 3
• For non-vegetarians: consume 8-12 ounces of low-mercury seafood weekly (limit white tuna to 6 oz/week; avoid tilefish, shark, swordfish, king mackerel) 4, 3
• Ensure a varied and balanced diet, as breastmilk composition is selectively affected by maternal diet, particularly for thiamine and vitamins A and D 5

Pharmacological Options (Only After Optimizing Technique)

Medications should only be considered after day 14 postpartum and only after full lactation support has been implemented, with no evidence supporting prophylactic use of galactagogue medications 2

• Domperidone can be used as a galactagogue and may increase milk supply when taken orally, with low levels in milk due to first-pass hepatic metabolism, 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, 4

Lifestyle Factors That Reduce Milk Production

• Avoid smoking and vaping, as these reduce milk production and shorten lactation duration 1
• Avoid alcohol completely while breastfeeding, as no amount is considered safe and it can affect milk production 3, 4
• Avoid pacifiers and unnecessary formula supplementation, as these interfere with establishing adequate milk supply 2

Access to Support

• 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 1, 2
• Provide a private room where family members can accompany the mother to reduce anxiety 2

Monitoring Success

The infant's satisfactory weight gain is the best indicator of adequate maternal nutrition and milk supply, with typical weight gain of 150-200 g/week in the first 3 months 3, 7