How can a lactating woman increase her milk supply?

How to Increase Milk Supply in Lactating Women

The most effective strategy to increase milk supply is frequent breast emptying through 8-12 breastfeeding sessions per day, ensuring proper latch and positioning, with consideration of galactagogues like domperidone or metoclopramide if behavioral strategies alone are insufficient. 1

Primary Behavioral Strategies (First-Line Approach)

Frequent milk removal is the cornerstone of increasing milk production. The mechanism is straightforward: more frequent and complete breast emptying signals the body to produce more milk 1, 2.

Optimal Feeding Frequency

• Breastfeed 8-12 times per 24 hours to maximize prolactin stimulation and milk production 1
• Mothers who breastfeed 9-10 times daily achieve better milk production compared to those feeding fewer than 7 times per day 1
• For mothers of premature infants who cannot feed directly, pump 8-12 times daily to establish adequate supply 1

Critical Technical Factors

• Ensure proper latch and positioning at every feeding - incomplete breast emptying signals the body to reduce production, creating a counterproductive cycle 1
• Maximize skin-to-skin contact, which promotes milk production through hormonal responses 1
• Initiate early and frequent skin-to-skin contact immediately after birth to establish successful breastfeeding 1

Common Pitfall to Avoid

Do not supplement with formula unless medically necessary - supplementation reduces breastfeeding frequency and subsequently decreases milk production 1. When supplementation is required, use expressed breastmilk rather than formula whenever possible 1.

Nutritional Support for Milk Production

Adequate maternal nutrition directly impacts milk volume and quality. Ensure minimum caloric intake of 1,800 kcal/day, with an additional 500 kcal/day above pre-pregnancy requirements for the first 6 months of exclusive breastfeeding 3.

Essential Macronutrient Requirements

• Maintain at least 20% of total energy intake from fat - fat is the main energy source in breast milk and inadequate maternal fat intake can affect milk fat content 3, 4
• Add 19 g/day protein during the first 6 months, then 13 g/day after 6 months beyond baseline requirements 3, 4

Hydration Requirements

• Consume 2.7 liters of water daily (700 mL more than non-lactating women) 3, 4

Critical Micronutrients

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

Food-Based Strategy

• 7 servings of vegetables daily (emphasize green leafy vegetables) and 2 servings of fruits 3, 4
• 2 servings of dairy products daily and 2 servings of protein-rich foods (pulses, legumes, lean meats) 3, 4
• For non-vegetarians: 8-12 ounces of low-mercury seafood weekly 3, 4

Pharmacological Galactagogues (Second-Line When Behavioral Strategies Insufficient)

When frequent feeding and proper nutrition fail to establish adequate supply, galactagogues can increase milk production by elevating prolactin levels 1.

Domperidone

• Used as a galactagogue to increase milk supply 5
• When taken orally, levels in milk are low due to first-pass hepatic and intestinal metabolism 5
• Ensure the woman has access to a breast pump if there is any delay in feeding her infant when using domperidone 5
• May play a role in resolving insufficient milk supply 2

Metoclopramide

• Also used as a galactagogue and may increase milk supply 5
• Increases prolactin levels to stimulate milk production 1
• Compatible with use in lactating women 5

Breast Pump Considerations

While pumping can help establish milk production, it presents both benefits and barriers that require careful assessment 6.

When Pumping is Beneficial

• Provides additional control over breastfeeding for mothers with supply concerns 6
• Allows milk removal when infant cannot feed directly 2
• Essential for mothers of premature infants at 8-12 times daily 1

Critical Warnings About Pumping

• Pumping without ever feeding at the breast is associated with much shorter milk feeding duration (3.3 times higher risk of cessation) compared to feeding at the breast 7
• Pumped volume can worsen milk supply concern if output appears low, even when supply is adequate 6
• Pumping can be painful initially and interfere with other nurturing activities 6
• Proper breast pump fit and use are essential to optimize supply and prevent injury 8

Pumping Strategy

• If pumping is necessary, establish feeding at the breast first whenever possible rather than exclusive pumping 7
• Assess the mother's experience shortly after initiating pumping, as further management may be necessary 6

Monitoring Effectiveness

Infant-Based Indicators (Most Reliable)

• Track infant weight gain - typical gain is 150-200 g/week in the first 3 months 3, 1
• Monitor diaper output - 6-8 wet diapers per day indicates adequate intake 1

Maternal Assessment

• Many women have unwarranted concerns about milk supply - "not enough milk" is the most common reason women give for stopping breastfeeding, though concern is often unfounded 2
• Determine if milk supply is truly inadequate through history taking and examination of both mother and infant 2

Underlying Causes to Address

Insufficient milk supply may be secondary to:

• Maternal conditions such as postpartum hemorrhage or breast reduction surgery 2
• Infant factors such as tongue-tie or ill health 2

Address these underlying causes while implementing the strategies above for optimal results 2.