How to increase milk production in a lactating mother?

How to Increase Milk Production in a Lactating Mother

The most effective strategy to increase milk production is to immediately implement frequent breastfeeding or milk expression at least 8-10 times per 24 hours with thorough breast drainage, as milk production operates on a direct supply-and-demand mechanism where removal frequency drives production. 1

Immediate Non-Pharmacological Actions

Optimize Feeding Frequency and Technique

• Increase breastfeeding or pumping sessions to at least 8-10 times per 24 hours with on-demand feeding rather than scheduled intervals, which is the cornerstone of increasing supply 1
• Ensure thorough breast drainage at each session, as incomplete emptying signals the breast to reduce production 1
• Implement continuous rooming-in to facilitate frequent, exclusive breastfeeding without mother-infant separation 1
• Initiate or continue skin-to-skin contact, which supports milk production by decreasing hypoglycemia risk and promoting earlier copious milk production 1

Address Modifiable Risk Factors

• Eliminate smoking and vaping completely, as these directly reduce milk production and shorten lactation duration 1
• Avoid alcohol entirely while breastfeeding, as no amount is considered safe and it can negatively affect milk production 2, 3
• Ensure access to skilled lactation support, as breastfeeding-supportive practices are associated with higher exclusive breastfeeding rates 1

Nutritional Optimization Strategy

Caloric and Macronutrient Requirements

• Consume at least 1,800 kcal/day minimum, ideally pre-pregnancy needs plus 500 kcal/day, as exclusive breastfeeding requires approximately 670 kcal/day for milk production 2, 1
• Ensure at least 20% of total energy intake comes from fat, as fat is the main energy source in breast milk 2, 3
• Add 19 g/day of protein during the first six months of lactation, and 13 g/day after six months 2, 3

Critical Hydration

• Drink 2.7 liters of water daily (700 mL more than non-lactating women), as adequate hydration is essential for milk volume 2, 3

Specific Food Recommendations

• Consume 7 servings of vegetables daily (emphasizing green leafy vegetables) and 2 servings of fruits 2, 3
• Include 2 servings of dairy products daily and 2 servings of protein-rich foods (pulses, legumes, lean meats) 2, 3
• For non-vegetarians: eat 8-12 ounces of low-mercury seafood weekly (limit white tuna to 6 oz/week; avoid tilefish, shark, swordfish, king mackerel) 2, 3

Essential Micronutrient Supplementation

• Continue iron and folic acid supplementation for 3 months postpartum 2, 3
• Take vitamin D supplement (10 mg daily) throughout breastfeeding, as maternal diet directly affects milk vitamin D content 2, 3
• Ensure adequate iodine intake (250 mg daily) through iodized salt and seafood 2, 3
• Consume 250 mg EPA/DHA daily plus additional 100-200 mg DHA during lactation 2, 3

Pharmacological Options (When Non-Pharmacological Measures Are Insufficient)

Only consider galactogogues after optimizing breastfeeding technique and frequency, as supplementation should occur only when medically necessary or after technique optimization fails 1

Medication Options

• Domperidone can increase milk supply when taken orally and is compatible with breastfeeding due to low levels in milk from first-pass hepatic metabolism 1
• Metoclopramide may also increase milk supply and is compatible with breastfeeding 1
• Consult the LactMed database (National Library of Medicine) for comprehensive medication safety information, as most maternal medications are compatible with breastfeeding 1

Monitoring Success

• The infant's weight gain is the best indicator of adequate milk supply, with typical weight gain of 150-200 g/week in the first 3 months 2
• Assess for objective signs of insufficient milk production before intervening, as maternal perception of insufficient milk is often unwarranted and is a major reason women stop breastfeeding unnecessarily 4, 5

Critical Pitfalls to Avoid

• Never restrict calories below 1,800 kcal/day, as this is the minimum threshold for maintaining adequate milk production 2
• Do not recommend supplements before optimizing breastfeeding technique and frequency 1
• Do not severely restrict fat intake, as this compromises the primary energy source in breast milk 2
• Avoid scheduled feeding intervals in favor of on-demand feeding, which better matches infant appetite to milk production 1, 6