One of the most common reasons a mother weans her baby before she might want to is that she is worried that she doesn't have enough milk. Nearly all mothers are capable of producing enough breastmilk for their babies. Just as you have already nurtured your baby in your womb for nine months, so your body is designed to continue providing nourishment once your baby is born. Everything your baby needs to grow strong and healthy is in your milk. It is the normal food for your baby and you and your baby will work together to establish your milk supply and maintain it as your baby grows. Of course, there might be other reasons why baby is fussy or crying and you might want to check with your medical adviser if you have any concerns. Here are some ideas to help you work out if your supply really is low and some suggestions that will help you make more milk for your baby.

How Do I Know if my Baby is Getting Enough Breastmilk?

If your baby shows two or more of the signs below then it is probable that you do have enough milk.

• At least 6 to 8 very wet nappies in 24 hours provided no other fluids or solids are being given. A very young baby will usually have 2 or more soft bowel movements a day for several weeks. An older baby is likely to have fewer than this. (Small quantities of strong, dark urine or formed, hard bowel motions do suggest that the baby is in need of more breastmilk.
• Good skin colour and muscle tone.
• Your baby is alert and reasonably contented and is not constantly wanting to feed. Your baby may still wake for night feeds - some babies sleep through the night at an early age while others wake during the night for some time...even years!
• Some weight gain and growth in length and head circumference – please ensure your baby is being measured on the correct growth charts that apply to breastfed babies – these are NOT routinely in clinics, and you can get them here.

How to Make More Milk:

Demand = Supply

MORE FREQUENT FEEDING MEANS MORE MILK

How to make more milk:

• Feed your baby more frequently than usual.
• Check that baby is well positioned at the breast.
• Whenever possible, allow the baby to decide on the length of a feed.

Some other points to consider:

Genetic patterns need to be taken into account when assessing a baby's growth. Slower weight gain may be more likely in a family where the parents are of small stature, but the baby will still show consistent growth over the first year.

A baby's stomach is only as big as his fist and can only contain small amounts at a time. This means babies need to feed quite frequently to get all the milk they require.

Some apparently contented babies are very undemanding and need to be woken for feeds so that they will continue to gain weight. Most breastfed babies feed at least eight to twelve times in 24 hours. If weight gain is a concern, your baby may need to be woken, particularly for a night feed, to ensure he is having a minimum of six feeds in 24 hours.

On the other hand, some colicky babies seem far from content, and may feed frequently, yet continue to gain weight steadily. Commonly, these babies appear hungry frequently, but may actually be getting too much milk, too fast and have tummy ache. You can tell if this is the case if your baby has lots of wet and dirty nappies every day.

Between six weeks and six months, it is normal for babies to have fussy periods from time to time, when they ask to feed more frequently than usual. You may wonder if your milk supply is still meeting your baby's needs. These times used to be called 'growth spurts' or 'appetite increases', however studies have shown that exclusively-breastfed babies' intake of breastmilk does not increase significantly between one and six months of age. Although it is not known exactly why babies have periods like this, it is a very common event that may be linked to their development. It does not mean that you don't have enough milk. If you follow your baby's lead and breastfeed more frequently for a few days, you will probably find that your baby soon settles down again. Hot weather may also trigger an increase in a baby's feeding frequency.

Most babies will feed best if they are put to the breast before they are crying hard. Crying is a very late hunger signal. Watch your baby; he may start to stir from sleep, maybe try to suck his fist or otherwise 'search' for food quite a while before crying. A lot of mums find that by offering the breast as soon as baby starts to stir can help baby to take a good feed. Some parents also will use kangaroo care (skin-to-skin cuddling by holding baby with bare chest against mother's bare chest) to help the baby relax into breastfeeding and this also boosts the mother's hormone levels to assist her milk supply. A blanket, shawl or shirt can be used to cover both of you to keep warm and baby can be carried in a sling to promote contact and settle your baby. We’re big slings fans!

You and your baby work together to start the milk-making process and to maintain it at the right level to ensure it meets your baby's needs. If you are concerned that this may not be happening, you might like to check the following possible causes of low milk supply:

• not enough feeds, or feeds too short or interrupted
• poor positioning at the breast, or poor sucking (often causing sore nipples)
• changing sides too soon
• tension, pain or fatigue inhibiting your let-down reflex
• using complementary feeds (comps) or top-ups of artificial baby milk; and/or stretching out time intervals between feeds with a dummy
• introducing solids too early (before six months)
• hormonal change in the mother eg ovulation, menstruation, pregnancy or contraceptives
• some medications or drugs - whether prescribed, over-the-counter, recreational or herbal
• cigarette smoking
• illness in mother or baby
• very rarely, a physiological inability (that a mother is born with or, for example, as a result of previous breast surgery or injury)

First, it's important to assess if you're truly dealing with a truly low milk supply. Sometimes mothers can perceive normal breastfeeding patterns and/or baby behaviour as an inadequate milk supply. If you determine that you really do have a low supply, consult with a lactation consultant to determine why so that you can get to work fixing the problem and prevent it from occuring again. I

In the meantime...
There are several positive steps you can take if you decide that your milk supply is low. If possible, plan to set aside a few days, perhaps a weekend, to spend doing little else but working to increase your milk production. Following the steps listed below, most women notice an increase in supply within 24-72 hours. (this guideline also applies for pumping mums wanting to increase supply)

• Breastfeed or pump frequently. Plan to feed your baby at least every 1 1/2 to 2 hours during the day and at least every 3 hours at night even if you must wake(or dream feed) your baby. Time your feedings from the beginning of one to the beginning of another. Breastfeeding is of course preferable to pumping as he will better stimulate your breasts to produce more milk.
• Allow the baby to nurse on each side until he pulls off himself or goes to sleep.
• Offer both breasts at each feeding.
• Although breastfeeding is preferable, if the baby cannot nurse directly at the breast, use a hospital-grade electric pump for double pumping instead. Double pumping has been shown to increase Prolactin levels. Prolactin is the hormone which stimulates milk production. Pump for 10-15 minutes per session. Longer sessions have not been proven to be any more beneficial at increasing supply.
• Along with breastfeeding, you may want to add another pumping session or two sometime during your day. You also may want to add a few extra minutes (5-10) of pumping after the baby has finished nursing.
• Allow the baby to meet all of his sucking needs at the breast. Avoid any bottles or soothers during this time. Your baby's need to suck ensures that he spends adequate time at the breast to stimulate your supply.
• Avoid supplements including solid food, water and formula. Adding these will result in your baby nursing less often and you getting less stimulation. You can be sure that your baby is getting enough by counting his wet diapers and bowel movements.
• If your baby requires a supplement for medical reasons, consider using a nursing supplementer at your breast so that you can continue to receive crucial BABY stimulation.
• Snack often on foods rich in protein and calcium.
• Drink enough to satisfy your thirst. Forcing fluids is not necessary and may have the opposite effect. Any type of fluid is satisfactory.
• Rest as much as you can. Consider taking the baby to bed with you for the time period. The rest will benefit you and the close skin-to-skin contact may encourage him to nurse more often.
• Oatmeal, Fennel tea and Beer have all been reported to help boost milk supply.
• Some mothers have found that the herb, Fenugreek, is helpful for increasing milk supply. It works best when combined with increased frequency of nursing and/or pumping. You can find it at your local health food store or nutrition store. The dosage is 2-4 capsules 3 times a day. Most women notice an increase in supply after using it 1-3 days. It is safe for your baby. While taking it you may notice that your perspiration and urine smell like maple syrup as Fenugreek is used to give artificial Maple syrup its odour. Some moms report diarrhoea while taking it that quickly resolves once they stop taking it. If you suffer from asthma, your symptoms may become worse with the Fenugreek. Dosages higher than the recommended one given above may result in hypoglycaemia in some mothers. If pregnant, you should NOT use Fenugreek as it may cause uterine contractions. Many moms use it for a quick boost to their supplies. Others have used it long-term with no problems. Other herbs often recommended for increasing milk supply are Blessed Thistle and Alfalfa. For some mothers a combination of herbs seems to work better than one herb alone. You may use the Fenugreek, Blessed Thistle, and Alfalfa in combination if you choose.
• If the above measures do not cause a significant increase in your supply, you may want to ask your doctor about Metoclopramide, sometimes prescribed for low milk supply. It is most effective at doses of 10-15 mg 3 times a day and should not be used for any longer than 2-4 weeks. If you have a history of depression, it should be avoided due to its potential side effects of depression and mood swings.
• Domperidone (Motilium) may also be used for low supply and seems to have far fewer side effects than metoclopramide. The dosage suggested for increasing milk supply is 10-20 mg 3-4 times a day.
• Both Domperidone and Metoclopramide can be used with any of the herbs mentioned above.See article on Galactagogues

The secret to boosting your milk supply is to fit in more feeds than is usual for your baby. More frequent and efficient milk removal by a well attached baby means more milk will be made. More frequent feeding means more milk.

Human babies are designed to need frequent feeds and by offering the breast at least every two or so hours during the day (and usually at least one night feed), your milk supply can increase quickly. Feeds don't have to be at regular intervals, you might find that you can fit in an extra breastfeed at any time if baby is awake and happy to accept it, or offer a 'top-up' fairly soon after a feed.

Very occasionally, a mother tries the ideas above and still finds that her milk supply is low. If you think this is the case with you, speak to a health professional who has a special interest in breastfeeding, as you may be able to try some medication to maximise your milk supply.

Dr Jack Newman – how to get past a low supply:

Here is the way I suggest mothers proceed for "insufficient milk supply" (actually, most mothers have lots or could have had lots, but the problem is that the baby is not getting the milk that is available).

Get the best latch possible. This needs to be shown by someone who knows what they are doing. Anyone can look at the baby at the breast and say the latch is good. The accompanying diagram shows how to get a good latch. If a mother has plenty of milk, the latch does not have to be perfect. But, if the milk supply is decreased, the baby will get more milk if he is latched on better. Get good “hands on” help. Videos can be seen at www.thebirthden.com/Newman.html that show you how to best latch a baby on.

Know how to know the baby is getting milk. When a baby is getting milk (he is not getting milk just because he has the breast in his mouth and is making sucking movements), you will see a pause at the point of his chin after he opens to the maximum and before he closes his mouth, so that one suck is (open mouth wide-->pause-->close mouth). If you wish to demonstrate this to yourself, put your index or other finger in your mouth and suck as if you were sucking on a straw. As you draw in, your chin drops and stays down as long as you are drawing in. When you stop drawing in, your chin comes back up. This pause that is visible at the baby's chin represents a mouthful of milk when the baby does it at the breast. The longer the pause, the more the baby got. Once you know about the pause you can cut through so much of the nonsense breastfeeding mothers are being told—such as “Feed the baby twenty minutes on each side”. A baby who does this type of sucking (with the pause) for twenty minutes straight might not even take the second side. A baby who nibbles (doesn't drink) for 20 hours will come off the breast hungry. You can see this “pause” on the videos at www.thebirthden.com/Newman.html

Once the baby is no longer drinking on his own, use compression to increase flow to the baby. Compression can be particularly helpful, but don't forget trying to get the best latch possible first. Babies tend to pull at the breast when the flow of milk is slow, so it is useful to know how to know the baby is actually getting milk and not just sucking without getting milk. When the baby no longer seems to be getting milk, and is sucking without getting milk, this is when to start compression, while the baby sucks, but does not drink. Keep the baby on the first breast until he doesn't drink even with compression. See handout #15 Breast Compression. You can see this how to use compression on the videos at www.thebirthden.com/Newman.html

When the baby no longer drinks even with compression, switch sides and repeat the process. Keep going back and forth as long as the baby gets reasonable amounts of milk at the breast.

Try fenugreek and blessed thistle. These two herbs seem to increase milk supply and increase rate of milk flow. There is more information on the handout #24 Cabbage Leaves, Herbs, Lecithin.

In the evening when babies often want to be at the breast for long periods, get help to position the baby so that you can feed lying down. Let the baby nurse and maybe you will fall asleep. Or rent videos and let the baby nurse while you watch.

It is not always easy to decide if a baby needs supplementation. Sometimes applying this Protocol for a few days gets the baby gaining more rapidly. Sometimes more rapid growth is necessary, and it may not be possible without supplementation. If possible, get banked breastmilk to use as a supplement if you can. If not available, formula may be necessary. However, sometimes slow but steady growth is acceptable. The main reason to worry about growth is that good growth is one sign of good health. A baby who grows well is usually in good health, but this is not necessarily so. Neither is a baby who grows slowly in poor health, but physicians worry about a baby who is growing more slowly than average. Growth charts are frequently interpreted poorly. A baby who follows the 10th percentile line is growing as he should be. Too many people, including physicians, believe that only babies on the 50th percentile or higher are growing normally. Not true. Growth charts were developed on information based on information gathered about normal babies. Somebody has got to be smaller than 90% of all other babies. Somebody normal.

If it is decided to supplement, the best way is at the breast with a lactation aid. Introduce the supplement with a nursing supplementer (lactation aid), not bottle, syringe, cup or finger feeding. See handout #5 Using a Lactation Aid at this website. Supplement only after steps 3 and 4 above and the baby has nursed on at least both sides. Why is it better to use the lactation aid?

• Babies learn to breastfeed by breastfeeding
• Mothers learn to breastfeed by breastfeeding
• The baby continues to get your milk
• The baby won't reject the breast
• There is more to breastfeeding than the breastmilk

If the baby is older than three or four months, and supplementation appears to be necessary, formula is not necessary and extra calories can be given to the baby as solid foods. First solids may include: mashed banana, mashed avocado, mashed potato or sweet potato, infant cereals, as much as the baby will take, and after the baby has nursed, if he is still hungry. Even at this age giving bottles when the baby is not getting much from the breast will often result in breast rejection. If you must give formula, mix it with the baby’s solids. Giving solids at three or four months if everything is going well is not recommended, and even if the weight gain is slow, there are several ways of getting the baby more breastmilk that can be tried before adding solids. Solids should normally be started when the baby is showing interest in eating solids (usually around six months of age).

If your baby was gaining well for a few months and now is not gaining well, see the handout #25 Slow Weight Gain After the First Few Months. Reasons for a decreased milk supply are listed there. Fix what you can, and then follow this Protocol.

Domperidone is a possibility. It is not a panacea (a magic bullet). Check the handouts on Domperidone (Domperidone and Domperidone-2).