How to increase milk supply while pumping

Signs That a Breastfed Baby Is Being Well Nourished

• Your baby nurses at least 8 to 16 times in 24 hours, or every 2 to 3 hours. Your baby may be fussy once or twice a day. At these times, he or she wants to nurse often for several hours before seeming full. This is called cluster feeding.
• Your baby wets at least 6 cloth or 5 disposable diapers and has at least 1 bowel movement in 24 hours. This occurs by 1 week of age.
• You can hear your baby swallow milk while nursing or you can feel your baby swallow when lightly touching his or her throat.
• Your breasts seem softer after nursing.
• Your baby gains 4 to 8 ounces a week after the first week. There is no need to weigh your baby at home. Your baby’s doctor will do this for you. You may notice that your baby has outgrown his or her clothing.
• Your baby has regained his/her birthweight by 10 to 14 days after birth.

Factors Which Can Cause Your Milk Supply to Decrease

• Your baby feeds fewer than 8 to 16 times in 24 hours. Milk production is affected by how well the breast is drained.
• Your baby has a very weak suck, or has an improper latch.
• Giving bottles of formula or water after nursing. Most babies will suck on a bottle after nursing. This just means they need to suck. It does not mean they are still hungry. Babies cry or fuss for many reasons, such as being tired, bored, wet, hot or cold.
• Giving solid foods too early and/or before you breastfeed. Most babies do not need solid foods for the first 6 months if they are breastfeeding 8 to 16 times a day.
• Smoking can cause a decreased milk supply and interfere with the letdown reflex. Here are some things you should do:
  • Try to quit or cut down.
  • Smoke after nursing, not before.
  • Don’t smoke in the same room with your baby.
• Beginning birth control pills too soon can decrease your milk supply. Wait at least 6 weeks before taking birth control pills and then use only the mini-pill (Progestin). If you still notice a decrease in your milk supply, talk to your doctor about other birth control options. Other medications may also affect milk supply. Check with your doctor. (Refer to PI-682, Breastfeeding and Birth Control: You Have Options.)
• Mothers who are exhausted may notice a decrease in milk supply. To keep yourself from getting too tired:
  • Sleep or relax when your baby sleeps.
  • Eat balanced diet that includes high-protein food.
  • Drink when you are thirsty so that your urine is pale yellow in color. Both under and excessive over hydration can decrease milk supply.
  • Take an iron supplement if your healthcare provider says you are anemic.
  • Talk with your doctor or nurse midwife about the need for vitamin supplement.
  • Accept help when it is offered.
• Use nipple shields and pacifiers with caution.
• A breast flange that is too small or too large in size can hurt your milk supply.
• Pregnancy
• Breast reduction surgery may reduce milk supply.

If You Notice Your Milk Supply Is Low

You can increase your milk supply by:

• Nursing your baby often. Nurse every 2 hours during the day and every 3 to 4 hours at night (at least 8 to 16 times in 24 hours). If your baby will not nurse, use a good quality double electric breast pump to increase milk production. Pumping after breastfeeding signals your body to produce more milk.
• Nurse your baby at least 15 minutes at each breast. Do not limit nursing time. If your baby falls asleep after one breast, wake him or her and offer the second breast. A few babies may benefit from nursing at one breast per feeding to increase the fat content of the feeding. Switch nursing- switching breasts several times during a feeding has been shown to increase milk supply.
• Gently massage breast before and during feedings.
• Use relaxation techniques to reduce stress and promote the flow of breast milk.
• Provide skin to skin time with your baby for about 20 minutes after feeds. This “kangaroo care” has been shown to increase milk supply.
• Be sure baby is positioned and latched correctly.
• Offer both breasts at each feeding.
• Try breast compression during the feeding to help drain the breast.
• Pump immediately after breastfeeding during the day. Rest at night. Some mothers find that they get more milk if they pump for 5 minutes, rest for 5 minutes, and pump for another 10 minutes.

Talk to your doctor about using medication or the herb fenugreek.

Works Cited

Wambach, Karen and Riordan, Jan “Breastfeeding and Human Lactation”, Fifth edition, Jones & Bartlett, 2016.

Whether you have a premature baby and need to pump for future feedings or you are simply struggling with a low milk supply, there are a number of things you can do to establish and increase your milk supply.

For premature babies, the NICU staff can feed him your pumped milk in a gavage tube or bottle until your baby grows big enough to breastfeed well. For other moms, you can continue to breastfeed while building your milk supply. The following tips will help you to establish a bountiful milk supply as your baby grows.

Establishing Your Milk Supply

Even if your premature baby is so small that they are only getting a few teaspoons of your pumped milk each day, it's important to establish a good milk supply in the early days. Soon, your baby will be big enough to drink the milk you'll be putting in the freezer.

Pump Often

Remember, breast milk is produced on a supply-and-demand basis. More pumping or more breastfeeding is what creates a plentiful milk supply, so in order to increase your supply, you need to pump often and well. You should strive to pump at least every two to three hours, for 20 minutes at a time, to establish a milk supply.

Select the Right Pump

Many breast pumps sold in stores are designed for occasional use only. These are great for moms of full-term, breastfeeding babies who want to give the occasional bottle. If you're exclusively pumping, though, you need the right pump—a fully automatic, hospital-grade breast pump to establish your milk supply. Ask for one at your baby's hospital. Many times, insurance will cover the rental fees.

Choose the Right Breast Shield

The flange, or breast shield, is the part of the pump that is placed on the breast during a pumping session. Because breasts come in all sizes, breast shields are not one-size-fits-all. So finding the right fit is essential.

For instance, if your nipples rub against the flange's tunnel or if your areola is pulled into the tunnel while you pump, you need a different size flange. Many moms find that their milk supply goes up dramatically when they switch to a breast shield that fits better.

Increasing Your Milk Supply

If you're still struggling to pump enough breast milk to meet your baby's needs, you may wonder what else you can do to increase your milk supply. Fortunately, there are a number of ways to increase your milk supply while pumping on a consistent schedule. Here's an overview of things you can try.

Increase Pumping Sessions

Once your milk supply is established, you can space out your pumping sessions every three to four hours instead of every two to three. But, to increase your supply, step the frequency back up to every two to three hours.

Use Hands-On Pumping

Breast massage, or hands-on pumping, during pumping sessions has been proven to dramatically increase a mom's milk supply. Massage breasts before you pump and while you're pumping for maximum benefit.

Make Sure You're Relaxed

If you're stressed while you're pumping, you'll pump less milk. You may even find your milk supply dwindling if your baby is sick, if you're arguing with your partner, or if you're worried about work or home. Having a baby in the NICU is very stressful, but making sure that you get enough rest, healthy food, and exercise can help you cope with the stress of having a sick baby.

Try Kangaroo Care

The hormones that are released when you hold your baby close can increase your milk supply. If your baby is too small to breastfeed, try kangaroo care. Just holding your baby skin to skin can increase the hormones that affect your milk supply.

Pump in the NICU

If your baby is too sick for kangaroo care, talk to NICU staff about pumping at the bedside. Most NICUs will be happy to provide you with screens and privacy so that you can pump next to your baby, making the most of your mothering hormones to increase your pumped milk supply.

Consider Supplements

If your milk supply still seems low after you feel like you've tried everything, talk to your doctor about herbs or medications to increase your milk supply. But, don't take anything over-the-counter until you have talked to your doctor. Anything you take could pass through your breast milk, and you want to ensure your milk supply is safe for your baby.

By Cheryl Bird, RN, BSN
Cheryl Bird, RN, BSN, is a registered nurse in a tertiary level neonatal intensive care unit at Mary Washington Hospital in Fredericksburg, Virginia.

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