image breast pump bottles with milk

Underproduction of Breast Milk: How to Increase Your Supply

How much is “enough” breast milk? The answer is not a number, because it is different for each mother. “Enough” is the volume needed to feed your baby.

On average, a woman will make 1-1.5 ounces of breast milk every hour, which means 3-4 ounces every three hours is typical. As a physician and breastmilk advocate, I get particularly annoyed when I see pictures of women pumping and there are five or more ounces in each bottle. That is not the message we should be giving our pumping moms, because it is unrealistic. Images like these make moms think they don’t make enough milk, when in fact they are doing just fine.

What about moms who don’t produce enough milk? As a neonatologist, I encounter this problem frequently. Moms who deliver prematurely, or who were separated from their baby after delivery, often struggle with their supply after the first few weeks. Some of these moms aren’t pumping enough, in which case the answer is simple, pump more often. Pumping more often, not longer, will often increase a woman’s supply.

Some moms may pump eight times a day and still find themselves struggling. Many things can contribute to this situation and not all of them are fixable, but here are a few suggestions to try to increase your supply:

  • Get a lactation consultant involved – this is extremely important!
  • Have someone skilled in lactation watch you pump – sometimes the pump settings need to be adjusted or sometimes the pump parts that attach to the breast do not fit correctly and need to be sized up or down.
  • Do skin-to-skin care, also known as kangaroo care, with your baby as much as possible.
  • Each time you start pumping, take 3-5 minutes to focus on your baby – take a few deep breaths, look at his or her picture, imagine what he smells like, what he feels like on your chest – taking this time to focus on your baby will help your milk letdown (or come out) when you pump.
  • Drink whenever you are thirsty (preferably without caffeine – caffeine tells your kidneys to urinate more, so drink extra water if you are also drinking caffeinated beverages).
  • Power pump – pump for 20 minutes every hour for three hours in a row or alternate pumping for 10 minutes and resting for 10 minutes for an hour (maybe while watching an hour-long television show) – this is done in addition to the eight pumps a day you are already doing! You will need to power pump for 3-4 days in a row to see an increase in supply – it takes extra effort, but often works.

Unfortunately, over-the-counter herbs and supplements are not recommended because they have not been shown to increase milk supply in research studies and it is unclear if they are safe for premature or fragile infants, particularly since they are not regulated by the FDA. Remember that no matter how much you pump, you are doing an amazing job and working very hard for your baby and that makes you more than “enough.”

For more information on Nationwide Children’s Hospital’s Clinical Nutrition and Lactation Services, click here.

Vanessa Shanks, MD, FAAP
Vanessa Shanks, MD is a Neonatologist at Nationwide Children’s Hospital and Wexner Medical Center at The Ohio State University. She is also assistant professor of pediatrics for The Ohio State University College of Medicine. Dr. Shanks received her bachelor’s degree from University of Maryland, Baltimore County and her medical degree from University of Maryland College of Medicine in Baltimore, Maryland. She completed a combined Internal-Medicine and Pediatrics residency at Nationwide Children’s Hospital and The Ohio State University Medical Center. She completed her fellowship at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA. She is married with one daughter and has a special interest in parental support.

2 thoughts on “Underproduction of Breast Milk: How to Increase Your Supply

  1. Peggy Shecket on said:

    I am now grandmother-aged, but when I had my first son and had terrible problems with supply, I saw physicians and lactation consultants, and more. I tried all the things that were suggested to me. Pumps were not great then, but, I did that too. The problem, which was never checked, was that I was extremely hypothyroid. Only much later and because of different symptoms, were my thyroid levels checked. So, just a reminder. It’s an easy way to check and rule out thyroid as the reason for low/no milk production.

  2. Vanessa Shanks on said:

    Agreed! If the above strategies do not help, then you should absolutely seek additional evaluation by your primary care physician or a breastfeeding medicine physician. Great point!

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