Tips for healthy breastfeeding

Clinical Editors: Megan Dodson, PA-C, Veronica DeVito, DMSc

Studies have shown the antibodies in breast milk protect the baby from illness, and breastfed babies have a decreased likelihood for asthma, type 1 diabetes, ear infections, sudden infant death syndrome (SIDS), and gastrointestinal infections. It also reduces the mother’s chances of developing high blood pressure later in life.

Despite the advantages to the mother and baby’s health, many new moms have concerns about breastfeeding. Among the top worries? Whether or not they’re producing enough milk. In fact, the perception of insufficient breast milk is one of the most common reasons mothers give for weaning or introducing their children to solids and supplements earlier than recommended. Although the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) both recommend exclusive breastfeeding for 6 months after birth (continuing up to 2 years of age or longer with the addition of solid foods), only 55 percent of infants born in the US in 2019 were breastfeeding at six months and only 35 percent by 12 months.

If you have concerns about your milk supply, it’s important to determine whether or not your supply is actually low and to consider tips to support lactation and produce more milk.

Some guidelines for gauging an adequate milk supply are:

• Starting at about 2 weeks, babies gain 5-7 ounces a week. Babies can often lose weight the first days—this is not an indication they are not eating enough.
• The baby nurses frequently, averaging 8 to 12 feedings per 24-hour period (although this can vary greatly).
• Length of feeding can vary, but generally, newborns may nurse for 20 minutes or longer per breast, while older infants may nurse for 5-10 minutes on each side.
• The baby’s swallowing sounds are audible.
• The baby is active, alert, and appears healthy.

Although it’s rare, an inadequate milk supply can result from a variety of factors, including:

• Not getting enough sucking stimulation or poor latching
• Separation from the baby or scheduling feedings too rigidly
• Limiting the amount of time the baby spends on the breast
• Being sick or under stress
• Certain diseases, such as diabetes, and certain medications
• Hormonal issues, such as thyroid problems, retained placenta, or hormonal birth control methods.
• Factors affecting the breast, including insufficient milk-producing breast tissue or previous breast surgery (especially if the surgery involved the nipples or milk ducts).
• Dehydration or poor nutrition: Adequate fluid intake and a balanced diet are important for milk production.
• Smoking or excessive alcohol consumption: These can negatively impact milk supply.
• Supplementing with formula: This can reduce the demand for breast milk, leading to decreased production.

The good news is that there are ways to support lactation and avoid the anxiety over inadequate milk supply:

• Nurse your baby on demand when he or she is hungry. Typically a baby will feed 8 to 12 times in 24 hours, although this can vary greatly.
• Avoid bottles and pacifiers if possible so the baby’s sucking needs are met on the breast, particularly during the first 2 months.
• Offer both breasts at each feeding. There are varying philosophies on when to switch breasts (as sucking slows down, versus when the breast is completely drained), but offering both is generally recommended.
• Reduce stress as much as possible, eat a balanced diet with enough calories to sustain your energy, and drink enough water to satisfy thirst. Nursing mothers don’t need to follow a special diet, but you should eat well and stay hydrated.

• Oatmeal
• Quinoa
• Barley water (3 glasses per day)
• Brewer’s Yeast

• Mother’s milk tea (4-5 cups/day)
• Blessed thistle
• Red raspberry
• Goat’s rue
• Nettle tea (2 tsp per 24 oz steeped for 8 hours).
• Rescue Remedy: This is a homeopathic remedy that is useful for triggering the letdown reflex. You take four drops under the tongue up to five minutes before pumping or nursing. Rescue Remedy can have a slight sedative effect, so use with caution.
• Fennel may be particularly useful for working moms who have found that they’ve stopped responding well to the pump. Fennel is best as a tincture, 2-4 ml up to three times a day, but can be taken in capsule form. Caution should be used with fennel because it can act as an appetite suppressant. Keep a careful eye on your caloric intake. Also, fennel contains phytoestrogens which if taken in excess can have a negative effect on your supply.
• Fenugreek (can cause gas in the baby, so increase slowly)

*Although these are commonly touted as “galactogogues” (lactation-promoting substances), there is limited supporting data on efficacy and safety. However, drinking nourishing teas can be a relaxing and enjoyable way for new moms to stay hydrated, and some experts cite anecdotal evidence for the efficacy of certain supplements.

If you’re concerned about your milk supply, seek out support from a trained professional or contact your healthcare provider.

Originally published May 13th, 2015