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Boosters and Barriers: Things that increase and decrease milk supply

One of the most common questions a new mother has is whether she will make the right amount of milk.
One of the most common questions a new mother has is whether she will make the right amount of milk.
Photo courtesy of L. Radcliff

A mother's breast milk supply naturally varies from day to day, and even from hour to hour throughout any given day. Milk volume is not a constant. However, most fluctuations in milk supply are not large enough for mother or baby to notice. There may be a few additional feedings requested by the baby for a few days if the supply has dropped a bit, but otherwise, a small decrease will not even register on Mom's radar. Likewise, it is often hard to detect when the supply is temporarily a bit higher than "normal" since the breasts can store varying amounts, and there are no "measuring cup" lines on our bodies to inform us of what's there. Generally speaking, as long as baby is happy, mommy is happy. It's when the fluctuations are greater than usual that a mother will take notice.

Certain circumstances can interfere with milk production, at least temporarily, and sometimes it is helpful to know what these barriers are, so that they can be avoided or at least minimized. For example, returning to work, for some women, means a gradual loss of milk supply. Knowing this does not mean a woman should avoid going to work, but instead that she may want to add additional feedings in her off-hours, and make sure she pumps the breasts well at work, at times which mimic baby's feeding times. These strategies can reduce the impact that working may have on her production. Another common barrier is the maturing baby's sudden ability to sleep longer stretches of time at night. While helpful to everyone's feelings of being well-rested, this change in baby's behavior may negatively affect milk supply over time. Some mothers seem more susceptible to losing milk volume from baby's new sleep patterns than others. The advice is generally to add either a pumping or feeding at some point during the night to break up any stretch of time greater than 6 hours wherein the breasts would be unrelieved. Often, this is all that is needed to keep supply on track for extended breastfeeding. A third potential barrier to maintaining milk supply is the use of hormonal contraceptives. Whether oral or the injection format, there may be some negative impact on milk supply from many of the hormonal contraceptives, especially if they are initiated before the lactation hormones have stabilized at around 3 months. When the medication is given in shot form, there is no way to remove it from the mother's body again, so one must wait until it "wears off" if the effect on milk supply was not desirable. In the meantime, the mother may try some strategies for building up supply like increased skin-to-skin time, pumping, or galactogogues, which are medications, herbs, or foods that may boost the lactation hormones in some women.

Some commonly known supply-boosters include the prescription medication metoclopramide, the herbs fenugreek and blessed thistle, and the healthy foods oatmeal and flax seed. While no galactogogue is effective by itself, sometimes, when these substances are combined with a plan of increased stimulation and skin-to-skin time with baby, the effect can be amazing. In order to be sure to follow a complete and well-designed plan, Fresno mothers should contact an International Board Certified Lactation Consultant for assistance. Local consultants are listed on this page in the resource column.