Milk supply is the number one reason mothers quit breastfeeding early or supplement with infant formula. The first line of defense for maintaining or increasing supply is establishing breastfeeding early and frequently breastfeeding or pumping. For many mothers, this is easier said than done. Get tips on what you can do to establish breastfeeding in the first few days and weeks and how to gauge your supply accurately. Learn the evidence on galactagogues and lactogenic pharmaceuticals, foods, and herbs to increase milk supply. Plus, information on oversupply and substances that can decrease the amount of milk you make.
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Many organizations, including the World Health Organization, the American Academy of Pediatrics, and other pediatric associations worldwide, are consistent in their recommendations for breastfeeding. You should exclusively breastfeed your baby for the first six months. At around six months, you should introduce your baby to solid foods with continued breastfeeding for up to two years and beyond. Despite these recommendations, only 24.9% of babies are exclusively breastfed at six months, and that number continues to decline as babies get older.
Not Making Enough Milk (Undersupply)
The number one reason mothers do not meet their breastfeeding goals or supplement with formula is undersupply. Evidence shows only about 5% of mothers experience actual milk insufficiency due to a pathological abnormality. The vast majority of mothers can produce enough milk for their babies. However, that number increases if mothers do not effectively establish breastfeeding in the first month.
During pregnancy, your body starts producing colostrum. This first milk has immune factors, protein, sugar, and fats, plus critical agents that help seal, protect and repair your baby’s intestines. Your baby’s stomach is tiny at birth. On their first day, they will only drink about an ounce of colostrum divided over several feedings. Around day 3 or 4, your milk will come in, and your baby will gradually increase its consumption for the first month. The amount of milk your baby consumes will be relatively consistent from one to six months. To know whether you are genuinely producing enough milk, you need accurate methods to gauge milk production.
Measuring Milk Production
The best way to measure milk production is by your baby’s weight gain and output in diapers. Your pediatrician will track your baby’s weight to ensure they are eating enough. Your baby will naturally lose weight after birth before they start gaining. In general, your pediatrician doesn’t want to see your baby lose more than 10% of its birth weight and wants to see your baby back at its birth weight within two weeks.
IV fluids during labor can cause your baby to maintain higher fluid levels, leading to more excess fluid loss after birth. Your doctor may see this as weight loss due to not eating enough. Please keep this in mind if you have IV fluids during your labor. This is very common in hospitals, especially if you have Pitocin or an epidural. There is an entire episode on the evidence of IV fluids if you want to learn more.
One way to measure how much milk your baby consumes is by weighing them before and after feeding. Research shows that test weighing can improve a mother’s breastfeeding confidence, impacting the perception of milk production.
You may have access to a scale at your pediatrician’s office or a breastfeeding support group. Many home use scales are not accurate enough for this purpose. To get a close measurement, you need an electronic scale that displays weight in grams. The density of breastmilk is approximately 1.03 grams per milliliter. Weight underestimates milk intake by 1-5% due to evaporative water loss between weighing. There are scales you can purchase for home use. There are more convenient and relaxed ways to measure milk intake. Please talk to a lactation consultant before buying a scale and weighing your baby before and after every feeding.
Output in Diapers
Another measurement of whether your baby is getting enough milk is by the output in their diapers. For the first 24 hours, you will probably only see meconium, which is thick, tar-like, black poop. In the second 24 hours, you should see two or more brown sticky poops. On days 3, 4, and 5, you should see three poopy diapers a day, starting green on day three and getting to yellow by day five, which will be the norm moving forward.
In addition to stools, you are also looking for wet diapers. According to La Leche League, by day two after your baby is born, look for two wet diapers over 24 hours. Look for three or more wet diapers every 24 hours on days three and four. You should see six or more wet diapers by five days old over 24 hours.
Perception of Insufficient Milk Supply
There is an important distinction between undersupply and perceiving that you do not make enough milk. Researchers use the term perception of insufficient milk supply. If a mother thinks she is not producing enough milk, she will supplement or switch to formula. Your baby needs breastmilk or formula as their primary source of nutrition for the first year of their life. Until your baby’s first birthday, if you decrease feedings or stop breastfeeding, you must introduce infant formula.
A systematic review and meta-analysis found approximately 50% of mothers reported perceived insufficient milk supply as the reason for stopping breastfeeding. The incidence of perceived insufficient milk supply for breastfeeding mothers ranged from 10% to 25%. This included studies from countries all over the world.
Building Your Breastfeeding Confidence
Studies show several factors affect your perception of your milk supply. A significant factor is breastfeeding self-efficacy, which describes your confidence in your ability to feed your baby. Educating yourself about breastfeeding and having a long-term breastfeeding plan can improve your confidence.
You are seven times more likely to perceive insufficient milk supply if you lack breastfeeding knowledge. Click here to view all of the Pregnancy Podcast episodes on breastfeeding, and see links to additional resources. The Womanly Art of Breastfeeding is a valuable book that covers everything about breastfeeding. It is a fantastic guide and reference tool throughout your breastfeeding journey. The Kelly Mom blog is an excellent online resource with detailed articles on every issue and question that can come up with nursing. Educating yourself about breastfeeding is a perfect way to prepare during your pregnancy.
Developing a Long-Term Plan
Once you have a basic understanding of breastfeeding, I encourage you to set a goal for the duration you would like to feed your baby. Research shows that having a long‐term breastfeeding plan is positively associated with breastfeeding self‐efficacy. This goal is not set in stone; you can always modify your goal or decide to stop breastfeeding or supplement.
Once your baby is born, you want to initiate breastfeeding as soon as possible. You are four times more likely to have a perception of insufficient milk supply if you delay the initiation of breastfeeding. One of the best things you can do to initiate nursing is to get skin-to-skin with your baby immediately after birth. There is evidence that mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Normal babies are born with the instinctive skill and motivation to breastfeed and can find the breast and self-attach without assistance when skin to skin. Nine observable behaviors lead to the first breastfeeding when your newborn is skin-to-skin. The breast crawl well documents this. Usually, all of these take place within the first hour after birth.
Demand and Supply
Once you begin breastfeeding, the amount of milk your body produces depends on how much you remove. This principle is the cornerstone of breastfeeding. There are some tips to help with establishing your supply in the first few weeks.
The number one thing you can do to establish your supply is to feed your baby frequently. In 24 hours you can expect to breastfeed your baby between 8-12 or more times. Frequent feedings are critical to establishing your milk supply and you cannot nurse too often. You may consider pumping, although pumping is not as efficient at removing milk as your baby.
Each breast is calibrated separately. It is not necessary to obsess over equally splitting the time between your left and right breasts but make sure you are using both throughout the day. You can always switch sides if one arm is sore and you need a break or if your baby is ready to switch.
As your baby grows, it will go through growth spurts and increase its feedings. This instructs your body to make more milk to meet your baby’s demands. This demand and supply system is the first line of defense and the key to maintaining your milk supply. You can also use this to your advantage when you need to increase supply.
Introducing Infant Formula
You will decrease your supply if you replace any breastmilk feeding with infant formula. If you or your baby do not remove milk, your body will not produce more of it. This isn’t an issue if your goal is to supplement or switch to formula and decrease or stop breastfeeding. Supplementing can derail your plans if your goal is to exclusively breastfeed, maintain or increase your supply. Of course, some mothers need to supplement if their baby is not getting adequate breast milk. Working with a lactation consultant can help you determine the best course of action by considering how breastfeeding is going and your goal.
Breastfeeding can take practice and patience as you and your baby navigate your nursing relationship. Many issues can come up during breastfeeding in the first few days and even months down the road. Problems can include symptoms in your breasts like leaking, sore nipples, pain, vasospasms, blebs, plugged ducts, mastitis, and engorgement. Some issues can affect your baby, like jaundice, tongue-tie, yeast infection, thrush, food allergies or sensitivities, nursing strikes, and cluster feeding. A significant barrier to removing milk from your breast can be inefficient sucking. Problems like poor latch, tongue tie or lip tie, or other issues can impact milk removal.
All of these issues can make it difficult to continue breastfeeding. The good news is that there are solutions and remedies for any problem that can come up. If there is a name for it, you can fix it. There is an episode of the Pregnancy Podcast dedicated to troubleshooting breastfeeding issues. This is a good starting place to educate yourself about common symptoms with tips for resolving the problems. If you or your baby have an issue causing inefficient milk removal, it can have a negative impact on your supply.
Galactagogues and Lactogenic Foods
Galactagogues and lactogenic foods are substances that are thought to increase milk supply. The first line of defense for maintaining or increasing supply is breastfeeding or pumping frequently. There are pharmaceutical galactagogues and foods, and herbs thought to increase milk supply. It is important to remember that these are the second line of defense. Taking medication or consuming foods will not compensate for the lack of milk removal.
There are pharmaceuticals your doctor can prescribe to treat lactation insufficiency. Doctors prescribe these drugs off-label, meaning their original approval from the FDA or other drug oversight organizations is for other disorders. As with any medication, there are varying levels of efficacy, risks, and benefits. A fantastic resource for medications during breastfeeding is the LactMed database. If you are considering taking any medications to treat lactation insufficiency or any other ailments, you can easily search for them on LactMed and get all of the information you need to make an informed decision on the safety of medications while breastfeeding.
An in-depth review examined the research on the efficacy and safety of pharmaceutical galactagogues to treat lactation insufficiency. The bulk of studies included is on Domperidone and metoclopramide. Domperidone is the first-line medication, but the FDA has not approved this drug for use in the United States. The next best option is metoclopramide, although it carries a higher risk of adverse events. According to LactMed, the clinical value of metoclopramide in increasing milk supply is questionable.
The review found antipsychotics like sulpiride are not a viable therapeutic option due to their side effects. This drug is also not approved in the United States. There is limited evidence and difficulties with respect to access to and administration of medications such as growth hormone, recombinant human prolactin, and thyrotrophin-releasing hormone. A pilot study evaluating metformin doesn’t provide compelling evidence to support its use to treat lactation insufficiency.
Overall, there isn’t an ideal pharmaceutical solution for increasing milk supply. In addition to medications, natural remedies, foods, and herbs are thought to increase supply.
Natural, Food, and Herbal Galactagogues
There are many substances thought to have a positive impact on milk supply during breastfeeding. Some cultures have used these for centuries. An Australian study found that 60% of mothers used one or more galactagogues. The most commonly reported galactagogues included lactation cookies (47%), brewer’s yeast (32%), and fenugreek (22%). One study surveyed U.S. women who used some type of galactagogue, and overall, they found it to help increase their supply. There is a possible placebo effect, and the mothers perceived an increase in milk supply because they were consuming something they thought would increase their supply.
There are studies that examine many natural galactagogues. They tend to have small sample sizes and use different methods for measuring outcomes. The results are pretty mixed when you look at the body of evidence as a whole.
A Cochrane Review examined 27 studies that compared natural oral galactagogues with placebo or no treatment. The studies included banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, Shatavari, silymarin, torbangun leaves, or other natural mixtures. Analysis for each intervention suggested either benefit or little or no difference (very low‐certainty evidence). Moringa and mixed botanical tea may increase infant weight compared to placebo. There was uncertainty about the efficacy of fennel or fenugreek. There was limited reporting of adverse effects, and where reported, they were limited to minor complaints. Overall, the studies on natural galactagogues included in the review were small, with an average of 80 participants. They conclude that high‐quality random controlled trials on the efficacy and safety of galactagogues are urgently needed.
Lactation cookies usually incorporate several ingredients purported to increase milk supply. Common ingredients include oats, brewer’s yeast, flaxseed, coconut oil, almond butter, and dates. These ingredients may provide nutrients like vitamins, minerals, iron, or healthy fats, but there isn’t evidence to support their efficacy.
Deciding Whether to Consume Natural Galactagogues
When deciding whether to employ any intervention, you want to examine the risks and benefits. In the case of natural galactagogues, you may not have precise data on efficacy, but you can weigh supposed benefits against risks. If you want to dive deeper into the potential positive and negative effects of supplementing, the LactMed database is an excellent resource. Below are links to entries for some of the most common galactagogues. LactMed includes a summary of use during lactation, drug levels transferred to your baby in milk, effects on breastfed infants, and effects on lactation and breastmilk.
- Blessed Thistle
- Goat’s Rue
- Ixbut (Euphorbia lancifolia)
- Levant Cotton (Gossypium herbaceum)
- Milk Thistle
- Torbangun (Coleus)
- Wild Asparagus (Shatavari)
Making too Much Milk (Oversupply)
On the opposite end of the spectrum of undersupply is oversupply. This may seem like a good problem, but it can create many other issues and make breastfeeding difficult. Oversupply can create a forceful let-down that makes it difficult for your baby to nurse. Oversupply can also contribute to problems like engorgement, plugged ducts, and mastitis. Kelly Mom’s in-depth article covers more information on forceful let-downs and oversupply.
Decreasing Your Milk Supply
Many moms who experience oversupply will notice a decrease by around three months. Reducing supply without overdoing it and creating a problem with not making enough milk is tricky. Kelly Mom has more information on using herbs to reduce your milk supply. A lactation consultant can be invaluable for dealing with oversupply.
Herbs That May Decrease Your Supply
Some herbs may decrease your supply. If you want to dive deeper into the potential adverse effects of these herbs, the LactMed database is an excellent resource. Below is a list from Kelly Mom of herbs to avoid, with a link to the LactMed entry if applicable. LactMed includes a summary of use during lactation, drug levels transferred to your baby in milk, effects on breastfed infants, and effects on lactation and breastmilk.
- Black Walnut
- Herb Robert (Geranium robertianum)
- Lemon Balm
- Parsley (Petroselinum crispum)
- Peppermint (Mentha piperita)/Menthol
- Periwinkle Herb (Vinca minor)
- Sage (Salvia officinalis)
- Sorrel (Rumex acetosa)
If you have a dish with oregano in it, it is unlikely that you will see a decrease in your supply. You may opt to avoid drinking oregano tea regularly. If you are considering using these herbs to reduce your supply when you are ready to stop breastfeeding, check out the episode on weaning for tips to navigate ending your breastfeeding journey.
Milk Removal Always Trumps Supplements
It is critical to keep in mind that the first line of defense for your milk supply will always be the removal of milk. No amount of pharmaceutical or herbal supplements will make up for frequent feedings. If you are comfortable taking a supplement with little or no risks, you can always try it. You can and should always discuss any supplements with your doctor or midwife. If you enjoy the taste of Mother’s Milk Tea and do not experience any adverse effects, why not drink it? Worst case scenario, you spend a minimal amount of money on the tea, and it helps you stay hydrated.
Talking to Your Doctor or Midwife
If your doctor, midwife, or pediatrician voices concerns that you may not be making enough milk, talk through the reasons and what you can do to improve how much you are producing or how much your baby is eating. If you wish to continue breastfeeding, please talk to a lactation consultant for additional help in resolving issues or increasing your supply.
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