One of the biggest frustrations that I have as a Lactation Consultant is hearing how moms are failed by the healthcare system again and again in their first weeks postpartum. While over 80% of expecting moms plan to breastfeed, unnecessary interventions and inaccurate information make it an uphill battle from the start. In this article, we will review how to increase your milk supply while also dispelling some common myths around breastfeeding and milk production.

Why hasn’t my milk come in yet?

When considering how to increase milk supply, we need to start at the beginning. Milk production has three stages that occur during pregnancy and postpartum:

• Lactogenesis I happens around 16 weeks gestation. Your body begins building pathways, increasing blood supply to your breasts and you may begin to leak colostrum. You may also notice your breasts becoming fuller, your areola darkening and your nipples changing. These changes are all caused by the hormonal response that happens during pregnancy.
• Lactogenesis II happens between day 2-3 postpartum. It is triggered by a hormonal shift when your placenta detaches. Before this happens, all your baby needs is the colostrum you have.
• Lactogenesis III is when the production of milk changes from a hormonal response to a supply-by-demand response. This happens around day 10 and continues on until you & your baby decide to wean.

In order to know why your milk hasn’t come in yet, we need to figure out whether there is an issue with lactogenesis I or lactogenesis II. Both of these stages are driven by hormones.

• In lactogenesis I, you would want to consider whether you noticed those breast changes during pregnancy. Your medical history is also important, because endocrine disorders such as PCOS, thyroid imbalances, gestational or type II diabetes, previous breast surgeries can all impact our ability to build those pathways to produce milk.
• In lactogenesis II, the most common reason for a delay that I see is due to birth interventions or complications. Things like excess IV fluids, intravenous pitocin, ceasarean section, prolonged labour and pushing, manual removal of the placenta, postpartum hemorrhage, preeclampsia… these all can interfere with the natural hormonal response that occurs. Often in these cases, a mom’s milk supply doesn’t fully “come in” until day 5 or 6, placing the baby at increased risk of losing 10% birth weight and/or becoming jaundiced and requiring phototherapy and/or requiring supplementation.

I’m not saying that all birth interventions are inherently bad. As an OB nurse, I know that many of these interventions are necessary & life-saving. What I am saying is that these interventions CAN place the infant at increased risk of feeding challenges. These risks should be discussed with you ahead of time so you can make an educated decision. Sadly, this rarely happens.

How to increase milk supply

The number one way to increase your milk supply is to ensure that your baby and/or your breast pump is removing milk frequently & efficiently.

• Frequently = every 2-3 hours through the day, with one 4-5 hour sleep stretch at night. If you can manage to pump in addition to this, then even better! The important thing is find a balance between feeding/pumping and your health & well-being.
• Efficiently = good swallowing heard throughout nursing sessions, and breasts feel drained completely after nursing & pumping.

Sometimes what happens is lactogenesis II does happen without problems, but you are not given the right breastfeeding support. So then your struggles with latching or a delay/burnout related to pumping end up causing your breasts to become engorged, which then signals your body to produce less milk. Remember, on day 10 lactogenesis III kicks in & results in that supply-by-demand reaction.

Okay, I’m removing milk frequently & efficiently. What else can I do to increase milk supply?

Sometimes it’s not that easy, unfortunately. Here is a quick list of some other interventions that you can try to increase milk supply:

• Power pumping
• Eating a diet full of nutrient-dense foods
• Staying hydrated
• Maximizing your pump settings
• Taking a herbal supplement or medication (always talk to your health provider first)
• Choosing to combination feed with donated breast milk or formula

Remember – your worth as a mother is not determined in ounces. No matter how much milk you are able to supply your baby, you are worthy. If you want some help to increase your milk supply, you can book an online session with me. I also have an online pumping course that reviews lots of tips and tricks to maximize milk production.