Milk supply

By Clare Byam-Cook

Good milk supply
When you are breastfeeding you should have a good diet and plenty of fluids.

Let your baby decide when he needs to feed and when he has had enough. All breastfeeding counsellors agree that in order to produce enough milk, it is essential that the breasts are stimulated frequently during the first few weeks.
The more often she feeds and the more milk she takes at each feed, the more you will supply.  This is known as supply and demand.
As time goes on your baby’s feeds will become more predictable and she will be able to go for longer stretches between feeds.  Once your milk supply is established you can start getting your baby into a routine.

Low milk supply

I am worried that I don’t have enough milk. How can I check?

If your baby is happy, contented and gaining the correct amount of weight he is clearly getting plenty of milk and there is no reason to worry that you don't have enough milk. Even if your baby is not particularly happy and content, you should still not doubt your milk supply, providing he is gaining the right amount of weight. Instead, you should try to find out why he is unsettled – wind, colic or reflux being the most common causes.

You only need to worry about your milk supply if your baby is not gaining enough weight, as this means that he  is clearly not getting enough milk. In this case, you need to find out whether this is because your supply is low or because he is not sucking well enough or long enough to get all the milk out. You can establish which it is by offering a top-up (preferably using your own expressed breast milk rather than formula) immediately after he has finished feeding on the breast; if he drinks some milk and then settles far better than usual,this shows that he wanted more than he got from the breast. You should then use a breast pump to see how much milk was left in the breast compared with how much he took from the bottle:

If you can easily express the same amount, your supply is fine and it is his feeding that is the problem. If this it proves to be the case, you need to check whether he is latched on correctly and feeding for long enough. Changing his nappy towards the end of the feed and taking some of his clothes off and may encourage him to stay awake and feed for longer . If you can’t express any milk, then your supply is almost certainly low - but see note below. Another simple way of checking your milk supply is to substitute several breast feeds with a bottle and then use the pump to see how much milk you can express at each feed compared with the amount he takes from the bottle.

Note: A very small number of mothers can never express any milk with a pump, even before a feed when they know their breasts are full. If you are one of these mothers, using a pump after a feed to see how much milk is left in the breasts is not an option as it will not give the right information and may even lead the mother to believe that she doesn’t have enough milk, when in fact she does.

If it becomes apparent  that your milk supply is low, you should not feel discouraged and assume that this means that you need to start topping up with lots of formula milk. Instead, you should concentrate on making sure that you are resting as much as possible, maintaining a healthy diet and drinking plenty of fluids. You should also aim to feed your baby slightly longer and more frequently than usual. If none of this helps, it is worth consulting (preferably by word-of-mouth referral) a good breastfeeding counsellor or lactation consultant in your area to see whether they can offer any advice that may help.

Final note: if you get the point where neither your baby nor a breast pump can get enough milk out of your breasts for your baby to be happy, contented and gaining weight, you should not feel a failure if you start supplementing feeds with formula. This is a case of nature getting it wrong, rather than you not trying hard enough.

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