If you have an undersupply of milk and you are exclusively breastfeeding (i.e., not supplementing with formula or feeding solids), your baby probably gains less than the recommended five ounces a week.

If you have an undersupply, your baby accepts both breasts at every feeding and sometimes still seems hungry after taking both breasts. You may even find yourself needing to offer “four boobs” or switch nursing in order to get your baby satisfied. If you pump within 15-20 minutes of completing a breastfeeding session, you will probably get less than an ounce from each breast. If you pump in place of breastfeeding, about two or three hours from your last breastfeeding or pumping session, you will collect less than the equivalent of an ounce per hour. So, if you pump after three hours, you will collect less than three ounces from both breasts combined. Occasionally, if the baby gives you a blessed chunk of sleep or you accidentally go four to six hours without pumping, you may not get much more than that three ounces.

If you have met with a quality IBCLC at two weeks postpartum or later and she has done a transfer weigh, your baby probably will have eaten less than one ounce from the first breast and even less from the second breast. Hopefully she set you up with a safe, realistic, and kind plan to boost your supply and supplement the baby and you are following up with her weekly.

Moms with an undersupply report a baby that pops on and off the breast and “is almost always hungry even after a long breastfeeding session.” Their babies ask to eat sometimes hourly around the clock and often go no longer than two to three hours without eating. Ever. This baby nurses for a long time, often 30 minutes or longer, but may not swallow very much. Even after encouraging baby to suck using breast compressions, baby still isn’t swallowing and mom has to take baby off the first breast and move him to the second.


Reasons to be concerned about a low supply and to schedule a Lactation Consultation:

  • Poor infant weight gain (fewer than five ounces per week for a baby younger than four months; fewer than four ounces per week for a baby older than four months)
  • Poor infant output (fewer than five wet diapers per 24 hours)
  • Significant change (one- to two-ounce drop) in pumping output when apart from the infant
  • Infant becoming very fussy at the breast, refusing to breastfeed, or needing to be given a bottle after or in place of breastfeeding

Supplements:

Fenugreek: three capsules three times per day (2400mg three times per day) 

  • This can be found at Health Food Stores, Vitamin Shoppe, and GNC. It often is not carried at drugstores.
  • Fenugreek has a cross sensitivity to the pea family, so those allergic to peanuts or soy should not take fenugreek.
  • Fenugreek can sometimes, but rarely, exacerbate asthma.  It is not a contraindication, but nursing mothers should be aware of this possibility and discontinue it if they notice asthma flare-ups.

Nursing Mother’s Tea (if desired): three to five cups per day

There are other herbs available that can boost lactation, such as blessed thistle, goat’s rue, brewer’s yeast, and nettle.  I find that Fenugreek is often the most potent. You are welcome to take the others, but it isn’t necessary, as you will already be taking at least nine pills per day.

Supplements take about three to five days to make any change, with the full effect seen in two weeks.  Once your milk feels “normal” again, you may choose to wean from Fenugreek slowly.

Nutrition:

-Make sure you are eating three healthy meals and about three healthy snacks per day for calorie intake.

-Make sure you are drinking water to thirst: enough to make your urine light yellow, but not forcing fluids in an uncomfortable way.

Oatmeal is said to help with supply, but this is not evidence-based. A nutritious, whole grain meal for breakfast with a source of good fats and proteins will support a healthy milk supply. If you like oatmeal, eat it! But also add a protein like cow’s milk or almond milk, eggs, nuts, or peanut butter.

Stimulation:

Feed baby ten or more times in a 24 hour period or feed as often as you can during the day, every two hours if you can. It is fine for baby to take longer stretches at night if baby is feeding frequently enough during the day.  It is not necessary to wake your baby every two hours throughout the night to feed; your rest is also important.  (Exception: if your baby is not yet back to birth weight, she may not go longer than four hours without eating.)

Pump after breastfeeding.  This should be done within 15-20 minutes of finishing a feeding. You do not need to pump after every breastfeeding.  This is way too exhausting and too much pressure for a new mom. Instead, pump after most daytime feedings when you feel like you can. The more you can get in the better, but at least four is a great start.  You have permission to skip nighttime pumping.  It is too disruptive to sleep.

Power pump: For three days, try power pumping.  Pump after baby nurses, then pump an hour later, then again after baby nurses. The idea is you want to stimulate your breasts frequently in quick succession.  So, for example, a morning may look like this:

9:00 am – nurse, pump

10:00 am – pump

11:00 am – nurse, pump

12:00 pm – pump

Then return to your typical nursing schedule.  Since milk stays good at room temperature for four to six hours, feel free to leave your pumping set out in room air and reuse within the power pumping time frame. Don’t expect to collect much milk when you do this. The hope is that after three days of this, your body will get the message and increase supply.

When you pump after breastfeeding, you may not get very much and that is normal.  You are only pumping to increase the demand on your body. Any extra that you get out is a bonus!