I find that end of the day its down to demand and supply although below are the specifics that may help.
1) Supplementing with formula: Its a double edged sword I feel. Initially when my supply was really low it was good to supplement a little. It took the stress away and stress REALLY prevents milk from coming in. However, milk production is about demand and supply so eg your body is producing X ml and baby needs X+Y ml, if baby keeps emptying the X mls that your body is producing, your body will know that X ml is not enough and slowly increase production. If Y mls of formula is given by formula, your body will think that Xmls is al that is needed and never produce more. What I did was after baby’s jaundice was down and her out put normal, I bit the bullet one day and just kept latching whenever baby is hungry. Any supplement by bottle is only expressed breastmilk from the same day to ensure that each day production is sufficient for baby. Initially baby was just nursing all the time non-stop and baby was crying of hunger all the time but slowly the times between feeds get longer and I really appreciated the times when baby is alert and smiling.
2) Medication / Galactatogues:
a) Motilium: This is actually medicine for indigestion which has as a side effect increase of prolactin secretion which promotes milk production. There is research showing it does have this effect but very little research on side effects. Known ones include headaches and dry mouth for mothers but nobody knows what are the effects the trace amounts that go into the milk and gets fed to baby has. I took one pill 3 times a day for 1.5 weeks, stopped for a week then took it again for 0.5 weeks and didn’t see any direct correlation between its consumption and milk production (ie both when I was taking and not taking it production seemed to be slowly increasing). I was told sometimes 1 tab 3 times a day is not enough and it needs to be increased 2 tabs 3 times a day and if still no effect 3 tabs 3 times a day and if no effect by then, it probably doesn’t work for that particular nursing mother. I’m not sure whether I increased dosage would it have made a difference but in my view its not worth riskin such large amounts of drugs tainting the milk.
b) Fenugreek: The galactatogues of choice among most mothers and LCs as it is “natural” as in its made from a spice but its taken in a far larger amount for lactation purpose han as a spice. Ancillary evidence from nursing mothers say it works but no conclusive research has been done. Basically mothers start with 2 tabs 3x a day and gradually increase if there is no effect. Apparently when it is working the mother’ sweat will smell like maple syrup. Even when I went up to 3 tabs 3x a day I didn’t smell maple syrup. I also didn’t see a direct correlation between its consumption and milk supply even though I was not regular about it and often forgot to take it. On days I went without and immediately after supply seems similar.
c) Malunggay: Something Sister Kang recommended. I took 1 cap 3x a day and saw no difference. Available on mumsfairy.com. Online literature seems to say it works only to the extent it provides extra iron, which is one of the minerals required in milk production. My friend who’s a yoga instructor also says that in the alternative medicine she studied milk is manufactured from blood and so things beneficial to the blood is god for milk production. Not sure how much of this is mumbo jumbo.
d) Soups: Soups are regarded by many asian cultures as being good for increasing milkflow. I thought it was just a chinese thing but an australian mother I met said her helper was cooking lots of soup and telling her its good for her milk supply. The most popular is green papaya with fish bones. Also there’s this chinese medicine called tong cao that can be cooked with pis’g trotters. Another mainstream soup is peanut with pork. A friend also recommended soya bean and tofu with any meat. I think the point of the last one was purely to increase protein intake.
e) Eating well: Lots of fluid (although some research say that excesive intake actually decreases supply) and a balanced diet is essential. Lots of protein and sufficient quantity helps. Iron supplements are also important. I also took DHA in the hope that some of it goes into the milk. Calcium is more easily absorbed in the form of dairy products but its difficult to take enough of that so a pill a day is good, more for ensuring mum’s calcium store is maintained than for stimulating milk production.
3) Making use of the pump:
a) Power pump: One of the lactation consultants I went to told me all her patients who tried this notice a visible increase. I tried it for 1 week, it did nothing much other than stress me out. Basically it requires one hour of time. Most online sources say start with 10/20 minutes, rest10 min, pump 10 min, rest 10 min, pump 10 for one hour but you will find that if you start with 10 minutes you’ll end with a rest, which is quite dumb so I do 20-10-10 with 10 min breaks in between. Baby usually cries in hunger by the time I start the pump the second time so its stressful. I insisted on not feeding the pumped milk to her though, she just has to learn to extract whatever is remaining.
b) Pumping after each feed: I expressed for 15 minutes after each of the 3-hourly feeds, even in the middle of the night to completely drain the breast and stimulate more production. By second month you can ease off the pumping to 2-3 times a day or none at all depending on how comfortable you feel about supply.
c) Feeding expressed milk to baby: Here’s where I can’t decide what are my views. Its a waste not to use the expressed milk but initially giving the bottle could lead to a preference for the bottle since flow could be slow at the nipple.If there is a latch problem then all the more baby will find it too difficult to extract milk. Yet baby’s suckling is e best way to stimulate production. Direct latch also leads to aproblem I am now grappling with : bottle rejection. Bad for working mums.
4) Latch problem: Most literature will first suggest eliminating a poor latch if baby is not getting enough milk. There are signs to look out for to determine if latch is good:
– feels comfortable; sore nipples are usually a sign of nipple sucking, as are pinched nipples
– baby’s mouth wide
– cheeks full – gulping sounds (to me the surest sign but some babies are just silent eaters so its one of those things where if its present you can heave a sigh of relief but if absent its not necessarily a bad sign
– wriggling ears
– pause in between suck and swallow
– baby happily drinking – struggling or falling asleep are both bad sighs.
Generally latch problems are best sorted out by an LC. Some find that aids like nursing pillow helps them get comfortable and therefore helps with the latch. This is particularly true for ladies with not very strong arms. Switching positions eg to a lying position or football hold may also be helpful. I also find that leaning forward seems to increase the flow.
5) Others: I had a malay massage lady come give me a massage for a few days. Immediately after the massage my supply will shoot up. I’m not sure whether its the breast massage she does or the fact that I’m relaxed but worth a try. Sometimes after a shopping trip or lunch with friends supply will also be up. Anything that makes you happy I guess.