The concern about low milk supply after the first few weeks often leads to the belief that it is too late to make a change. The initial six weeks postpartum mark a transition where lactation shifts from being primarily driven by hormones to becoming a system controlled by local demand. Milk supply is highly responsive to signals of increased demand, meaning it can be successfully increased even months after this initial period. Applying targeted strategies can effectively boost production.
The Science of Supply After Six Weeks
Milk production transitions from hormonal control (the endocrine phase) to local control (the autocrine phase) around six weeks postpartum. During the initial period, production is high regardless of milk removal. Once established, supply maintenance becomes a matter of supply and demand, regulated within the breast.
This local regulation is governed by the Feedback Inhibitor of Lactation (FIL), a whey protein in breast milk. When the breast is full, FIL concentration rises, signaling milk-producing cells to slow synthesis. Conversely, frequent and thorough milk removal drops the FIL concentration, signaling the body to increase production. Therefore, the most effective way to increase supply after six weeks is to focus on frequent and complete milk removal.
Maximizing Milk Removal Through Pumping and Nursing
The primary strategy for boosting supply is increasing demand and emptying the breast completely to lower FIL levels. This requires focusing on the frequency and efficiency of milk removal. Parents should aim for a feeding or pumping session every two to three hours.
Power Pumping
A specific technique called “power pumping” mimics the cluster feeding behavior of an infant. This involves replacing one regular pumping session with an hour-long, on-and-off schedule to hyper-stimulate the breast. A common pattern is to pump for 20 minutes, rest for 10 minutes, pump for 10 minutes, rest for 10 minutes, and then pump for a final 10 minutes. Repeating this intense session daily for three to seven days signals the body to increase baseline milk production.
Ensuring Efficient Removal
Whether nursing or pumping, efficient milk transfer is paramount, starting with proper latch or pump equipment. For pumping, using the correct flange size is crucial for comfort and thorough expression. To determine the right size, measure the nipple diameter at its base and choose a flange 0 to 4 millimeters larger to allow for movement without friction. An incorrectly sized flange can cause pain, damage tissue, and lead to poor milk removal, suppressing supply.
Another technique to maximize removal is breast compression. This involves gently squeezing the breast during a feeding or pumping session when the flow slows. Compression helps push milk out of the ducts, encouraging the baby to keep swallowing or the pump to collect more milk. This action ensures the breast is more fully drained, which signals the body to increase future milk production.
Lifestyle Factors That Support Supply
While frequent milk removal drives supply, overall physical and mental well-being supports it. Adequate hydration is foundational, as breast milk is largely water; parents should maintain consistent water intake. Nutrition is equally important, requiring an additional 330 to 500 kilocalories per day to support milk production.
These extra calories should come from nutrient-dense sources, focusing on a balanced diet rich in protein, calcium, and iron. Foods like oatmeal are often mentioned as galactagogues, though their exact scientific mechanism is not fully understood.
Prioritizing rest and managing stress is vital because high levels of the stress hormone cortisol can inhibit the release of oxytocin. Oxytocin is responsible for the milk ejection reflex, or “let-down.” Stress inhibition of oxytocin can prevent the breast from emptying completely.
Engaging in skin-to-skin contact with the infant is an effective way to boost both prolactin (the milk-making hormone) and oxytocin. This physical closeness reduces cortisol levels, promoting a state of calm that facilitates easier and more complete milk release.
When to Seek Professional Guidance
While behavioral and lifestyle changes often increase milk supply, professional help may be necessary when self-management is insufficient. The most comprehensive support comes from an International Board Certified Lactation Consultant (IBCLC). An IBCLC conducts a thorough assessment, observing feeding technique and medical history to pinpoint the underlying cause of low supply, which a general practitioner might miss.
Medical Causes of Low Supply
Low milk supply may be tied to an underlying medical condition requiring specialist attention. Causes include undiagnosed thyroid issues, since thyroid hormones are necessary for lactation, or a history of significant postpartum hemorrhage (PPH). Another possible cause is retained placental fragments, which release progesterone that suppresses prolactin and inhibits full milk production.
Prescription Galactagogues
If behavioral and mechanical strategies fail, a medical provider may discuss prescription galactagogues. These medications, such as Domperidone or Metoclopramide, are dopamine antagonists that increase prolactin levels. They must be used under strict medical supervision due to potential maternal side effects. These include the risk of depression with Metoclopramide and cardiac risks associated with Domperidone. Prescription galactagogues are generally considered a last resort after non-pharmacological methods and medical assessments have been exhausted.