The most common reason that mothers wean early or add in supplemental formula is due to concerns about inadequate milk supply. As a doula and lactation counselor, this is the postpartum concern I hear the most frequently.
First, determine if you need to work on your supply. If your baby has exceeded her birth weight and is producing at least 4 stools a day, then you have a healthy, adequate supply. Striving to increase your supply may lead to engorgement, sore nipples, and other problems associated with breastfeeding. Stay the course!
If there are indications that you are not producing enough milk (baby is producing fewer than 4 stools / day and is not gaining weight well), then the following tips will help increase your supply:
1. Optimize Time with Baby:
SKIN-TO-SKIN: Breastfeeding is a system of supply and demand. Your body is looking to your baby to set the pace and supply of milk production. Cuddle time with your baby (ideally skin to skin—naked baby except diaper and bare-chested mom) will help to trigger your body into breastmilk-making mode (this closeness will cause your body to release the hormone prolactin, which is responsible for milk production). Allow your baby touch your breast and nipple, to salivate on your chest, and enjoy the close sweetness with your baby. This is also going to be the best way to begin a feeding, as it helps to prime both you and baby for nursing.
BED-SHARING: This is a very personal choice, but consider bringing your baby into bed with you. This closeness during the night hours will continue to stimulate your breastfeeding hormones and will likely lead to more frequent feedings. If you choose to bed share, be sure to follow all of the safety guidelines, which can be found here: http://cosleeping.nd.edu/safe-co-sleeping-guidelines/
2. Focus on the Feedings:
Your baby should be at the breast every 2-3 hours (every 2 hours during the day; you can stretch to 3 at night if she’s sleeping) for at least 20 minutes, ideally more. This interval is from the start of one feeding to the start of the next (like labor contractions—so if you start a feeding at 1PM, baby should be back at the breast by 3PM, even if she nursed until 2PM). Many newborns get sleepy at the breast after 10 minutes, so you may need to work to stimulate her to nurse more (changing a diaper, applying a cold face cloth, and tickling her cheek are all good tactics to wake her up). Be sure to have baby skin-to-skin prior to as many feedings as possible (see tip #1).
3. Introduce the Pump:
Because milk production is a system of supply and demand, introducing the breast pump or hand expression will signal to your body that more milk is necessary (than your baby is signaling).
Start with introducing 1-2 pumping sessions / day and follow these tips to optimize the effects of pumping:
Begin with nipple stimulation. Just as skin-to-skin is a great pre-feeding behavior to get your body ready for breastfeeding, so is nipple stimulation for pumping. Simply roll your nipples in your fingers, stroke your breasts, and the stretch your nipple slightly (the stretching of the nipple simulates the stretching of your nipple in your baby’s mouth, which causes the release of the hormone oxytocin that is responsible for milk let down).
Pump both breasts at the same time.
Visualize your baby at the breast, take a few deep breaths, release any tension in your shoulders, and try to relax. You can even listen to guided imagery (there are two apps, in fact, just for this: guided imagery for breastfeeding).
“Power Pump”: Pump for 5 minutes, Pause for 5-15 minutes, Pump for 5 minutes, Pause, etc. for up to 30-40 minutes (hint: watch TV and pump on the commercials to help pass and manage the time).
4. Seek Professional Support
Certified lactation counselors and consultants have the training and professional expertise to help with this issue. Sometimes a minor correction in your baby’s latch can solve an issue with supply that you would not otherwise know of. Don’t hesitate to seek support.
Ellie Lindenmayer is a certified lactation counselor offering breastfeeding education and support to Boston, its North Shore, and the seacoast of New Hampshire.