There are many ways to increase your milk supply, most of them involving only simple changes in your routine. All of them take a little time - a wise lactation consultant once told me that it takes as long to restore your supply as it did for it to decrease, so don't expect results overnight. But take heart - within just a few days, you should see your milk supply begin to gradually increase.

Before you convince yourself that you have a supply problem, troubleshoot your pump. If you're pump is failing, you'll have a terrible time pumping, so check this first.

I organize my supply increasing strategy into seven steps. The steps are not meant to be followed in any particular order - if one doesn't work for you, just try another. Not every way to increase supply works for every mother. Experiment a little, and you'll find what works for you.

Page Index

Step 1: Send what you pump

Step 2: Breastfeed more

Step 3: Pump more

Step 4: Give fewer bottles

Step 5: Avoid supply busters

Step 6: Feed your milk-making machine

Step 7: Use galactogogues

What if it doesn't work?

Links to other supply-boosting websites

Step 1: Send what you pump

The best way to keep up with what your baby needs during the day is to just send what you pump the day before. Babies are smart - if they don't get enough during the day, they'll nurse more in the evening. Just like you and me - if your lunch was terrible, you'll have a little more dinner, right? Only babies aren't self-conscious about asking for that third helping of mashed potatoes.

The key to making this work is unlimited access to the breast during the evening and night hours. Nurse your baby as often as he or she wants to, and your baby will get enough to eat. With this strategy, some babies will start to reverse cycle, where they do most of their eating when they are home with you, and most of their sleeping when you are away. This may sound exhausting, but almost every working mother with a reverse cycler is relieved that she doesn't have to pump as much, and has found ways to get plenty of sleep. The page on reverse cycling contains lots of strategies for getting enough rest - some of which may surprise you!

If you're sending a little milk from your freezer stash, you may be decreasing your milk supply without even realizing it. I've devoted a special page to the freezer stash, because this is such a common problem.

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Step 2: Breastfeed More

Every feeding that your baby gets from your breasts is one less bottle that you'll have to pump during the day. Focus on breastfeeding as much as possible. Nurse your baby right before you leave for work, or at your daycare center right before you go. Even if your baby just fed 20 minutes ago, offer your breast for a "top-off" feeding. This will push back the time of day when the first bottle is given, ultimately meaning less milk will be needed for bottles.

Talk to your care provider and ask that they not feed your baby in the hour and a half to two hours before you get there. As soon as you arrive to pick up your baby, or as soon as you get home, sit down to nurse. This is a wonderful way to reconnect with your baby, and the breastfeeding hormones will help you to release the stresses of your workday.

Allow plenty of time in the evenings and at night for nursing - if you have a partner or friends or family who can help, let them cook dinner and clean up. You won't be nursing this baby forever, and giving your baby the advantages of breastmilk is important enough that you can have someone else do the cooking and put off dusting your collection of Aztec frogs for another few months. Breastfeeding gives you a great excuse to sit down in the evening and rest - remember that even three or four months after giving birth, your body is still recovering, and you need to take care of yourself!

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Step 3: Pump More

Sometimes adding one more pumping session is all you need to do to get enough milk for your baby during the day. Did you know that your milk supply is highest in the morning? Take advantage of this fact to pump a little extra early in the day.

I'm pumping, but there's no milk!

The nurse-shower-pump routine: Depending on when your baby wakes up, you can sneak in an extra pumping session before you leave for work with this routine. Nurse your baby, then take a relaxing shower, then pump. Or, if your baby is a late sleeper, pump first, then shower, then nurse. The shower in the middle helps you relax and helps stimulates let-down for the second feeding/pumping session. Don't worry about pumping before your baby eats - your baby is much more efficient than any pump, and will be able to get plenty of milk. And remember, you're going to nurse again right before you leave, so he'll have another chance to fill up soon.

Another great time to pump is right when you get to work. But wait, you say, in Step 2 I just started nursing right before I left - my commute is only 20 minutes, and now I pump?? That's right! If you pump when you first get to work, you're not interrupting the flow of your day, you're more relaxed, and you're taking advantage of those high morning prolactin levels. If you're lucky enough to pump at your desk, it can also be a good opportunity to go through emails and voice mails. Make sure you learn the hands free pumping tricks!

Other tricks: Some moms nurse their baby on one side and pump the other. Others pump after their baby has gone to bed. A few particularly dedicated moms that I know have gone so far as to set an alarm and pump in the middle of the night - they had babies who slept through. It can be done!

But there's no milk!!

Maybe you've added a pumping session but you're not getting any more milk. Don't give up! Pumping more gives your body an important signal to make more milk. Keep pumping at that new time, and within a few days you will see your supply gradually start to increase. Even "dry-pumping", when nothing is coming out, is just a request to the kitchen to make more tomorrow. Stick with it a few days, and you'll see results.

If you never have much milk when you pump, see the tips for Better Pumping

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Step 4: Give fewer bottles

This goes right along with "send what you pump". It's important not to overfeed the breastfed babies, but because bottle-feeding is easier for a baby than breastfeeding, it can be easy to do.

How to avoid overfeeding:

1. Let your baby decide when a feeding is over. Don't ever encourage your baby to finish a bottle when he's stopped on his own. Unlike many grown-ups, babies know when they've had enough to eat, and honoring this helps prevent overfeeding, and possibly obesity later in life. How many of us wish we always stopped eating when we'd had enough? If you are worried about wasting milk, learn more about reheating bottles that haven't been finished.

2. Small, frequent feedings are best for breastfed babies, so send milk in several smaller bottles. Breastfed babies do not always need to increase the amount of milk that they get as they get older. Studies have shown that the amount of breastmilk eaten does not change much between three months and six months, so even though the formula-fed babies are getting bigger and bigger bottles every month, your baby can get as much nutrition from smaller amounts. Breastmilk is just more efficiently digested.

2. Use a slow-flow nipple. Unless your baby is very fussy about taking a bottle, stay with the newborn flow nipples as long as you are breastfeeding. Using a faster flow nipple will lead to overfeeding, and can also lead to a bottle preference or breast refusal.

3. Use other comfort measures. Breastfed babies are generally used to more skin contact and touch than formula-fed babies.  Talk to your care provider about holding and walking your baby when she fusses, and not always reaching for the bottle. If your care provider has a lot of other children to care for, she may want to wear your baby in a sling or carrier during the day.

kellymom.com has a great handout called bottle-feeding the breastfed baby that you can print out and give to your care provider.

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Step 5: Avoid Supply Busters

The number one supply buster is not emptying your breasts often enough. This is covered in steps 2 and 3. However, there are others that are less easy to spot.

Birth control pills: Some moms can take birth control pills with no effect on supply. For others, even a low-dose, estrogen-free pill causes a supply drop within days. If you're on the pill and having supply problems, switch to another birth-control method and see if things get better.

Decongestants: We finally have a published study showing what we've known anecdotally for years - that Sudafed (pseudephedrine) can decrease milk supply by up to 20%. It's possible that antihistamines (like Benadryl) might do the same thing. If you have a cold, there are other things you can do for your congestion - stay hydrated, take hot showers (the steam is very healing), use a neti pot to rinse your sinuses (here it is packaged to look more scientific), or use a nasal decongestant spray carefully, as they can become addictive (though even daily use probably won't hurt your baby, you'll just be stuffed up all the time).

Return of your period: There's nothing you can do to avoid this one - but the return of your period is often accompanied by a dip in supply. However, if this is the cause, your supply will usually bounce right back up by the time the bleeding stops. Pumping a little extra and letting your baby nurse a lot will help, and try to avoid dipping into your freezer stash. Some studies show that supplementing with calcium before your period can make this supply dip much less.

Stress: I lied. This is the number one supply buster. Stress is just bad for you all-around, but it can put a major dent in your milk supply, which then - guess what? - increases your stress! Try to find ways to relieve your stress - pay someone to clean the house, turn down the new contract at work, ask family and friends for help. Practice deep breathing exercises, and take time to care for yourself.

Sickness: If you get sick, it's likely your supply will take a dip. Staying hydrated and taking care of yourself will help. When you are breastfeeding, you need to take sickness seriously. However, maybe you used up all your sick days in your maternity leave, and feel like you have to go to work anyway. Try to take it easy, and listen to what your mother told you - chicken soup, drink lots of juice, and get some rest!! Ask for help whenever you can. Hot showers are also great therapy.

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Step 6: Feed your milk-making machine

Your body will make milk pretty much no matter what you eat. But - to make milk efficiently, there are a few tricks that can help. There are three primary ingredients in breastmilk – water, protein and fat. Be sure your body has enough of these to make milk. The fat is pretty efficiently moved from your butt, belly and thighs into the milk even if you don’t have much in your diet (hooray for biology!), but protein and water are different. You need a pretty high daily intake of protein and water to keep milk production up. Try keeping peanuts in your desk, or bringing hard-boiled eggs with your lunch. And be sure you have a big water cup or bottle that sits on your desk at the ready all day.

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Step 7: Use Galactogogues

A galactogogue is any substance that increases milk production. These are generally herbal remedies, and I've found that with herbs, some work for some people, some don't. Try a few and see what works for you. Most are available at health food stores or online. At the end of the list are prescription galactogogues.
Here are my favorite herbal and food-based galactogogues:

• More Milk Tincture – 1 dropperful per hour till supply increases. Then decrease until supply is maintained. Take in a little cup of water, it’s nasty. Use More Milk Two if you’re pregnant.
• Fenugreek – 3 capsules 3 times a day until you smell faintly of maple. Don’t use if you’re pregnant. Can increase dose to 3 capsules 5 times a day. More effective if used in combination with Blessed Thistle.
• Mother’s Milk tea (From Traditional Medicinals) 3 cups/day – I found this didn’t really increase supply so much as maintain it. Lots of honey, also nasty.
• Alfalfa tablets – also a great laxative to counteract the iron in your prenatal vitamins! 2 capsules 2x/day.
• Other herbs – blessed thistle (not milk thistle), nettle, fennel, anise. B vitamins can also help. Hops are good galactogogues as well, but I think they don’t just mean in beer.
• Avoid - sage, peppermint and wintergreen as some people find that these decrease supply.
• Foods - oatmeal is reported to increase supply, and it sure can't hurt. I like a bowl of all-natural, whole grain, rolled oats in the morning, but I'm kind of a hippie that way. Others get their oatmeal from the instant packets, or even oatmeal cookies - yum!

Prescription Medications

There are two drugs that are commonly used to increase milk supply, Reglan and Domperidone. In both cases, their use to increase milk supply is what the FDA calls "off-label" - meaning that increasing milk supply is not what they are approved for, but it is legal to prescribe them for that purpose. These drugs are a last resort - please go through steps 1-6 and try some of the herbs first. Personally, I would take one of these before I gave my baby formula - but it's your choice.

Reglan is more widely available, but has more side effects. One side effect is depression (as if you weren't depressed enough having a low milk supply) so if you have any history of depression this drug should be avoided. For my own funny Reglan story, click here.

Domperidone is harder to get these days. The politics behind the Domperidone "ban" are complex, but based on the research, I believe that this drug is the best medical choice for low milk supply. Click here for more information.

What if it doesn't work?

What if you've tried all of the above tricks and still can't pump enough? What if your work schedule just doesn't allow you to pump enough? Do you need to quit entirely??  Breastfeeding is never an all or nothing proposition, and there are a lot of ways to find a solution that works for you. Read this page for some encouragement.

Links
Being that I'm not the worlds expert on everything, here are a few different takes on the issue of milk supply:

Angelfire's supply pages

Ask Lenore: Breastfeeding information for adoptive mothers, with lots of supply boosting tips and information

BFAR.org: The women who run the "Breastfeeding after Reduction" website have put together a number of supply boosting tips. Scroll down the navigation bar on the left side of the homepage for a lot of useful tips and information.