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Lets Get Nerdy! The Science of Breast Milk Supply

First, it is imperative that you determine if you truly have a low milk supply.  There are many reasons why mothers may believe their supply to be low when it is not actually the case.  Check out this article by Breastfeeding USA for more details.

 

Many companies today prey on mother’s insecurity regarding their breast milk supply.  Even the most confident of breast feeders will have moments of doubt during their journey.  This article is meant to dissect some of the misconceptions being spread by these companies as well as provide scientifically proven methods for increasing milk supply. 

 

Supply and Demand

Our bodies know how much milk to produce based on demand.  Removing more milk will inform our system that an increase in supply is needed.  There are a few methods which can help accomplish this:

  1. Nursing Vacation:  Spend a few days with your baby nursing as often as possible with a lot of skin to skin contact [1]. 

  2. Double pump:  After baby is done feeding, pump for 5-10 minutes.  This artificially increases the demand for milk which should enhance your supply.  You can do this after the same feed every day (first morning feed is best since supply is shown to be higher then) or try after every feed.

  3. Power pump:  Spend an hour alternating between pumping and resting (pump 20 min, rest 10, pump 10, rest 10, pump 10).  Even if you don’t believe you are getting any additional milk during the last pumps, this mimics a growth spurt and will increase supply. 

 

Avoid Supplementing and Pacifiers

This one is simple:  The more formula a baby gets, the less breast milk they will drink [2].  Likewise, if a baby’s suckling needs are being met with a pacifier, they may spend less time at the breast.  Beginning supplementation is a slippery slope with often ends breastfeeding altogether.  One formula bottle a day quickly becomes two as the demand for breast milk dwindles down until you are no longer producing.  Some women are lucky enough to have this process extend out for a long period of time while others are not.  If you do decide to supplement, pump at the time of that feed to keep your supply up.

 

Hospital-Grade Pumps

Rent a hospital-grade pump for a few days.  These pumps are not as portable, but they are more powerful.  They will allow you to remove milk more efficiently and therefore increase demand.  These pumps are also available for purchase, however with an average $1000 price tag, most mothers prefer to rent.  Utilize the pump in conjunction with your typical nursing schedule.

 

Natural Galactagogues

Galactagogue (which sounds like another name for a Star Trek character) is a broad term for substances which increase milk supply.  Commonly known herbal galactagogues include fenugreek, alfalfa, raspberry leaf, and stinging nettle.  Some food substances which are promoted as galactagogues are oats, garlic, spinach, and apricots.  Unfortunately, there is little scientific evidence to support any of these claims.  Companies that promote their supplements as the “magic bullet” for milk production are overstating claims with poorly designed or absolutely no research. 

 

Domperidone (Motilium)

Primary use: Increase stomach and bowel contractions

 

Domperidone is available in non-US markets as an over the counter drug which has been shown to increase milk supply.  This medication is well-tolerated by breastfeeding mothers and is associated with an average daily increase of 75% when compared to a placebo [3].  The FDA pulled Domperidone in the US due to its link to cardiac disorders.  A recent study indicated that Domperidone increases the chance for cardiac death in patients over 60 but does not have that effect in patients younger than 60 [4].  The fact that a clear majority of breastfeeding mothers are well under 60 explains why there are no reports of significant adverse effects to date.   

 

Metoclopramide (Reglan)

Primary use:  Heartburn, Healing ulcers/sores in the esophagus, Speed stomach emptying

 

Metoclopramide augments breast milk production by stimulating prolactin for women who have low volumes of lactation [5].  Unfortunately, this medication comes with a plethora of possible side effects including gastrointestinal distress, severe depression, seizures, and sedation.  This medication is also known to enter breast milk; however the concentrations are low and the side effects are unknown [6]. 

 

Sulpiride (Eglonyl, Sulpitil, Sulparex, Dolmatil, Equemote)

Primary use:  Schizophrenia

 

Sulpiride increases prolactin secretion through hypothalamus stimulation and has been shown to significantly enhance milk production.  Similarly, this medication also enters milk in low doses which could have an impact on central nervous system development.  Medical professionals have also recommended against this antipsychotic drug as a galactagogue due to its potentially harmful side effects.

 

Takeaways

Breast milk is about supply and demand for a majority of the population.  To increase supply, tell the body that there is a higher demand.  While some women swear by natural remedies, there is little proof that any of these work beyond a placebo effect.  Medication may be an option for the few women who have a medical condition which reduces their prolactin levels and you should speak to your primary physician or OB/GYN.  More research is being published every day on this topic and we are looking forward to better understanding the intricacies of milk supply. 

 

 

1. Aghdas, Karimi, Khadivzadeh Talat, and Bagheri Sepideh. "Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial." Women and birth 27.1 (2014): 37-40.

2. Kim, Eliane, et al. "Relationship between intention to supplement with infant formula and breastfeeding duration." Canadian Journal of Public Health 104.5 (2013): e388-e393.

3. Osadchy, Alla, Myla E. Moretti, and Gideon Koren. "Effect of domperidone on insufficient lactation in puerperal women: a systematic review and meta-analysis of randomized controlled trials." Obstetrics and gynecology international 2012 (2012).

4. Johannes, Catherine B., et al. "Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case‐control study." Pharmacoepidemiology and drug safety 19.9 (2010): 881-888.

5. Ehrenkranz, Richard A., and Barbara A. Ackerman. "Metoclopramide effect on faltering milk production by mothers of premature infants." Pediatrics 78.4 (1986): 614-620.

6. Zuppa, Antonio Alberto, et al. "Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production." Journal of Pharmacy & Pharmaceutical Sciences 13.2 (2010): 162-174.

 

 

 

 

 

 

 

 

 

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