Angie's Tips for Building Milk Supply
By Angela Cannon, D.M.A., aka “Issy”
Over the years Angie, a MOBI volunteer, has developed a list of tips, based on her experience and that of other MOBI moms on MOBI Groups. This post is an often requested post on MOBIGroups. Angie has expanded the list to share with all MOBI readers. Remember these are not rigid rules that are pass or fail, but guidelines that lead to ways of approaching milk supply that have been helpful for many mothers. There are many roads to reach a destination; this path has been helpful for many.
After it was necessary to supplement my first two children due to my low milk supply, I was able to exclusively breastfeed my third child past 18 months of age; we are still breastfeeding. These are the things that worked for me:
- Carry your baby to term - as close to 40 weeks as is possible. Probably the single most important thing that I did to have a successful breastfeeding career is to insist that I carry this baby to term. My first child was born at 37 weeks and she was sleepy, jaundiced, and she was not good at nursing. My second child was born at 33 weeks and he was a premature baby who was too weak to nurse all of the time. I had to use 20 or more techniques to teach him to nurse as he was born too early to have developed the suck/swallow/breathe reflex. My third child was born at 40 1/2 weeks via VBAC in spite of many obstacles; I worked very hard to carry the baby to term and it was well worth the effort as she was terrific at nursing from the time that she was born.
- See if alfalfa is a safe and viable option for you; explore the benefits and risks of this herb. I took alfalfa once a day or less during the last 2-3 weeks of pregnancy and after the birth. Be aware though, that it has a reputation of promoting oversupply and women are advised to stop taking it a couple of weeks prior to giving birth so that they don't develop an oversupply. I feel strongly that this contributed to my oversupply.
- Nurse your baby every 1-2 hours or more often, around the clock, for the first 6-8 weeks. Be vigilant! Don't ever go more than two hours the first four weeks; I maintained this schedule with the exception of allowing one three-hour period a couple of days a week to accommodate my teaching schedule.
- Never go more than four hours without nursing during the first three months post-partum. Ever.
- Always pump when you feel the least bit engorged. If you have any doubts then pump.
- Don't give your baby a bottle prior to four weeks of age; wait longer than that if you have the luxury of staying home (I didn't - I had to go back to work at four weeks post-partum).
- Protect your supply by pumping some; maybe even just once every 2-3 days. My baby nursed on just one side per feeding because she was satiated -- this after having to struggle constantly to provide one-half of the milk that my first and second children required! But I pumped some anyway,”just in case,” because there was no way that I was going to take a chance that my supply would drop. I know how impossible it can be to build it back up again, after going through what I went through in trying to provide milk for my first two children.
- Rent a hospital grade pump and experiment with other pumps, not all moms respond the same way to the same pump. That way, if you do need to pump, you will have a good chance to empty your breasts well at each pumping session. I can only express about one-half the milk with a Medela Pump-in-Style and it makes me sore. Ditto for the Medela Symphony, and the Avent Isis doesn’t work at all for me. I have had a rented Lactina since about four weeks post-partum and I wanted to have one when I left the hospital.
- Learn about birth plans and have one that is very specific. Write a birth plan that details your wishes for medical management during labor, delivery and the immediate post-partum period. Discuss these issues with your healthcare provider and have him/her sign-off on it prior to the last month of your pregnancy. Issues that you may want to include in your plan are possible situations for induction, fetal monitoring, pain management techniques for labor, positions that you would like to labor in (Will you be allowed to walk around the hospital or birthing center? Will you be restricted in your movements by a fetal monitor? Can the monitoring be done intermittently or will you be required to have continuous monitoring?), working with a certain doula, use of vacuum extractor or forceps, use of pain medications or epidural or other blocks during labor, episiotomy, breastfeeding immediately after the birth of your baby, etc. List your requests regarding the treatment of the baby, too. I requested: no bottles, no pacifiers except for pain relief if the baby needed tests that were painful, etc.
- Enlist the help of a good lactation consultant. Brief them about your unique situation a month or so prior to your due date. Request that the lactation consultant or someone from the lactation department visit you and your baby as soon as is possible following the birth of your baby.
- Take everything that you might need with you to the hospital. For me, that included hiring a doula and enlisting the help of the lactation consultants a month prior to the birth. I took my Pump-in-Style. I ordered a Symphony to have bedside immediately post-partum. I took domperidone and alfalfa with me to the hospital. I had my SNS cleaned and ready for use. And because I have severe asthma, I had all of my asthma medications, a nebulizer, and prescriptions for all of those treatments with me during my hospital stay so that I would be as comfortable as possible during labor, delivery and post-partum. I also had standing orders for those asthma treatments and I asked my doula to make sure that they were administered as necessary since I knew that one is not always capable of managing these things during labor. I had a very bad experience with this during the labor and delivery of my first child; labor was 37+ hours long and my asthma was left untreated by the nursing staff and doctors, in spite of the standing orders for medication and the fact that I had also brought all of my own medications and nebulizer equipment, per the instructions of my OB. The labor and delivery staff was very good at treating labor concerns, but they were not at all proactive about treating my asthma. And as a first-time Mom I did not know and was not really capable of asking for these things during labor and delivery; I was too wrapped up in the induction and contractions to know to ask for these things. This time, I knew that I might not be capable of recognizing and treating my asthma symptoms myself, so I asked for help ahead of time (which I did with the first birth, too, although I didn’t receive any help during the process!) and then I made sure that I had someone who would see that my wishes were carried through during the actual labor and delivery process. If you have any medical conditions that require treatment, is advisable to have an action plan for the treatment of those conditions during your hospital stay.
- Get a doula. I ended up being confined to lying on my side during labor and for quite some time immediately post-partum due to high blood pressure. My doula taught me how to nurse a newborn while lying down, and she held my baby there for the first hour post-partum so that I could nurse immediately.
- Eat lactogenic foods and drink lactogenic beverages. Hilary Jacobson's book "Mother Food" is a terrific resource and is fun to read!
- At my peak I was producing 70-75+ ounces per day. My baby takes about 50-60 ounces of that and I freeze the rest of the milk. I have had an oversupply the entire time with my third child and she is currently 18 months old. If I suspect that my supply is decreasing, I drink barley imitation coffee drinks, take a couple of alfalfa tablets (research this carefully - there can be some bad effects for some people and some people should not take alfalfa) and I pump if I feel like it. I am very, very careful to protect my supply.
Good luck! If you have any questions, the mothers of MOBI are a very supportive group and have a lot of good advice to offer on the subject. And you may contact me through MOBI if you have any specific questions for me.
Angela Cannon, D.M.A., aka “Issy”