How to increase breast milk supply, or make the most of what you have

I never had a doctor mention to me that I had any risk of supply issues, and had several doctors and nurses give me some very bad advice on how to deal with them.  They ranged from "your baby's getting what she needs despite the fact that she's crying all the time and can't sleep." to "just wait, your milk will come in," to "well if your milk hasn't come in by now (five days after delivery) it's not going to come in so you might as well just give up and use formula."  I can't believe how un-informed I found everyone from  the hospital maternity ward staff to my own personal OB!  I mean, it is your job to advise and care for women who have just had a baby, and to make sure that both mother and baby are cared for properly.  One would think that you could recognize that I have SEVERAL of the most severe risks for supply issues and at least warn me that I may have some work ahead of me!

Especially since supply issues are not the end of breast feeding, and there's a lot that can be done to head them off at the pass, but because I didn't know I had supply issues until nearly two weeks after my baby was born I am STILL constantly playing catch-up.  It also seemed like so many caregivers in the hospital were actually afraid to offer any advice.  For example, when my baby had jaundice I kept hearing over and over that hydration was the most important thing to focus on, and that I needed to make sure my baby stayed hydrated, but no one would tell me HOW!  I mean, this was a day or two after she was born, so of course I had next to no supply yet (no one does at that stage) and I was nursing her every 2-3 hours for 30 minutes at a time.  That's what they said I should do, and yet she obviously wasn't getting enough (not enough wet diapers) and the jaundice was getting worse!

Even once I did know I had supply issues I got conflicting advice from doctors, nurses, parenting books, and lactation consultants.  For example my lactation consultant said to supplement the baby with 1-2 oz of formula before each feeding and then finish up on the breast so she comes to associate me with satiation, while my baby's pediatrician said to breastfeed first when she's hungry and will go after it more and finish up on the bottle.  With such conflicting advice, and so many sources that completely ignore breast feeding supply issues I want to share what I've managed to glean about ways to improve supply and get the most you can or your baby.  I really feel the need to consolidate everything I learned and to let other women going through this know it's NOT that uncommon!

So first some of the worst advice I got starting from the very beginning:
"Don't worry about her nose, it's pointed down so she can always breath, and if she needs to breath better she'll just adjust."  Um, no.  You can definately smother a baby with a boob.  Yes, she'll notice if she's not getting enough air and adjust, but that adjustment will mean pulling back and letting go of her latch to gasp for air.  Which will mean you have to go through the process of re-latching over and over.  This leads to slower nursing (since she's not staying on) and nipple soreness from the re-latching.  For goodness sake tilt her head back or push your boob down so she can breathe!

"Just wait and your milk will come in."  In actuality the longer you wait to deal with a supply issue the more you'll be playing catch-up.  I'm STILL playing catch-up over two months later and there's a LOT you can do to improve things, the earlier the better.

"You don't need a breast pump."  The truth is, the more you empty your breasts, the more they will realize that they need to be making more.  The best way to empty your breasts is by baby, but babies get tired, their appetites wax and wane, they sleep through feedings, and you want to make sure you're emptying every last drop!  One of the best ways to increase production is to pump and feed frequently.  There are lots of different techniques and schedules that can help, and I'll discuss that more later, but suffice it to say I wish I'd gotten the pump when I first wanted to rather than listening to the hospital staff and putting it off until after they said I needed it.

"Fifteen minutes on each breast is enough." Ha!  The more stimulation your breasts get the better, and if your baby's tired or is a sleepy nurser like mine was then she may not be working at it that full 15 minutes, so your breasts may not be empty after 15 minutes.  Once I found out I had supply issues I'd feed her for over an hour at a time switching back and forth between breasts to help keep her awake and interested.

"You need to feed her 6-8 times a day."  More like 10 or more.

"You shouldn't supplement with formula."  You need to get 8 wet diapers a day, and if you're not getting that then you need to do what it takes to do that.  We were getting 4.  We told the lactation consultant that and she wigged out!

"Drink a beer as soon as you deliver, and every day after and you won't have any problems."  I heard this over and over, and always from women who'd had copious supply and could AFFORD to pump and dump.  Just when am I supposed to be drinking my beer?  All the books say not to drink within 2 hours of breast feeding, so I have the option of drinking a beer bright before I pump or drinking a beer right before I go to bed with my baby.  Neither of which makes sense when I'm trying to give every drop for my child.  Of course there is barley water and we'll talk more about that when we talk about what you can do for your diet to help.

So now you know what not to listen to, how do you get started trying to establish a good supply.  Keep in mind I'm not any sort of medical professional.  All I know is what I learned with my one baby.  So take everything I say with a grain of salt, I may have no idea what I'm talking about.  It starts before your baby is born.  Have your thyroid checked.  Have your complete blood count checked.  Make sure that your hormones are working and that you're not lacking in any nutrients.  Keep taking your prenatal vitamins and supplement to make up for any deficiencies.

Once you have your baby nurse as frequently as you possibly can.  The more nipple stimulation that better.  In fact you might try the pump before your baby's born, just make sure you don't try this until you reach full term since this can trigger labor.  If you have a premi or a baby with health problems this may be harder than it sounds, this is where the pump comes in.  Use breast compression during nursing to help your baby get ALL the milk out, and once you're done with a feeding see if you can express out any milk remaining.  An empty breast is a breast in production mode, so basically you want to empty your breasts as often as possible.

If you need to supplement  do so guilt free!  You don't want to starve your baby, and you want plenty of fluid moving through your baby to clear out waste.  Just be sure you supplement very small amounts at a time.  This is where it gets really frustrating.  Formula seems to only come in 2 oz doses, but you'll probably only want to supplement .5 to 1 oz at a time to start.  I guess the formula companies want you to over-prepare what you need and dump it out when it doesn't get used?  You can however mix up 2 oz and stick it in the fridge, then pour out .5 of an ounce at a time to reheat when you need it, just be sure to use it up within 24 hours of mixing.

Supply can also change throughout the day.  You may have plenty first thing in the morning, but when it comes time for that last feeding at night don't have enough to satisfy for an hour much less a good night's sleep.  So you may find you need to supplement different amounts at different times of day.

I've been given conflicting advice on whether to breastfeed first or supplement first, so I've tried to do a combination.  After all, I have two boobs!  So I generally start with one breast, supplement  then feed from the other breast.  This takes practice to know how much to supplement   If you give to much your baby won't be interested come the second breast, which isn't good for your supply.  If you give to little then you'll end up giving more late because your baby will be hungry, so the whole issue of what your baby comes to associate with satiation comes into play.  And as a baby goes through growth spurts his apatite will change, so it really can keep you on your toes constantly adjusting what you're doing.

Use wide neck bottles!  I'd bought a really nice set of Dr. Brown's bottles before the baby was born, only to be told that these can cause nipple confusion when you try to use them while breast feeding.  The wider nipples are supposed to latch more like your breast, so your baby won't get as confused about what to do when presented with either.  How you offer the bottle makes a difference too.  Don't just pop it in your baby's mouth nipple down.  Gravity will make it flow faster, and if your baby gets used to the faster flow then this can lead to frustration when they go back to the breast.  Hold the bottle horizontally, tilted so there's just enough milk to fill the nipple.  This way your baby has to work for it, and it has the added bonus of helping to prevent the baby from overeating.  After all, it hurts to work so hard to give him what breast milk you can, only to have it spit right back up at you!

There are a variety of herbs that can be used to help increase supply including milk thistle, and fenugreek, and proprietary blends like More Milk and More Milk Plus.  Keep in mind if you have thyroid issues that fenugreek can lower T3 hormone, so go for straight milk thistle or plain More Milk (not More Milk Plus) if you're worried about your thyroid.  These can be harder to find in stores, but you can order them online.  I saw a pretty fair increase in supply when I started on More Milk.

Eat well, and eat foods that can increase production.  This is not the time to go on a diet.  Be sure you're getting plenty of protein (eggs are a complete protein) and fat, and a wide variety of nutrients.  There are some foods that are supposed to help.  Oatmeal's the one I found most commonly recommended, but google lactation foods and you'll find lots of things to try.  A lot of folks recommended I drink a beer a day, but I tried a few alternative routes so that I could avoid having the alcohol in my system that is not good for the baby.  I cooked with beer.  This cooks out most of the alcohol, but leaves the rest behind, besides beer in chili is good!

You can also make your own barley water which has all the good stuff of beer without the alcohol, and it's not as nasty as it sounds.  You basically want to add a cup or two of barley to a LOT of water and then boil the heck out of it.  I found a recipe that called for about a cup of barley to two liters of water (or about two cups of barley if I filled up my largest soup pot with water).  Bring the water to a boil and then reduce the heat to a simmer for several hours until it's reduced by half.  You can then strain out the barley and eat it or throw it out (I added it to soup) and let the water cool for drinking.  I tried several things to make this more palatable.  You can add sugar and lemon to make a kind of thick lemonade, or add a dash of lemon to each glass for lemon water.  I would also sometimes mix it half and half with a strong flavored juice I liked (cranberry grape worked well), but milder juice like apple seemed to be overwhelmed by the barley water.

No matter what you're drinking, you want to make sure you're drinking plenty to stay hydrated.  After all, you're drinking for two now, and much of what you're drinking is being passed on to your baby.  You don't want to get dehydrated.

You'll also want to be sure you have a breast pump.  I read a lot of suggestions that sound like good ideas but don't really work in the real world.  Who has enough hands to hold a wriggling baby to one breast and a pump to the other simultaneously?  Some folks suggested pumping after every feeding to make SURE the breast was empty, but I never seemed to have time for that.  However I do pump when I wake up in the middle of the night, if it looks like she's going to sleep through a feeding, and very frequently during my work day to try to make things as empty as possible.  The type of pump you use does matter.  I've heard some women swear by the medicinal grade pumps that can be rented, and I wish I'd tried one of these before I bought the one I'm using.  Some women have better results with different flanges.  I got a lot of advice that suggested you should try different pumps, but at $300 to buy a decent electrical pump, or $50 a month to rent that could get very expensive very quickly.

Every little bit of breast milk you can give your baby helps.  It cuts down on tummy ailments and helps your baby's immune system.  Even with all that I've tried I still only make about a third of what my baby needs, but it's worth it to know I'm doing what I can to keep her as healthy as possible.

Myths about breastfeeding

I've run across SO many websites dedicated to dispelling the "myths" surrounding breastfeeding, but it seems like so many of them are afraid to say anything unpleasant about breastfeeding for fear it will convince you not to try it.  Now I'm all for breastfeeding, heck it's been really difficult for me and I'm still working to make it better, but I think it's worth sharing that it's not all puppies and rainbows.  I would encourage every mother to breast feed as much as she is able.  There are lots of health benefits involved for all parties, and even if you can't stick with it for one reason or another, every bit that you can do helps both you and your baby.  But if you only hear the good things about breastfeeding, never informing yourself about the ups and downs involved then how can you prepare yourself for what you'll need to do to give breast feeding a concerted effort.  So without further ado here are some myths I see all over the internet that I wish someone had dispelled for me.

Myth: Breast feeding doesn't hurt if you do it right.
Ha!  My nipples have ranged from slightly sore to downright painful for the last two and a half months.  From the week my baby was born I would cringe just to have my towel brush against my nipples when I got out of the shower.  Ever tried to dry your face without your towel touching your nipples?  Maybe if you're more flat chested than me, but I can't seem to manage it.  Now things might be better for you if you're used to having someone suck on your nipples five hours a day, yes that's 10 feedings a day at 15 minutes per breast which is the MINIMUM my lactation consultant recommended to get started, so it just stands to reason that women who haven't breast fed before are going to be sore.  It doesn't help that she sometimes kicks one boob while feeding from the other.

Now there are lots of things that can help, starting with getting your baby to latch properly.  The lanolin cream really does help, and they make these really fantastic gel nipple pads that are cooling and soothing and really fantastic!  The pain gets better with time, well, it comes and goes really.  You'll get a schedule going and be fine for a couple weeks (sore but fine) and then your baby will go through a growth spurt and be ravenously hungry and rub your nipples raw again.  Keep in mind, I haven't had anything like bad nursing problems, no cracked and bleeding nipples like I've read about.  But you'll want to have a few thick bras that  are really protective (and hide the lines from the gel pads mentioned above), and don't be afraid to take a little Ibuprofen now and then.

Myth: The pounds just melt off.
I'm sure they do for some folks, but don't count on it.  I lost weight pretty fast for the first few weeks home from the hospital and then stalled out with about ten pounds to go to my pre-pregnancy weight.  I was talking to a retired GYN nurse who works at my daughter's daycare and she says that's about par for the course.  She said it's because breastfeeding tends to cause fluid retention (makes sense, if you're providing fluid to your baby then your body would want to have plenty of fluid on hand) so most women stall out somewhere around 5-10 lbs above their pre-pregnancy weight.  Of course you can then watch what you eat and probably slowly lose more, but you want to be careful about that when your breastfeeding because you don't want your body to think you're starving.  You also don't want to loose weight to fast because that can release toxins into the breast milk.  Either one can hurt breast milk quality or quantity, so don't plan on slimming down quickly.

Myth: Breastfeeding is free.
Nope, there's still no such thing as a free lunch.  Yes, breastfeeding is more cost effective than formula, but it's still far from free.  Here's a breakdown of what you can expect to spend on breastfeeding:

• Lanolin - I go through a tube every month and a half or so, and the tubes run about $8 at my local Kroger.  It might be more cost effective to buy them online or in larger sizes, but I haven't checked.
• "Soothies" Gel Nipple covers - You may not need them all the time, but they're great help for the worst soreness, and you can put them in the fridge for even more effective soothing.  They run about $10 a pair and I forget where I got this last set.
• Sleep Bras and Nursing Bras - No, they're not the same thing.  You'll want extra protection for your boobs, so even if you don't normally need support while you sleep you'll probably want to get a couple of sleep bras (I got Medela sleep bras, $15-20 on Amazon.com, and wore them 24/7 for my maternity leave).  You'll also want some nursing bras, preferably something without under-wire for the first little while.  I got one actual nursing bra, and then found that my really old stretched out Victoria's Secret bras could be pulled down for nursing pretty conveniently.  Unfortunately, they don't make them like they used to, and you couldn't do this with their memory foam bras, and Victoria's Secret now appears to be addicted to memory foam.  You can get nursing bras that unhook from the top to fold down, or with stretchy bra cups that just pull to the side or down.  I found the second to be more convenient, but they're less supportive than the ones that unhook, so you'll have to figure out what works best for you.
• Vitamin D drops and other baby supplements - Our pediatrician recommended that unless our baby eats 32 oz or more of formula a day we should give her vitamin D drops daily.  My husband's been the one to buy these, so I don't know how much they are, but I'm sure they're not terribly expensive.  I've heard of other folks needing other vitamin and mineral supplements as well, but we've never needed more, possibly because we're feeding both breast milk and formula.
• Bottles - Unless you're never planning on leaving your baby with anyone else, or for that matter never planning to need to feed her in her car seat on the way somewhere, you'll need to get some bottles.  How many will vary according to how long you'll ever be away or how often you want to wash dishes, but my lactation consultant strongly recommended using the wide nipple bottles because they're more like a breast which can reduce nipple confusion.  However I haven't seen any wide neck bottles in consignment like I have standard size bottles, so you may find these to be more expensive than if you were exclusively bottle feeding.
• Breast Pump - Wile I've heard some people have great success with hand expression, the few times I've tried it I got much less than pumping and it took a very long time.  Breast pumps can ranbe from about $50 for the cheapest hand pump I've seen, to around $1000 for a hospital grade pump.  That's to buy.  You can also rent for about $50 a month, and there are accessories to buy to go with that.  I got a decent electric pump for $300 and it works pretty well, though some folks swear the hospital grade pump works better.  I kind-of wish I'd tried it to see if it worked any better, but at this point it seems like a waste.
• Lactation Consultant - I'm sure this is optional for most folks, but I found our lactation consultant extremely helpful and have been very glad to have someone to go to when I have questions.  I'm sure there's a wide range of cost here, but four our board certified (IBCLC) consultant it was a little under $200 for her to come to our house for three hours, and then she was available to help us by phone and email thereafter.
• Lactation support foods, herbal supplements  and medicines - You may not need these at all, and some of the foods probably shouldn't be counted.  After all, you have to eat breakfast anyway, and it doesn't cost any more to eat oatmeal (which supports lactation) than any other breakfast.  Still, there are a few things I got specifically to help with lactation including: hulled barley (for making barley water, $10 for a pound on Amazon.com but much cheaper if you buy in bulk), More Milk or More Milk plus (an herbal supplement to increase breast milk production, about $20 for a 2-3 week supply, more cost effective if you buy in larger amounts), and I also got a prescription galactogogue that was $100 for a three month supply.
• Specialized nursing pillows if you want one - I just used bed pillows, but some folks swear by their Boppys.
• Your time - It takes longer to breast feed than bottle feed, and takes more work from your baby to get the milk out.  The slower flow is actually one of the benefits of breast feeding since it prevents overeating which in turn can reduce spit-up.  It also makes a baby more aware of when she's full.  I mean, it's the difference between scarfing your food and having a leisurely meal, you have more time to detect satiation.  This can lead to better eating habits in your child's life moving forward, but it also takes more time at each feeding.  My baby can take a bottle in 10 minutes or so, but at the breast takes 40 minutes to an hour per feeding.  That's probably on the long end of things, but if you believe your time is worth something then you'll want to tally that cost.  Remember the adage "Time is money."  I also recently read that breast feeding mothers have reduced earnings over the first five years of their child's life than bottle feeding mothers.  It's possible that's because they're more likely to be stay at home moms or work reduced hours, but it's still worth keeping in mind.

Sure, your actual costs may not add up to the projected $600-1800 cost of formula for the first year.  Many of the costs of breastfeeding are optional, and my largest expenditures have been covered by FSA.  Bottle feeding may also have additional costs due to more child illness and doctor visits; here's a study that says that the extra medical costs to never breast fed babies average $331 to 475 (http://www.ncbi.nlm.nih.gov/pubmed/10103324).  But I'm so tired of hearing about this "free" feeding method.  I wanted you to know what to expect.  

I still think breast feeding is totally worth it.  There are lots of good reasons to at least give it a good try.  If nothing else, it can be an amazing mother/baby bonding experience.  But if we can take the rose colored glasses off and prepare ourselves for the reality of breast feeding then we're much more likely to be successful when we hit the bumps in the road.