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| Education and Support for Nursing Mothers |
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| Common Concerns p. 7b |
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| SUPPLY ISSUES - continued |
| If you suspect that reflux is the issue, you should examine the possibility that something in your diet is affecting the baby. The most common culprit is a dairy sensitivity, and you should consider removing all dairy -- even in trace forms -- from your diet. This requires reading labels for all food products, as dairy can be found "hidden" in many unsuspected places. Bread crumbs, for example, may contain dairy products, and bread crumbs will be found in meatballs, chicken nuggets, etc. More information on dietary eliminations for reflux can be found here. |
| More likely, your low supply is due to insufficient breast emptyings. Many moms overproduce in the beginning, and may be able to get by for a while with less frequent nursing sessions, or less frequent pumping at work, or pumping with an inadequate breast pump. Eventually, these actions may catch up with you. After 3-4 months, the body is less resiliant to bouncing back from insufficient maintanance of your supply. However, there are still steps you can take. |
| What if my supply really is low? (Continued) |
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| Supply Issues: Increasing Low Supply |
| Begin your war on low supply by nursing much more frequently, or pumping more frequently if you are not able to nurse more often. The pump you should use should be a high-quality, double-electric, hospital-grade pump. If you can rent a Medela Classic, terrific. If you own a Medela Pump in Style, that may be adequate. Aim for at least 8 breast emptying sessions per day (a good nursing session or a double-pumping session counts as a breast emptying). Several times, test to see if your child really is draining the breast well by pumping immediately after a nursing session. You should not get much milk by pumping immediately after nursing. If you are, you should revisit possibilities of reflux or of poor suck or poor latch or problems such as an unusual palate. |
| Increased Demand = Increased Supply |
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| Natural Supply Boosters |
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| There are many things reported to be natural supply boosters (galactagogues). These typically require that you also increase pumping and/or nursing frequency in order to work. Some of the supply boosters with the best annectodal records for working are fenugreek and blessed thistle. Other natural remedies reported to be galactagogues are anise seed, alfalfa, brewer's yeast, dill, fennel, goat's rue, ignatia, marshmallow plant, milk thistle, nettle tea, and red raspberry leaf. The action and doses of these herbs can be researched here. Some people also report that oatmeal helps increase their supply. |
| Another cause of low supply is the return of your menstrual period. This is a temporary dip, manageable for many women by taking extra calcium and magnesium either daily or from time of ovulation through the beginning of your period. 1500 mg of Calcium combined with 750 mg of Magnesium works well for many women; some women (particularly ones who eat little red meat) find they can get by with just 500 mg of Calcium and 250 mg of Magnesium. Magnesium helps your body absorb calcium, so look for a supplement that combines the two. Calcium and iron interfere with each other's absorption, so you should take your calcium supplement separately from any iron supplements you may be taking. |
| Other causes for a sudden drop in supply are pregnancy, beginning to use estrogen-containing birth control, and use of decongestants or cold medicines containing sudafed. Estrogen-containing birth control should not be used by nursing mothers as most will experience a severe supply drop. For more information about birth control while breastfeeding, see this KellyMom link. Some additional hidden causes of a low supply can be found here. |
| Last Updated January 12, 2004 |
| Prescription Supply Boosters |
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| If the usual methods for increasing supply fail, there are also prescription supply boosters available. These drugs should be reserved as a last resort. Many doctors in the United States will prescribe Reglan (metoclopramide) -- although it is not AAP approved for use in nursing mothers. This medication, however, does have some nasty side-effects, including depression that may not go away when the medication is stopped. It should never be used by anyone with a family history of depression, and it should not be used long-term by anyone else. Also, if you do take Reglan to increase your supply, you must wean off it slowly, as stopping the Reglan "cold-turkey" can result in a rebound effect, where your supply actually drops to below the level it was at before your treatment with the Reglan. Motilium (domperidone) is typically used in Canada and elsewhere. It is AAP approved for use in nursing mothers, but it is not easily available directly in the United States. You may be able to get it in the US if you find a compounding pharmacy and get your doctor to prescribe it. An alternative is to order it from overseas. In this case, you do not need a prescription, and it is also likely to be cheaper than securing it from a compounding pharmacy in the United States. (More information on prescription supply boosters and on supply issues on the next page.) |
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