Increasing your milk production with a breast pump

Using an electric breast pump to increase your milk production can be very useful. However, some points need to be considered.

First, we need to understand how milk production works

For most, milk production is based on the principle of demand and supply - you have to demand that your body supply it. Milk production takes energy; if milk is not being removed, then there must not be a baby who needs it, so why would the body go to the effort of supplying it?

Many mothers are made to feel that there is something wrong with their bodies if they are not making enough milk. They usually aren't told that in the majority of instances, low milk production is actually caused by a lack of demand, and in most cases, this ISN'T the mother's fault. This can be caused by a baby not removing milk efficiently or not removing milk as frequently as the body needs to understand that it needs to make more.

I often tell clients to think of breasts like a factory - they make a particular product, and they make enough to fulfill the orders they receive. They should not make much more than what is being ordered because it would be more work than it needs to be, and that may cost more than what they make. However, if their customer/s start to order more product (demand), chances are they can increase production (supply); it may just take a few days to catch up.

I often have clients coming to me saying they were told to express after feeds for XX minutes per session. But their supply is not increasing.

The issue with this is that if the baby is taking 50mls from the breast (for example) and they can remove another 20mls from the breast in 10 minutes of expressing, how are they telling their body that they need more? The volume being removed is the same each session, so the body thinks that is all it needs to supply.

Breasts are like factories - they should be able to increase production, if there is increased demand

What they should be doing is DRAINING the breasts, not watching the clock.

The next question I usually get is, 'how do I know my breasts are drained?'

So I came up with this graphic

This mimics how a baby would feed at the breast - quick sucking to stimulate a letdown, then long, slow sucking when drinking the milk. When the milk flow slows down, they go back to the quick sucking. If another letdown happens, they go back to slow 'drinking'. Round and round they go until they have either had enough or cannot stimulate another letdown (normally, this would be when you switch breasts - if you are expressing both sides at the same time, one side may drain a bit quicker than the other).

The next consideration is frequency.

If you were to read textbooks on breastfeeding, they would tell you that newborn babies feed at least 8 to 12 times in 24hrs. A study at the UWA found that from 4 weeks, babies feed an average of 11 times in 24hrs (+/- 3).

Unfortunately, many 'experts' in baby care will emphasize getting babies to go longer between feeds. However, this is not conducive to breast milk production. Milk production is usually optimised when milk is removed from the breasts as frequently as the baby wants to take it.

Think FREQUENT, EFFECTIVE milk removal

Remember - if you do not remove milk from the breasts, you tell them that they do not need to make more. By removing as much milk as possible, as frequently as possible, you tell them they need to make more.

Because expressing is often labour intensive, mothers are often told to express at least 3 hourly during the day and 4 hourly overnight. However, if you add this up, it usually equates to 7 times in 24hrs. Have a look back at how often newborns will generally feed....8 to 12 times. Missing 1 session in 24hrs might not make much of a difference to some, but it could be crucial to others.

Doing 8 sessions in 24hrs does not mean it needs to be strictly every 3 hours - you can do some sessions closer together so that you can go slightly longer overnight. Ideally, one session should be between 1 and 5am, as this is when prolactin levels are highest. This can be difficult when you are triple feeding and the baby is feeding every 3 hours, but again their schedule could be 'tweaked' slightly so that they are being fed around the same times or you could maybe skip directly feeding the baby overnight so that you can stretch out the expressing times a bit (or vice versa if the baby is able to take enough milk from the breast at night and doesn't need top-ups).

If you are attempting to wean off expressing and increase direct feeding you should always express any time a top-up is given. If a top-up is not being given then you can skip expressing at that time.

Drain the breasts at least 8 times in 24hrs

Next, we need to consider what type of pump you are using

Unfortunately, not all pumps are made equal - chances are, any pump you can buy off the shelf at a baby store may not be strong enough to increase your supply.

If you are using a pump and doing the above, yet your supply is not increasing, or you feel milk is still sitting in the breasts afterward, your pump may not be sufficient for the task of increasing your supply.

Generally speaking, if you need to express with a pump to increase your supply, you will want to use a hospital-grade pump. There is no official definition of what a hospital-grade pump is, but is usually considered one that is capable of 'initiating, increasing, and maintaining breast milk production in the absence of a baby latching directly'. Some well-known hospital-grade pumps include the Spectra S1 and S2, the Medela Symphony, and the Ameda Platinium. This doesn't mean that other pumps may not work for some.

If you are using one of these pumps but still the milk supply is not increasing, you probably want to check your flange sizing. Rather than write out the whole article on flange sizing again, click here to read the original.

A visual guide to how your flange size should look (but trying flanges in person might be the only way to know exactly what you need)

Click here for instructions on how to choose your flange size correctly

Keep in mind that doing these things may not be a 'quick fix' - it can take a few days for your body to start making more milk, and it could take a few weeks to increase to an optimal amount, maybe even a month or more.

The type of pump and flange sizing may also be very important for increasing milk production

Other things to know and try

A lot of mothers say that one side will produce more milk than the other - usually, the right side is more productive (we don't know why, but the majority of mothers make more on their right than on their left). Some say this is 'normal', some say it is not. It may be one side needs different settings or needs a bit more attention. You may need different-sized flanges on each side. Some will say to power pump one side (more on power pumping below)

Another thing you can try to remove more milk is breast compressions - while you're expressing rub your hand or fingers down the breast - literally attempting to push the milk down towards the nipples. You can also compress the breast to 'squeeze' more milk out. Don't compress or squeeze too hard - this can cause pain and damage that might lead to mastitis.

Hand expressing - some find that they can still hand express a bit after using an electric breast pump. Stanford University has done research on the combination using hand expressing and an electric breast pump compared to just doing one - they found that the combination increase milk production overall. Here is a good video on hand expressing - click here. Some may also find that hand expressing is more efficient than using a pump, and knowing how to hand express properly can be useful, especially if you find yourself without an electric pump.

Power pumping - this is a common technique used to mimic cluster feeding. Babies 'cluster feed' to increase supply, but if baby is not latching directly or not properly, they might not be able to signal the mother's breasts to make more milk - cue 'power pumping'.

The main points of power pumping are -

a. Always start the session like you would any other - drain the breasts first;

b. Ideally do 1 power pump session each day for 3 days in a row;

c. Do your next session at your next normal session time - a power pumping session should not be used to replace an expressing session

d. The aim of power pumping is not to get more milk in that session, but to increase the production overall

For example, my 8 pumps per day schedule was - 2am, 6am, 8am, 11am, 2pm, 5pm, 7.30pm and 9.30pm. If I did a power pumping session at 2pm I would still do my next session at 5pm, even though I probably only finished around 3.30/4pm. I would also get significantly less at the 5pm session, which is normal, but the point is to drain the breasts at much as possible, to tell the breasts the baby is REALLY hungry and you need more milk.

Another form of power pumping - put containers at various places around your house and whenever you pass the container spend a couple of minutes on each side hand expressing into them.

Try 'mini power pumping' - if you find that you only get 1 letdown and could keep expressing for 15mins or more after with not much happening try this - after the first letdown go back to massage or letdown mode for 5 minutes. Turn the pump off (unless you get another letdown) and wait 10-20mins (do something different in this time, like feed your baby, eat or drink something, etc), then come back to the pump and do another 10mins or for as long as needed to drain the breasts. This could mimic how a baby falls asleep for a bit then wakes up and realises they want more.

Power pumping mimics cluster feeding - the aim is not to get more volume in that session, but more overall

Possible reasons why your supply won't increase

If you have done all of this for at least a week or more, yet your supply is not increasing at all, there could be underlying reasons why you cannot make more.

Common issues include hormonal imbalances and physical issues with the breast.

Common hormonal imbalances:

Untreated or undertreated hypothyroidism - little is known about what thyroid levels should be during breastfeeding and most doctors will go off 'non-pregnant' levels, which might not be optimal for breastfeeding. If you were treated for hypothyroidism during pregnancy and have low supply, talk to your doctor about going back on treatment.
Insulin resistance (aka diabetes) - often those with gestational diabetes have 'delayed onset of milk production,' and there also appears to be evidence that those with long-term insulin resistance (eg, type 2 diabetes, or on the verge of developing type 2 diabetes) may also struggle with milk production. Like hypothyroidism, this is not really well understood, so there might be much that can be done, but insuring your blood sugar levels are optimial is a good start
Polycystic ovarian syndrome - does not always cause low supply, but can. The hormonal imbalances caused can affect breast milk production. For the same reason/s, needing IVF for hormonal reasons could also affect milk production
Retained placenta - progesterone secreted by the placenta inhibits prolactin (the milk-making hormone) from working - if you have no other reason for low supply ask your doctor to investigate this issue.

Physical issues can include

Insufficient glandular tissue is when the breasts have not developed properly, so there are physically just not enough milk ducts to make enough milk.
Previous surgery on the breast/s may have severed ducts and/or nerves. This can include implants, reductions, and surgeries to remove lumps or ducts. Having had surgery does not always mean that you will have low production though.

A word on galactagogues

A galactagogue is a food or herb that is thought to increase milk supply. Some commonly suggested ones are fenugreek, oats, lactation cookies (or brewer's yeast), moringa, and goat's rue.

The issue with these is that many people may think that just taking them will 'magically' increase their supply - ie, they can take them, and suddenly the milk floodgates will open. Unfortunately, this is just not the case.

Yes, it can be nice to have a biscuit as a treat. Some have side effects, such as lowering blood sugar, which could be useful if there is an underlying issue like insulin resistance. But in most cases, they won't work without increasing the frequency and/or efficiency of milk removal.

The same is true for the medication domperidone or Motilium, which is often prescribed to increase supply - it won't work if you do not have frequent, effective milk removal.

If you do notice an increase after having one or more of these, it could be more of a placebo effect - you think you're doing something about your supply issue, you relax and stop worrying about it, and you produce more milk.

Summary

In order to increase your milk production, when a baby is not able to do it, there 3 things to consider:

DRAIN the breasts AT LEAST 8 times in 24hrs - remove as much milk as you possibly can, as often as you can
With an EFFICIENT pump
And the CORRECT SIZED flanges