How to produce more breast milk

Most mothers make plenty of breast milk for their babies. The best way to establish a normal supply of breast milk is to start breastfeeding early, breastfeed frequently and making sure your baby is latching on correctly. The fluid your breasts produce in the first few days after birth is called colostrum (the thick golden liquid that your breasts produce). It’s thick and usually a golden yellow color that provides all the nutrients your baby needs. It’s a very concentrated food, so your baby will only need a small amount, about a teaspoonful, at each feed. Your baby may want to feed quite often, perhaps every hour to begin with. They’ll begin to have fewer, but longer feeds once your breasts start to produce more “mature” milk in three to five days after birth. The more you breastfeed, the more your baby’s sucking will stimulate your supply and the more milk you’ll make. You’ll be able to feed your baby with only breast milk for the next six months. Even if you get sick, your body will make antibodies that go into your breast milk. The antibodies will help your baby fight off any colds or infections. And the amount of your breast milk grows along with your baby in the following weeks and months. It’s very rare that a mom doesn’t make enough milk to feed her baby, so trust your body. Unlike formula, your breast milk adjusts according to your baby’s needs and is easy to digest.

Your baby’s sucking causes muscles in your breasts to squeeze milk towards your nipples. This is called the let-down reflex. Some women get a tingling feeling, which can be quite strong. Others feel nothing at all. You’ll see your baby respond when your milk lets down. Their quick sucks will change to deep rhythmic swallows as the milk begins to flow. Babies often pause after the initial quick sucks while they wait for more milk to be delivered. Occasionally this let-down reflex can be so strong that your baby coughs and splutters.

Your milk supply is considered low when there is not enough breast milk being produced to meet your baby’s growth needs. Some women have low supply, particularly during the early weeks of breastfeeding. This is the main reason some mothers start weaning or move to formula feeding. However, it’s rare for a mother to produce less milk than her baby needs. If your baby is having a good number of wet nappies each day, low milk supply is not a likely cause. Breast milk supply is considered to be low if you are not producing enough milk to meet your baby’s normal growth and development needs. Low milk supply is usually a temporary situation that will improve with appropriate breastfeeding support and management. Making more breast milk is all about supply and demand — the more milk is removed from the breast, the more milk is made. The less milk removed, the less breast milk is made.

If the breast milk supply is genuinely low it is usually a temporary situation and can be improved with appropriate support. If you are concerned about your milk supply it is important to seek advice from your lactation consultant or doctor.

The following may help increase your breast milk supply:

• Make sure your baby is latching well, positioned well and removing milk efficiently from the breast. Breastfeeding is a skill that you and your baby learn together, and it can take time to get used to. Read our post on how to breastfeed
• Breastfeed often and let your baby decide when to end the feeding. Be prepared to feed your baby more frequently — breastfeed on demand at least 8 times in 24 hours
• Switch your baby from one breast to the other at each feeding; offer each breast twice at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops.
• Ensure your breasts are emptied well at each feed or pumping session; you can express after breastfeeds to make sure
• Do not go longer than 5 hours without breast milk removal — your baby at the breast sucking is the most effective way to do this, but otherwise use a hand or electric pump
• When your baby is feeding, compress your breast to aid milk flow as this will also encourage more effective sucking
• Make sure you are drinking a lot of water, eating a healthy balanced diet and not missing any meals
• Also ensure you are resting as much as possible between feeds

Other options that can assist with a low supply include:

• a supplemental nursing system or ‘supply line’
• herbal and pharmacological remedies that are known to increase milk supply

Talk to your doctor, lactation consultant, breastfeeding counselor or child health nurse about these options.

Although breastfeeding is different for every woman, the following do NOT mean that you have a low supply:

• your breasts suddenly seem softer — this is normal as your milk supply adjusts to your baby’s needs
• your breasts do not leak milk, stop leaking or only leak a little
• you don’t feel a ‘let-down‘ when milk pushes out of the breast
• you are unable to pump very much with an electric pump — remember the baby is much more efficient and will always get more than a pump
• how much you pump decreases over time
• when your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and your baby are just getting used to breastfeeding and getting good at it.
• growth spurts can make your baby nurse longer and more often. These growth spurts often happen around 2 to 3 weeks, 6 weeks, and 3 months of age. Growth spurts can also happen at any time. Don’t be worried that your supply is too low to satisfy your baby. Follow your baby’s lead. Nursing more and more often will help increase your milk supply. Once your supply increases, you will probably be back to your usual routine.

There are many different reasons why some women have low supply including:

• Delays in breastfeeding after delivery or separations of mother and baby such as if the baby needs to be admitted to the special care nursery or if the mother is unwell after delivery
• Poor attachment to the breast, which can be caused by flat or inverted nipples, a tongue or lip tie, a sleepy baby because of jaundice, or a difficult or prolonged delivery
• If the mother is unwell due to problems like mastitis, retained placental tissue or large blood loss after the baby is born
• Scheduled or timed feeding, rather than feeding baby on demand. Nearly all babies need to feed at least 8 to 12 times in 24 hours.
• Your baby does not feed effectively at the breast.
• You have started using formula milk as well as breastfeeding.
• You are taking oral contraceptive pill that contains estrogen
• Skipping breast feeds and offering a supplement formula feed but not expressing breast milk at that time to ensure that supply continues to meet baby’s demand
• Long-term use of dummies or nipple shields
• You smoke cigarettes
• You have had breast surgery that is effecting your milk supply.
• You take some medications, including over-the-counter and herbal preparations such as cold/flu tablets, may reduce your milk supply.
• Rarely, there may be reduced or no milk production because of a medical condition. This occurs in less than five per cent of mothers.

Breast milk supply can be low if the woman has medical problems such as polycystic ovarian syndrome (PCOS), hypothyroidism (underactive thyroid), diabetes and pre-diabetes, or takes some blood pressure medications and cold and flu preparations, or has taken the contraceptive pill or has been infertile.

In some women, breast or nipple surgery makes breastfeeding difficult. In a few women, the breasts did not change during puberty and early pregnancy in a way that makes breastfeeding easier.

Some issues with breastfeeding include:

• wanting to be fed often — breast milk is digested in about 1.5 to 2 hours, whereas formula takes longer to digest
• being more fussy in the evening; you might produce less milk at this time and your baby will request fewer feeds or will ‘cluster feed‘ (feed frequently at certain times of the day)
• having a fussy or unsettled time in the day that may last for a few hours
• liking to suck even if they have had a good breastfeed — sucking comforts them
• wanting lots of cuddles and skin to skin contact — this makes them feel secure and ensures that baby’s needs are being met
• wanting to feed more frequently, which will happen when a baby is having a growth spurt — increased feeding will increase your supply
• reduces the amount of sucking time at the breast — this often happens after 2 or 3 months as your baby becomes more efficient at the breast.

Tips for breastfeeding success:

• Learn your baby’s hunger signs. Signs your baby may be hungry include:
  • Becoming more alert and active
  • Putting hands or fists to the mouth
  • Making sucking motions with the mouth
  • Turning the head to look for the breast
  • Crying can be a late sign of hunger, and it may be harder for the baby to latch if he or she is upset. Over time, you will be able to learn your baby’s cues for when to start feeding.
• Follow your baby’s lead. Some babies will feed from (or “take”) both breasts, one after the other, at each feeding. Other babies take only one breast at each feeding. Help your baby finish the first breast as long as he or she is still sucking and swallowing. Your baby will let go of your breast when he or she is finished. Offer your baby the other breast if he or she seems to want more. If your baby falls asleep while nursing and you are worried he or she did not get enough milk, try switching to the other breast or squeeze your breast to encourage more milk to flow and wake up your baby.
• Keep your baby close to you. Skin-to-skin contact between you and baby will soothe his or her crying and also will help keep your baby’s heart and breathing rates stable. A soft carrier, such as a wrap, can help you “wear” your baby.
• Avoid nipple confusion. Do not use pacifiers and bottles in the first few weeks after birth unless there is a medical reason. If you need to use supplements, work with a lactation consultant. She can show you ways to give supplements that help you and your baby continue breastfeeding. These include feeding your baby with a syringe, a tiny tube taped beside your nipple, or a small, flexible cup. Try to give your baby expressed or pumped milk first.
• Make sure your baby sleeps safely and close by. Have your baby sleep in a crib or bassinet in your bedroom so that you can breastfeed more easily at night. Research has found that when a baby shares a bedroom with his or her parents, the baby has a lower risk of sudden infant death syndrome (called SIDS) ¹⁾.

Figure 1. Normal breast

Common reasons why women may think their milk supply is low

My baby feeds too often.

Babies naturally feed frequently (normally 8 to 12 times in 24 hours), and in the early days babies can be very unsettled. This does not mean that there is not enough milk. In fact, frequent feeding is necessary to establish a good breast milk supply.

My breasts feel soft.

When your milk supply adjusts to your baby’s needs your breasts may not feel as full (this may occur anywhere between 3 to 12 weeks following birth). As long as your baby continues to feed well, your breasts will produce enough milk for your baby.

My baby has suddenly started to feed more frequently.

Your baby may want to feed more during a ‘growth spurt’, but this increased feeding over a couple of days will help you to increase your supply.

My baby only feeds for a short time.

This is no cause for concern as long as your baby continues to grow. After two or three months your baby becomes more efficient at feeding and therefore will take less time at the breast.

How can I produce more breast milk?

The best way to make more breast milk is to breastfeed often and to empty your breasts completely at each feeding. Breastfeed frequently, two to three hourly – a total of at least eight feeds in 24 hours. Your baby may need to be woken for some feeds, or may wake to feed even more often. After emptying your breasts at each feeding, less milk builds up in your breasts between feedings.

To better empty your breasts, follow these tips:

• Make sure that attachment is good and that your baby is both sucking and swallowing (you may need to seek help with this).
• Use breast massage and compression.
• Offer your baby both breasts at each nursing, offer each breast twice. When you notice your baby is becoming tired or not swallowing very frequently anymore, take your baby off that breast and ‘switch’ to the next side. Repeat on both breasts. This will ensure your baby is draining the breast more efficiently.
• Pump after breastfeeds if your baby does not remove all the milk from your breasts. Your breasts will soften when the milk is removed. If the baby empties your breasts, then you can pump to remove milk and increase milk production between nursing sessions.
• Hold your baby skin-to-skin at the breast (baby dressed in a nappy only, so that there is direct skin contact between you and your baby). This will help to keep your baby awake and also to increase the release of hormones involved in breast milk production.
• If your baby is sleepy at the breast and not feeding well you may need to cut short the feed and use the time to express each breast twice, for example, five minutes left side, five minutes right side and then repeat. The expressed breast milk should then be fed to your baby.
• When breastfeeding or expressing, compress or massage your breasts to assist with milk flow and drainage.
• If you need to give your baby extra milk, give expressed breast milk separately and before any infant formula. Seek advice from a lactation consultant or other health professional before commencing infant formula.

Sometimes prescription medicines are used to assist with increasing milk supply; these are available from your doctor.

What can affect how much breast milk I make?

You may make more or less breast milk, depending on:

• How completely milk is removed each time you breastfeed. An empty breast means better milk production.
• How often you nurse or pump to remove milk. The more often you empty your breasts, the more milk your breasts will make.
• The amount of milk your breasts store between feedings. If your breast stores too much milk between feedings (because your baby doesn’t empty the breast), your breast will make less milk. If your breast is emptied, it will make more milk. It is common for one breast to make more milk than the other, and it is normal for babies to prefer one breast over the other. This can affect how much milk you make in that breast.

How do I know if I will make enough breast milk?

Many mothers worry about making enough milk to feed their babies. Some women worry that their small breast size will make it harder to feed their babies enough milk. But women of all sizes can make plenty of milk for their baby. The more often your baby breastfeeds, the more milk your breasts will make.

Your baby’s weight should double in the first few months. Because babies’ tummies are small, they need many feedings to grow and be healthy. You can tell if your baby is getting enough milk by the number of wet diapers he has in a day and if he is gaining weight.

If you think you have or will have a low milk supply, talk to a lactation consultant.

What if my breastmilk supply goes down?

If you don’t feel as “full” as you did in the first few weeks of breastfeeding, you may worry that you are not making enough milk for your baby. But know that the milk is still there and flowing to your baby. Usually, after a few months of breastfeeding, your body learns to make the right amount of milk for your baby.

Also, your baby may only nurse for short periods, such as five minutes at each feeding. These are not signs of lower milk supply. Your body adjusts to meet the needs of your baby, and your baby gets very good at getting milk from the breast. It’s also normal for your baby to continue to nurse longer on each breast at each feeding.

How often should I feed my baby?

You should breastfeed as soon as possible after giving birth. Then, breastfeed your baby every 2 to 3 hours each day so that you will make plenty of milk. This means that in the first few days after birth, your baby will probably need to breastfeed about every one to two hours during the day and a few times at night.

Healthy babies develop their own feeding patterns. Follow your baby’s cues for when he or she is ready to eat.

In the first week, your baby may want to feed very often. It could be every hour in the first few days.

Feed your baby as often as they want and for as long as they want. They’ll begin to have fewer, but longer feeds after a few days.

As a very rough guide, your baby should feed at least 8 to 12 times, or more, every 24 hours during the first few weeks.

It’s fine to feed your baby whenever they are hungry, when your breasts feel full or if you just want to have a cuddle.

It’s not possible to overfeed a breastfed baby.

When your baby is hungry they may:

• get restless
• suck their fist or fingers
• make murmuring sounds
• turn their head and open their mouth (rooting)

It’s best to try and feed your baby during these early feeding cues as a crying baby is difficult to feed.

How long should I breastfeed my baby?

The American Academy of Pediatrics recommends breastfeeding as the only source of food for the first 6 months of your baby’s life. The American Academy of Pediatrics also recommends continuing breastfeeding (after starting solid food) beyond your baby’s first birthday and for as long as both you and your baby would like.3 The easiest and most natural time to wean is when your child leads the process. But how you feel is also very important in deciding when to wean.

Your decision may depend on several factors, such as returning to work, your or your baby’s health, or a feeling that the time is right.

What is the let-down reflex during breastfeeding?

The let-down reflex also called just “let-down” or the milk ejection reflex, happens when your baby begins to nurse. The nerves in your breast send signals that release the milk into your milk ducts. Let-down happens a few seconds to several minutes after you start breastfeeding your baby. It also can happen a few times during a feeding. You may feel a tingle in your breast or you may feel a little uncomfortable. You also may not feel anything.

Let-down can happen at other times, too, such as when you hear your baby cry or when you’re just thinking about your baby. If your milk lets down as more of a gush and it bothers your baby, try expressing some milk by hand before you start breastfeeding.

Many factors affect let-down, including anxiety, pain, embarrassment, stress, cold, too much caffeine, smoking, alcohol, and some medicines. Mothers who have had breast surgery may have nerve damage that interferes with let-down.

How long should breast feedings be?

There is no set time for feedings. They may be 15 to 20 minutes per breast, or they may be shorter or longer. Your baby will let you know when he or she is finished feeding. If you worry that your baby is not getting enough milk, talk to your baby’s doctor.

Breastmilk changes throughout the feed:

• Early in the feed, the milk has a lower fat content. This helps to quench the baby’s thirst.
• As the feed goes on, the fat content of the milk rises which satisfies the baby’s hunger.
• A baby who is allowed to finish the first breast, so that he feeds until he comes off by himself before being offered the second breast, receives the higher fat milk.
• At times your baby may be satisfied with just one breast, at others he may also want the second side, or even a third.
• By switching which breast you feed from first, you will ensure each breast keeps making a good amount of milk.

Will my breastmilk change as my baby grows?

Yes. Your breast milk changes in the days after birth and continues to change as your baby grows. Learn what will happen with your milk, your baby, and you in the first few weeks.

Birth

• Milk: Your body makes colostrum (a rich, thick, yellowish milk) in small amounts. It gives your baby early protection against diseases.
• Baby: Your baby will probably be awake in the first hour after birth. This is a good time to breastfeed your baby.
• You (Mom): Let your baby begin the process of searching for your nipple. This baby-led way of breastfeeding can help your baby get a good latch.

First 12 to 24 hours

• Milk: Your baby will drink about 1 teaspoon of colostrum at each feeding. You may not see the colostrum, but it has what your baby needs and in the right amount.
• Baby: It is normal for the baby to sleep heavily. Labor and delivery are hard work! Some babies like to nuzzle and may be too sleepy to latch at first. Feedings may be short and disorganized.
• You (Mom): Your body is still making colostrum. Take advantage of your baby’s strong instinct to suck and feed upon waking every couple of hours to help your milk come in faster.

Next 3 to 5 days

• Milk: Your mature (white) milk takes the place of colostrum. It is normal for mature milk to have a yellow or golden tint at first.
• Baby: Your baby will feed a lot, at least 8 to 12 times or more in 24 hours. Very young breastfed babies do not eat on a schedule. It is okay if your baby eats every 2 to 3 hours for several hours, then sleeps for 3 to 4 hours. Feedings may take about 15 to 20 minutes on each breast. The baby’s sucking rhythm will be slow and long. The baby might make gulping sounds.
• You (Mom): Your breasts may feel full and leak. (You can use disposable or cloth pads in your bra to help with leaking.)

First 4 to 6 weeks

• Milk: White breastmilk continues.
• Baby: Your baby will now likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and may be farther apart.
• You (Mom): Your body gets used to breastfeeding. Your breasts may become softer and the leaking may slow down.

Dealing with leaking breasts

Sometimes, breast milk may leak unexpectedly from your nipples. Wearing breast pads will stop your clothes becoming wet with breast milk. Remember to change them frequently to prevent an infection.

Expressing some milk may also help. Only express enough to feel comfortable as you do not want to overstimulate your supply.

If your baby has not fed recently, you could offer them a feed as breastfeeding is also about you being comfortable.

When can I start using a breast pump?

Talk to your health care provider about when you can start pumping your breast milk. You may want to start pumping soon after your baby is born. This can help build up your milk supply, and you can freeze the expressed breast milk to use later. Your milk supply is the amount of breast milk you make for each feeding. Pumping your breasts after your baby breastfeeds can help you increase your milk supply.

Wait until your baby is breastfeeding well before you start feeding him pumped breast milk from a bottle. Starting your baby on a bottle (or giving him a pacifier) too early can cause nipple confusion. This is when your baby has trouble latching on and sucking after being given a bottle or pacifier. Your baby forgets how to latch on to your breast, so he doesn’t feed well or doesn’t want to breastfeed.

If you’re going back to work or school:

• Start pumping at least 2 weeks before you go back.
• Try to pump as often as your baby usually feeds. This may be every 3 to 4 hours for about 15 minutes each time.
• Find a private place to pump. Talk to your employer before you go back to work so she/he knows what you need.

Breast pumping tips

Pumping while away from your baby can be tricky. Finding the time and space to do it, as well as relaxing while you do it can be easier said than done.

Mothers who have successfully pumped are a great resource and can provide many suggestions to make the process easier. Here are some of those suggestions:

• Find a quiet place where you are not likely to be interrupted. You may want to look around your work area before you go out on leave to find the best place. It does not have to be fancy, but it should be private. The restroom is not an acceptable place to be asked to pump. Be aware that there are laws in place in some countries to protect you.
• Relaxing is important. Many mothers look at pictures of their babies, listen to music, drink water or have a snack. Some use their phones to watch videos of their babies or face time the baby and caregiver.
• Some mothers find that hand expressing for 1-2 minutes before using the pump gives them better results. The warmth of their hands and “Skin on skin” first provides good stimulation so that their milk is released better.
• Stay hydrated. Drink plenty of fluids so that you do not become overly thirsty. If you can snack as well as get a good meal break, this is helpful as well.
• Invest in a hands free pumping bra. There are several on the market or you can make your own. If you make your own, simply use a sports bra and cut holes where the flanges will go through. You can use duct tape to seal the edges so they don’t fray.
• Invest in a good pump. It will be cheaper than formula in the long run and it will be more comfortable for you. Most manufacturer’s have various sizes of flanges. Be sure your flange is not too tight, nor too loose.

How often will I have to pump my breast when I go back to work or school?

How long you are apart from you baby influences this decision. Ideally, you would pump as often as your baby would nurse. This may not be possible with your work/ school schedule. Most mothers find that pumping every 2-3 hours maintains their milk supply and does not cause them to become uncomfortably full.

For example, if a mother worked an 8 hour work day, she would nurse her child before coming to work, then pump mid-morning, at lunchtime and then mid-afternoon. She would nurse her baby when she returned home.

Should I single or double pump?

Using a pump that can express milk from both breasts at the same time will save the most time. It may take about 15 minutes to pump both breasts instead of 30 minutes or more to pump each breast separately. Double pumping also provides very strong stimulation to keep a good milk supply. Prolactin, which is an important hormone for making milk, becomes very elevated when mothers double pump.

Is there any way to decrease the number of times I have to pump at work?

If it is possible for you to go home at lunch, or have someone meet you on your break with your baby, you can breastfeed instead of pump. Some employers have onsite child care and this could allow you to take your breaks with your baby.

Some babies develop a pattern known as “reverse cycle breastfeeding.” This means that your baby will sleep more while you away and breastfeed more when you are together. If this happens, you may find you need to pump less when you are away from your baby. Keep your baby near you at night, so that you may nurse easily and get as much sleep as possible.

How do I choose a breast pump?

They type of breast pump you need depends very much on your situation. Your ability to pump well will depend on matching your specific needs to the best pumping system that meets those needs.

If you do need to leave your baby because you are returning to work or school, a good pump will be needed. There are many options to choose from. It is important to choose one that will meet your specific needs. Some things to consider are cost, efficiency, how easy it is to transport and how much noise it makes.

If you only need to pump occasionally, a hand operated pump may be the right one. They are small, easy to carry and use and are not very expensive (for example they may cost $20-50 in the US). One pump that is no longer recommended is the “bicycle horn” style manual pump. This pump did not work well and many mothers found it to be uncomfortable to use.

If you will only be away a few hours a day and only need to pump once or twice, a small electric pump may be appropriate. The cost of these range from about $50 to $150 in the US. Some are double pumping styles, others will pump one breast at a time. Some of them are fairly quiet, but some are rather noisy. These can be plugged into the wall or use batteries. Some have AC adapters.

If you will be away for 8 or more hours, a double electric pump is likely the best choice. These are recommended if the time you have to pump is limited and/or you will be pumping 3 or more times per day. These pumps are automatic and they have a suck release cycle that mimics the pattern of a baby nursing. They can be fairly large, and come in carrying cases that resemble a large handbag. These cases hold all of the accessories needed. They are usually quiet. They cost between $200 – 300 in the US and are classified as single user pumps by the manufacturers.

The last option is the hospital grade pump, also called the multi user pump. This is a very strong pump and is used when mother and baby are separated, such as pumping milk for a premature baby in the hospital, or if mother needs strong stimulation to increase her milk supply. These are rarely purchased. Most mothers rent them from a hospital or from a Durable Medical Equipment Company.

Many mothers find it helpful to talk with their friends about whether or not a pump is needed, and if so, what kind worked best. Be sure to ask what features worked well and what didn’t.

My friend no longer needs her pump and said I can use it. Is this okay?

It is important to know that most breast pumps are considered single user. Milk can flow backwards into the pump mechanism and cause contamination. For this reason, sharing or borrowing single user pumps is not recommended.

How breastmilk is made

Breasts often become fuller and more tender during pregnancy. This is a sign that the alveoli, cells that make breastmilk, are getting ready to work. Some women do not feel these changes in their breasts. Other women may feel these changes after their baby is born.

The alveoli make milk in response to the hormone prolactin. Prolactin levels go up when the baby suckles. Levels of another hormone, oxytocin, also go up when the baby suckles. This causes small muscles in the breast to contract and move the milk through the milk ducts. This moving of the milk is called the “let-down reflex.”

The release of prolactin and oxytocin may make you feel a strong sense of needing to be with your baby.

How your breasts make and give milk

• The onset of breastmilk production is triggered by delivery of the placenta which results in a sudden drop in progesterone levels.
• The skin covering the nipple contains many nerves that are triggered by the baby’s sucking. This causes hormones to be released into the mother’s bloodstream.
• One of these hormones (prolactin) acts on the milk-making tissue, building up the milk supply.
• The other hormone (oxytocin) causes the breast to push out or release the milk already there.
• This release of milk is known as the let-down reflex (sometimes called the milk ejection reflex).
• The more often your baby’s sucking causes a let-down and the more milk that is removed from your breasts, the more milk will be made.
• Respond to your baby’s feeding cues. Crying is a late sign of hunger.
• Breastfeed your baby often.
• Don’t limit time at the breast or delay the time between feeds. A well drained breast ensures more milk is made quickly.
• The breasts are never completely empty.
• Babies stop feeding when they have had enough, while at the same time, your breasts are already at work making more milk.
• Whatever your baby drinks is automatically replaced, producing a constant supply, perfectly matched to her need, whenever she needs it.

Building up your milk supply

Around 2 to 4 days after birth you may notice that your breasts become fuller. This is often referred to as your milk “coming in”.

Your milk will vary according to your baby’s needs. Each time your baby feeds, your body knows to make more milk for the next feed. The amount of milk you make will increase or decrease depending on how often your baby feeds.

Feed your baby as often as they want and for as long as they want. This is called responsive feeding. In other words, responding to your baby’s needs. It’s also known as on-demand or baby-led feeding.

In the beginning, it can feel like you’re doing nothing but feeding. But gradually you and your baby will get into a pattern and the amount of milk you produce will settle down.

It’s important to breastfeed at night because this is when you produce more hormones (prolactin) to build up your milk supply.

In the early weeks, before you and your baby have become comfortable with breastfeeding, “topping up” with formula milk or giving your baby a dummy can lower your milk supply.

Speak to a midwife or doctor if you are worried about breastfeeding or you think your baby is not getting enough milk.

They might suggest giving your baby some expressed breast milk along with breastfeeding.

How do I know that baby is getting enough milk?

When you first start breastfeeding, you may wonder if your baby is getting enough milk. It may take a little while before you feel confident your baby is getting what they need.

Always look at the whole picture to ensure that baby’s growth and development is with normal limits.

Signs your baby is getting enough milk if your baby:

• go through 6 to 8 wet nappies in a 24-hour period including at least a few dirty nappies
• from the fourth day, they should do at least 2 soft, yellow poos the size of a $2 coin every day for the first few weeks.
• from day 5 onwards, wet nappies should start to become more frequent, with at least 6 heavy, wet nappies every 24 hours. In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies.
• after about 5 to 6 days, your baby’s poop should stop looking black and thick and they should also have at least 2 soft or runny yellow poops.
• wake for feeds by themselves and feed vigorously at the breast
• has 8 to 12 breastfeeds in 24 hours
• pass a soft yellow stool
• settle and sleep fairly well after most feeds
• when your baby is 3-4 days old and beyond you should be able to hear your baby swallowing frequently during the feed
• is back to birth weight in about 2 weeks. Your baby gains weight steadily after the first 2 weeks – it’s normal for babies to lose some of their birth weight in the first 2 weeks.
• gain on average 150 grams or more every week for the first 3 months.

Other signs your baby is feeding well:

• Your baby starts feeds with a few rapid sucks followed by long, rhythmic sucks and swallows with occasional pauses.
• You can hear and see your baby swallowing.
• Your baby’s cheeks stay rounded, not hollow, during sucking.
• They seem calm and relaxed during feeds.
• Your baby comes off the breast on their own at the end of feeds.
• Their mouth looks moist after feeds.
• Your baby appears content and satisfied after most feeds.
• Your baby appears healthy and alert when they’re awake.
• Your breasts feel softer after feeds.
• Your nipple looks more or less the same after feeds – not flattened, pinched or white.
• You may feel sleepy and relaxed after feeds.

Nappies

The contents of your baby’s nappies will change during the first week. These changes will help you know if feeding is going well. It can be hard to tell if disposable nappies are wet. To get an idea, take an unused nappy and add 2 to 4 tablespoons of water. This will give you an idea of what to look and feel for. Speak to your doctor if you have any concerns.

Baby’s age	Wet nappies	Dirty nappies
1-2 days old	1-2 or more per day urates may be present*	1 or more dark green/black ‘tar like’ called meconium
3-4 days old	3 or more per day nappies feel heavier	At least 2, changing in color and consistency –brown/green/yellow, becoming looser (‘changing stool’)
5-6 days old	5 or more heavy wet**	At least 2, yellow; maybe quite watery
7 days to 28 days old	6 or more heavy wet	At least 2, at least the size of a $2 coin yellow and watery,‘seedy’ appearance

Footnotes: *Urates are a dark pink/red substance that many babies pass in the first couple of days.At this age they are not a problem, however if they go beyond the first couple of days you should tell your midwife as that maybe a sign that your baby is not getting enough milk.

** With new disposable nappies it is often hard to tell if they are wet,so to get an idea if there is enough urine, take a nappy and add 2-4tablespoons of water. This will give you an idea of what to look/feel for.