My menstrual cycle has resumed. Can that affect my milk supply?

Each woman will respond to the menstrual cycle's resumption differently. Some do not notice a difference at all, while others report a drop in milk supply beginning about a week before a menstrual period and continuing a few days into the period. During this time, there is a steady decrease in blood calcium levels, and some women have had success stabilizing their supply by adding a calcium/magnesium supplement to their diet during this time. Calcium should be taken with magnesium in a 2/1 ratio (the ratio that is usually found in foods and supplements). Tums is not an adequate dietary calcium supplement and is also an antacid (calcium needs an acidic gastric environment for assimilation). As an aside, some moms notice that even though supply is stable, the baby acts as if the milk tastes differently during menstruation. If this is the case with your baby, keep an eye on healthy growth factors if she doesn't want to nurse as often or long as usual. Things should return to normal in a few days, but report any concerns to your physician or a lactation consultant.

How is milk supply established?

Milk supply is a demand/supply process. When the nipple is stimulated, prolactin is released by the body. Prolactin levels directly influence the amount of milk a mother's body makes. During the early months of nursing, the prolactin receptors are laid down that control the body's ability to provide breastmilk long-term. Some research indicates that during the first three to four months of life milk supply is controlled through this process in the endocrine system. After that time it moves to the control of the autocrine system, leading some to think that milk supply can not be significantly increased after that time other than in situations like normal growth spurts. For moms trying to breastfeeding in a cyclical pattern or routine (see my page on routine)that means that your ability to breastfeed long-term may be influenced by how carefully you maintain a flexible routine. Using the clock as your only guide can cause you to miss growth spurts or low milk supply cycles (for instance in the late afternoon for some women). Milk supply is also influenced by how effectively the breast is emptied. When the breast is emptied, the body signals the cells that make milk to begin making more. Prolactin release and milk removal both depend on adequate stimulation through a good latch. If your baby is having trouble latching, see a lactation professional to insure your milk supply.

I have been under a great deal of stress. Can this negatively impact my milk supply?

The release of prolactin is dependent only upon nipple stimulation, but the release of oxytocin can sometimes be inhibited by the release of adrenaline. That is why some moms of premature babies may have difficulty pumping long-term for their baby. Learning how to relax can greatly help the mom that must pump long-term, or the mom who is having trouble with the milk ejection reflex (let-down) because of stress. If the milk does not let-down, then the breast will not be adequately drained, more milk will not be made, and thus the concern for supply.

My supply has taken a nose dive due to a recent illness. What can I do to increase my supply?

Remember, more milk is made when prolactin levels increase due to stimulation and when milk is removed from the breast. That means that when your supply is low, increasing the frequency of your feedings will help build your supply to the level that your baby needs. This is the same principle that applies during a growth spurt. Another way to increase overall stimulation is to use a hospital grade pump to pump each breast an additional ten minutes after each feeding. Some women find that the use of herbals to help increase supply is effective. Using herbals should probably be a complementary measure in addition to decreasing the interval between feedings, and/or pumping though. While Fenugreek is probably the most popular, there are other choices, (such as Blessed Thistle, Nettle, and a tincture of herbs called More Milk/More Milk Plus) and a lactation consultant or certified herbalist can help you with this decision. Whatever you decide to do, in general it should take a few days to a week for levels to stabilize (depending on how long you have had a supply problem). ***Added note: it is important to consider your personal history with allergies when deciding to use an herbal to help increase milk supply. In addition, Fenugreek is contraindicated during pregnancy because it is a uterine tonic and stimulant and early in pregnancy can be abortifacient. (See an article about Fenugreek by Kathleen Huggins for more information--link on this page). For more great information on herbal galactogogues, check out this informative site: Herbal Remedies For Increasing Milk Supply. I've heard great things from moms who have tried More Milk/Plus, including a few moms who were breastfeeding twins! Motherlove Breastfeeding Herbal Extracts You can also browse the Motherlove website and find places near you that carry their products!

One common fallacy about increasing milk supply is that women must eat or drink a certain amount to have adequate supply or to increase supply. At least two studies have shown that encouraging women to drink excessive amounts of water and eat more in the effort to increase supply has absolutely no impact on milk volume or composition. That is not to say that breastfeeding women should ignore advice on nutrition, because it is a fact that maternal diet affects the well-being of the breastfeeding mother. When breastfeeding, moms should seek to maintain a healthy nutrition intake, with a healthy fluid intake. All women benefit by drinking 6-8 glasses of water daily (urine should be clear). In addition, seek the advice of your health care provider if the use of a multi-vitamin supplement would be beneficial during breastfeeding (many doctors recommend moms continue taking prenatal vitamins when breastfeeding).

What are other factors that can contribute to breastfeeding or supply problems?

1. At least three different studies show a significant decline in duration of breastfeeding with pacifier use (see AAP News Release--Pacifier Use Linked to a Decrease in Breastfeeding. The reasons for that are not clear, but the incidence of acute otitis media (ear infections) also increases with the use of pacifiers.
2. Cigarette smoking decreases prolactin levels.
3. The use of water bottles contributes to weight loss by decreasing a baby's hunger and desire to nurse (which in turn decreases supply).
4. Lack of flexibility and failure to consider context in your routine. The clock should not be the only guide to feeding your baby. See my page on routine for more information on this topic.
5. Introducing artificial nipples before breastfeeding is well established can lead to difficulty getting the baby to feed at the breast. If mom then resorts to bottle feeding, this can result in a cycle that eventually leads to low milk supply.
6. Physiological factors. True insufficient milk syndrome occurs only in roughly 2%-5% of breastfeeding women.
7. Lack of adequate support and encouragement. Sometimes women doubt whether or not they have enough milk because of certain behaviors the baby is exhibiting (like fussiness or waking more often than usual). If a mom responds to that doubt by giving the baby formula "just to see," she may be creating a supply problem where one did not really exist. Seek the encouragement of other breastfeeding women and lactation professionals if you are having doubts or a problem.
8. The use of oral contraceptives with estrogen (some anecdotal concern for progestin only contraceptives as well).
9. Indiscriminate use of nipple shields.
10. Some women report a temporary decrease in milk supply upon the onset of menses or ovulation.
11. Although generally safe to continue nursing while pregnant, some moms find milk supply decreases rapidly.