This is segment two of a series on breastfeeding. Click here for segment one.

How many times have you heard another mom say, “I stopped breastfeed because I didn’t have enough milk”? Or maybe that’s the reason you stopped breastfeeding. According to one study published in JOGNN, milk production is the main reason that mamas cite for premature weaning. Although there are physiological/anatomical issues that affect milk production (IGT, PCOS, breast surgeries, thyroid conditions, pituitary tumors to name a few), the vast majority of women are physically able to breastfeed. The real problem is that cultural and societal expectations, norms, and beliefs negatively impact milk supply.

Cultural Beliefs

I’ve already climbed on my soapbox about the cultural impact of unethical advertising from formula companies, so I’ll attempt to avoid doing that again. Unfortunately the ripple effects of a society who believes artificial infant feeding is a very close second to the real deal extend further than we think. It creates an environment where formula is the first go-to instead of the last resort. In addition to gut microbiome effects, formula supplementation will actually decrease your supply. The body is an efficient machine. Much like an unused muscle will atrophy, an underutilized breast will decrease output. It’s literally a use it or lose it scenario. There are a few situations in which supplementation is necessary, but there many, many, MANY scenarios that it’s uncalled for. If supplementation becomes necessary, it’s best to do it at the breast with a sryinge/feeding tube set up, or a supplementary nursing system filled with the mother’s expressed milk or donor milk. If you have a low supply due to formula supplementation, you are not alone. Since the problem is decreased demand on the breast, the solution is increased demand. You can do this by pumping and/or putting baby directly to breast as often as possible. A baby directly nursing will stimulate supply the most effectively, however.

Social Expectations/Norms

Family structure in the United States is primarily nuclear, meaning that in many cases infants are raised in a household with only their parents and siblings. In other countries a new mom receives postpartum support from from experienced female relatives who may even live with them. If you are lucky enough to have female relatives who live with you, or stop by frequently, that’s great. However, many of us don’t. And for those who do, what level of breastfeeding knowledge do they possess? They may even be the ones incorrectly leading you down the path of supplementation because that’s all they know (again, negative generational impact from unethical marketing practices). Since breastfeeding wisdom has been lost, you must look elsewhere to find support. This can be in the form of a lactation consultant, friends/peer breastfeeding groups on social media, websites, blogs, etc.

How do I make so much milk? How do I breastfeed twins?

Fortunately I do not have issues with low supply. I start breastfeeding off on the right foot as discussed in segment one, and I have breasts with an extra extra extra large storage capacity. Women with smaller storage capacities need to be more careful in managing breastfeeding. As a general rule, the smaller your breast storage capacity, the more frequently your breasts need to be emptied. When they reach a certain stage of fullness, the signal is sent that milk production should be decreased. Because of my super storage capacity, I can pump 38oz in one sitting!  I empty my breasts frequently by pumping/nursing throughout the day and night. Although I haven’t experienced low supply, the same techniques I use to maintain my supply can be used to increase supply.

• I almost always empty both sides at once by:
  • Tandem feeding the twins on the My Brest Friend pillow.
  • Breastfeeding one baby positioned on a sideways turned Boppy while pumping the other side.
  • Breastfeeding one baby and using a haakaa on the other side.
  • Pumping both breasts for 15-25 minutes.  I use a Medela Symphony at home and a Spectra S2 at work. Both pumps work rather well, but I find that I get more milk in less time with the Medela.
• Pumping and breastfeeding often. 
  • When I’m home the babies are fed on demand, i.e. whenever they signal that they want to nurse. Babies are NOT biologically designed to be fed on a schedule.
  • At work I try to pump 15-20 minutes every 2-3 hours. Due to the nature of my job, this can be challenge, but my coworkers are all very supportive.
• Middle of the night and morning pump. Milk production is highest in the early hours of the morning. I take advantage of this by pumping BEFORE I feed the babies. I can typically sock away an extra 45-55oz for donation by doing this. As I mentioned, babies are more effective at removing milk from the breast than the pump is, so it’s okay for me to pump before feeding. I try to wait 15-30 minutes after pumping to feed, but sometimes they want to eat NOW. And that’s okay too, because they’re just going to stimulate my supply even more.

What I haven’t tried and may work for you:

• Power pumping
• Herbal galatalogues
• Lactation treats (cookies, bars, etc). I hope to be trialing and reviewing these products soon. If I do, I’ll link my reviews here as well.
• Reglan (ask your doctor)
• Domperiodone (off market use in the USA; use at your own risk)

Stay tuned for segment three! I plan on discussing milk storage, pumping at work, and milk donation. I will be reviewing a hands-free pump bra soon!