Q&A: My doctor says I'm not producing enough milk. Help!

Don't panic! Meet with a lactation consultant to help you determine if your milk supply is adequately meeting the needs of your baby.

If you're not producing enough milk, your baby may be fussy and gaining weight slowly. If you discover that you aren't producing enough milk, there are things you can do to help.

But first, let's talk about how your body makes milk.

After your baby is born and the placenta detaches from the uterine wall, there is a big shift in hormones and your milk-making hormone, prolactin, begins to rise. This hormonal shift lets you body know that the baby is out and it is time to start making milk. Prolactin continues to rise through stimulation, which happens when your baby nurses.

Nursing your baby soon after delivery and with frequency (eight to 10 times a day) will help your milk come in quickly and plentifully. In addition to nursing often, a good latch will go a long way in helping you to reduce nipple soreness and maximize your milk production. (Your lactation consultant can help your baby achieve a proper latch.)

Is Baby Getting Enough Milk?
Try these tips and watch for the following signs to ensure that your baby is getting enough milk:

• Make sure Baby is having plenty of wet and soiled diapers. (A baby that is a week old should have six to eight wet diapers and at least four yellow-colored stools in a 24-hour period.)
• Listen for swallows when the baby is nursing.
• Do your breasts feel softer after feeds? If Baby is nursing properly, they should feel less full after feedings.
• Does Baby appear content between feedings? Sated babies tend to be less fussy.
• Most babies can be fussy in the evening and want to nurse more frequently—this is normal.
• Growth spurts occur about every three weeks—Baby will want to nurse more often than usual. Follow her lead: She will increase your milk supply through this increase in stimulation.
• Limit pacifier use. If Baby is hungry, pacifiers may temporarily soothe her rather than satisfy her hunger.
• Avoid use of supplements, unless your doctor suggests it as medically necessary.
• Watch Baby's weight. Was she back to her birth weight by two weeks of age? Did your baby gain about an ounce a day for the first three months? And then half an ounce a day from three to six months?

Increasing Milk Production
If you're hoping to increase milk production, try the following:

• Follow the baby's lead—nurse on demand (eight to 10 times a day)
• Spend time skin-to-skin with Baby
• Make sure you are drinking at least 64 ounces of water a day
• Eat a healthy, balanced diet
• Rest! (Sleep when the baby sleeps)
• Make sure the baby is latched properly
• Use a double electric pump two to three times a day after nursing to increase stimulation
• Talk to a lactation consultant or your healthcare provider about medications (galactagogues) that can be used in special situations to increase milk production

Effects of Supplementing
Supplementation with infant formula will definitely impact your supply and decrease how much milk you produce. Your body will usually respond in kind to your baby's demands. If it is determined that you can't make enough milk, supplementation may be necessary. Some mothers find that their supply may drop temporarily when going back to work or after being ill. Situations such as these may necessitate using infant formula.

Again, I encourage you to meet with a board-certified lactation consultant who can consult with your doctor to help you determine if you need to supplement your breastmilk. The lactation consultant can work with you to maximize your supply and ensure continued breastfeeding success.