How to Increase Milk Production

General Guidelines: Milk Removal, Foods, Herbs and Medications

Frequent removal of milk is the best way to increase your production. Try to remove milk at least every three hours if you can. If the baby is not an effective remover of milk from the breast, you need to pump after every nursing session. If the milk is not removed from the breast, the breast will start to decrease its production. What is most important is how many times you try to remove milk, not how long you nurse or how long you are on the pump. Pumping when milk is no longer coming out is not helpful to increase your production. Renting a hospital grade pump is usually recommended when you are trying to establish a milk supply. See Pumping article.

Foods

Foods that may lower production if eaten in large amounts: soy, sage, parsley, peppermint.

Foods that may increase production according to many cultures are: protein, oatmeal, barley (malt), almonds and sesame seeds.

Herbs

Some herbs can help increase milk production. We do not know the mechanism of action of these herbs but we do know that they are minimally excreted in the milk with no reported dangerous effects to the mother and baby.

Fenugreek and Blessed Thistle are the two major herbs used to increase milk. They are sold in tea, capsule and liquid extract forms. Fenugreek is related to chick peas and walnuts, so avoid it if you are allergic to these things.

The teas (fenugreek tea or mother’s milk teas) are very mild and you have to drink a lot of tea to see major improvement. The capsule dose is 2 to 3 capsules of each herb, three times per day.The extract dose is 1 ml 4x per day.

Other herbs used to increase breast milk are fennel, red raspberry and nettle.

Combinations of these herbs are also available.

Medications

Domperidone is a medication used to treat acid reflux. The side effect of the drug is that it increases the hormone prolactin and thereby increases milk production. This is the major side effect of the drug. It is unusual to have other side effects with domperidone. It is minimally excreted in the milk, so the baby will not be affected by it. It is on the list American Academy of Pediatrics list of drugs thought to be safe for nursing mothers.

Domperidone is not FDA approved. It was made by Janssen Pharmaceuticals over 25 years ago along with another drug named Reglan (metoclopromide). Both of these drugs are for acid reflux and both have the side effect of increasing milk production. Reglan was put through the USA FDA approval process and is approved for acid reflux. I do not prescribe it to increase milk production because of the side effects. It can make you feel very tired and can cause depression or other central nervous system reactions. It is unusual for domperidone to do this.

A few years ago, the FDA came out with a warning to nursing mothers regarding Domperidone. It basically said that they never studied the drug and that by taking it, nursing mothers may be putting themselves and there babies at risk. They had no new data about the drug. They did quote company data from 10 years previous which stated that the intravenous form of the drug was taken off of all markets by the company because it could cause a dangerous irregular heartbeat that could lead to sudden death. The IV forms were taken off of all markets, but the oral doses were maintained on the markets. The drug is by prescription in Canada and Australia and is over the counter in most European countries, Central and South America and New Zealand.

If you do decide to use domperidone, you should be monitored by a doctor. Domperidone is not a miracle drug. It works slowly to increase milk production. For most mothers, it takes one to two weeks to start to see a small increase in the milk. Then, each week, the milk production will continue to increase. For most women, after 8 to 10 weeks, the production will plateau. At this time, I recommend going off of the drug slowly, over a 2 to 3 week period. As long as the milk is being removed on a timely basis, the milk production will stay up without having to be on the drug. If the production has reached the desired level before the 8 weeks, of course you would wean off of the drug at that time.