Maintaining or increasing your milk supply
How to tell you have enough milk:
  • You have enough milk if your baby is getting enough! Here is how to tell if a baby is getting enough milk.
    WARNING! These tests work only if your baby is exclusively breastfed. If you give your baby supplements, including water, some of these tests won't tell you whether your baby is getting enough food. As supplements cause your milk supply to decrease, it's best to avoid them. As a bonus, you'll be able to use the tests described here to make sure your baby is thriving.
  • An exclusively breastfed baby is getting enough milk if:
    1. She or he has at least six very wet diapers a day. You should use cloth diapers when you conduct this test, as it's often hard to tell whether a disposable diaper with super-absorbent filling is wet or not. If you insist on using a disposable, put a piece of tissue inside it, and check if the tissue is wet.
      • A diaper with a yellowish wet spot the size of a quarter does not count as a wet one.
      • A wet diaper is one that's thoroughly wet. It should be heavy. When you touch it, it should feel wet.
      • Your baby's urine should be colorless or very pale yellow. Bright yellow indicates concentrated urine, which occurs if the baby is not getting enough to drink.
    2. She or he is energetic. If your baby is lethargic or too tired to cry or feed properly, call your doctor immediately.
    3. She or he is properly hydrated and plump.
      • The front fontanel (soft spot) should be convex (curving out) when your baby is crying, and only slightly concave (curving in) at other times. If it dips seriously, your baby might be dehydrated. Call your doctor.
      • Your baby should have dimples at her or his knuckles and elbows. This is enough to qualify your baby as officially plump. You can forget about the baby weight charts and those roly-poly fat babies you see in pictures.
      • Your baby's skin should be nice and tight. When you grab the skin on her or his tummy, you should get a nice thick fold, which indicates that your baby has enough puppy fat. If the skin is loose and looks dry, your baby is probably undernourished. See your doctor.
    4. Your baby is gaining weight at a satisfactory rate. You can go to the hospital between doctor's appointments and have the nurses weigh your baby for you. Don't worry about the percentile position of your baby on the weight chart. However, if your baby's percentile weight drops drastically from one weighing to the next, you might want to call your doctor just to make sure.
    5. Your baby shows signs of eating well at the breast.
      • She or he latches on correctly.
      • You can hear her or him swallow. Even better, you can look for a suck-pause-suck pattern. The pause indicates that your baby's mouth is filled with milk and she or he is swallowing the milk before resuming sucking.
      • Your breasts feel full before feeding and soft after feeding.
      • You feed your baby on demand, and no less than eight times a day.
      • Your baby doesn't go longer than four hours between feeds. If your baby is gaining weight rapidly and you are sure your milk supply is well established, you can let your baby sleep longer at night. Until then, however, your baby should nurse several times during the night. The easiest way to assure this is to sleep with your baby. If she or he does not wake up spontaneously, you should wake her or him up once or twice in the night, and more often during the day.
    6. Your baby nurses happily most of the time. It's expected that a baby will have fussy periods at certain times of the day (usually in the evening). But if your baby always fusses at the breast and nursing never satisfies her or him, there may be a problem. The problem may be that your baby isn't getting enough milk. However, it might also be that you have too much milk and a hyperactive letdown reflex. Or your baby may be reacting to something in the milk. If your baby regularly fusses at the breast, call a lactation consultant to assess the situation. She or he will tell you to call your doctor if necessary.

How to maintain your milk supply.
If your baby is doing well on your milk, you'll be happy. However, you'll need to make sure you maintain your good milk supply. Here is how:
  • Perform natural breastfeeding:
    • Feed on demand: nurse your baby every time she or he wants to, for as long as she or he wants to. Hide away all the clocks if necessary. Banish the phrase "she (or he) can't possibly be hungry." So what if you nursed your baby five minutes ago? If she or he wants to, nurse her or him ago. And don't worry. Nursing often and long will not cause sore nipples. Those are caused by improper latch-on.
    • In addition to feeding your baby whenever she or he wants it, feed her or him whenever you want or need to.
      • When your breasts begin to feel engorged.
      • When your milk starts leaking.
      • When you just feel like cuddling and nursing.
  • Make sure your baby is nursing at least eight times a day. If necessary, wake her or him up to nurse. If your baby is too sleepy or tired to nurse, see the page on nursing a sleepy baby.
  • If necessary, pump to provide extra milk and stimulate your breasts to produce more. This may be necessary if your baby is sick and can't nurse well for a while, or if you have to be away from your baby for a few hours.
  • Make sure you are eating and drinking enough. Let hunger and thirst be your guide. You don't need anything beyond a regular well-balanced diet that includes a variety of good food. You don't have to drink any specific amount of fluids, though you will need to drink more than usual. Most women drink about eight glasses of fluids a day, but if you make sure you drink every time you feel thirsty, you don't need to count glasses.
  • Try to get as much rest as you possibly can. Forget about cleaning the refrigerator, cooking a gourmet dinner, and so on. If anyone offers help, jump on it. Forget about politeness and deference. You need all the help you can get.
  • Don't take birth-control pills. Although most women produce enough milk on the mini-pill, it's possible that some experience decreased milk production. Try other methods of birth control.
  • Don't smoke. Smoking not only reduces your milk supply, but also increasing the risk of SIDS, asthma, cancer, and other diseases for your child.
  • Don't drink more than one alcoholic drink a day. Alcohol not only passes to your milk and can harm your baby, it is also dehydrating and can adversely affect your milk supply.
  • For the same reason, it's best not to have more than two or three cups of coffee a day (or equivalent amounts of tea, chocolate, etc.).

How to increase your milk supply.
If you don't seem to have enough milk, don't give up breastfeeding. You can increase your milk supply. Here is how: 
  • First, see your doctor. If your doctor recommends supplementation (with formula), call a lactation consultant. Chances are you can increase your milk supply fast enough that you don't need to use any formula. You can trust a certified lactation consultant's judgment better than a pediatrician's; medical professional do not receive much of a training in lactation.
  • If you have to supplement for a while, always breastfeed first. Pump some milk after each breastfeed. Use this pumped milk for supplementation. If you still need more, you can use formula. Use just as much as your baby wants. Don't force her or him to have any more. You'll only be delaying the next feeding and slowing down the increase in your milk supply.
  • Try to pump a few extra times too, just to stimulate your breasts to make more milk.
  • If you possibly can, take a couple of days off, and just lounge around with your baby, nursing as much as you can.
  • Try to follow the recommendations for maintaining your milk supply.
  • Depending on how low your milk supply was to begin with, how long this situation has been going on, how well your baby is doing, how often you are managing to nurse and pump, you will usually establish a great milk supply in two to ten days.
  • Continue to follow the recommendations for maintaining your milk supply. Enjoy your nursing relationship and be proud of the hard work you have put in. It's definitely worth it. Your reward is a healthier and happier baby.
  • If you give up and switch to bottle-feeding, don't feel bad. Whatever breastmilk you have been able to give your baby has been beneficial. Bottle-feeding does not preclude good parenting. The fact that you have tried to increase your milk supply shows that you are a committed parent. See the page on making the best of bottle-feeding.
 

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