A common concern mothers have is building adequate breastmilk supply. As breastfeeding advocates, we must ensure that mothers receive proper education and support.

It is important to distinguish between building and maintaining supply. To stimulate the initial milk supply, exclusive breastfeeding 8-12 times daily should support the milk demand of the baby. It is recommended that mothers exclusively breastfeed for the first 4-6 weeks. After this time pumping can be incorporated into a nursing routine dependent on the baby’s needs and milk supply. Another common concern is maintaining an established supply. Mothers should continue emptying breasts 8-12 times daily if nursing, or 8-10 times daily with a hospital grade dual electric breast pump if bottle feeding expressed breastmilk. If she is nursing and separated from baby it’s recommended she pump every three hours.

Mothers run into challenges including over-supply due to nursing and pumping from the start. This is not recommended as it may cause oversupply, stasis, clogged ducts and/or mastitis. Furthermore, mothers should be educated about pumps that fit their lifestyle. Although no pump imitates a baby perfectly, it is an excellent alternative when separated from baby or when supplementing nursing with pumped milk. Hand expression is underutilized but another great way to obtain breastmilk. Mothers may opt to spoon or syringe feed with hand expressed or pumped breastmilk until breastfeeding is well established. Hand expression for 3-5 minutes after nursing/pumping can increase supply if low supply is a concern.

Mothers may want to try galactagogues to increase and/or maintain milk supply. Studies do not always prove efficacy and some methods can be harmful, therefore she should be directed to discuss potential safe options with her healthcare provider. Additionally, the importance of consistently stimulating and emptying breasts should be reinforced since emptied breasts make more milk!

Lastly, mothers should be encouraged to attend prenatal breastfeeding classes, seek lactation consultation, and attend lactation support groups. This is optimal for informed decision-making and meeting the mother’s breastfeeding goals.

Jennifer L. Giordano is a lactation consultant for the BFREE team and Peds First Pediatrics and the owner and director of Latch with Love, Inc.

Angie Lee is an associate program coordinator for the BFREE team and research assistant at Cohen Children’s Medical Center.