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Mum of 1

Hi! I would specifically like help with my milk supply.

My little girl is tracking perfectly against her growth curve (25th percentile) and has the right amount of wet and dirty nappies. But I definitely feel like my supply dips in the evenings. I’ve always worried about my supply and as such, I started taking fenugreek and domperidone about four to five weeks ago. I stopped domperidone about 10 days ago and my milk supply really suffered so I immediately got another prescription. But I’m told I can’t stay on it long term and my goal is to breastfeed until six months - longer if it’s going well.

My specific question is:

How should I use pumping to increase my supply in preparation for coming off domperidone? Is this the best approach and is there anything else I can do? Should I get a hospital grade pump? I do pump a bit, but it’s sporadic and I get really varied results.

First of all, are you exclusively breastfeeding? My advice on increasing milk supply is the following:

1. Have skin-to-skin with your baby as much as you can. A baby who is held by her mum is more 'alert' for feeding as they’re closer to the nipple/breast where the areola smells like amniotic fluid. Skin-to-skin also stimulates prolactin and oxytocin, both of which help your body produce and release more milk.

2. Increase breast stimulation. Breast massage helps to stimulate milk hormones and you can do it while you are under warm shower, when you are breastfeeding or when you are pumping. There are many ways to massage the breasts, but the basic principles are common to all: with your hand, apply light pressure - without rubbing on the skin - in various areas of the breast, away from the nipple and the periphery to the areola.

It is important at this stage to have stimulation in both breasts, with frequent changes from one to the other (switch feeding, which means frequent changes from one breast to the other during the same meal).

It is also important to learn the correct ways to place the baby on the breast and hold the nipple. It is useful to familiarise yourself with breastfeeding while lying down, which is often more relaxing, comfortable and enjoyable for the baby.

It’s a good idea to choose moments to put the baby to the breast that will lead to a positive experience: with the baby relaxed or in a light sleep, in a quiet room without many lights and with classical music or music you listened to during pregnancy, and in combination with skin-to-skin contact and breast massage.

It’s very important for the baby to touch your nipple even if not feeding, even at the stage when milk production is still low as you said. Non-nutritive breastfeeding where the baby just sucks is of great value for the consolidation of breastfeeding and should not be degraded. You should not be afraid if at this stage the baby does not swallow milk but sucks on the surface, licks the nipple and sleep. A necessary step for the success of breastfeeding is the familiarisation of the child with the nipple and the activation of the mother’s hormones through contact.

You can also rent automatic electric hospital breast pumps, preferably dual. You must do at least eight pumps per 24 hours, even distributed, including overnight. It is good not to have intervals longer than four hours without using the breast pump. The dual pump offers simultaneous stimulation of both breasts, which results in higher levels of prolactin in your blood and less time-consuming pumping. Each breast should be stimulated in a breast pump for at least 15-20 minutes, whether or not there is flow.

Dual-phase breastfeeding machines have been shown in research to better activate the milk reflex. The intensity in the breast pump should be such that it does not cause you discomfort or pain. I need to emphasize that in the beginning you may not produce the milk as much, but our aim is to stimulate the breast. That is why you should not worry about the quantity that comes out, which is never indicative or your production, which may initially be small. When more than 10-15ml of breast milk is pumped at a time, then store this milk in the refrigerator, add it to a container after the day’s pumping.

Increasing milk supply can take from three weeks up to six weeks. You should also avoid giving a dummy to the baby at this stage as you need to see her feeding cues and also avoid nipple confusion. Any supplements you’ve taken to increase your milk supply cannot replace the need for stimulation by the baby.

Eirini, Tinto Expert