120 East 56th Street Suite 330

New York, NY 10022

  212.920.3047

Supply

Breasts function individually and together, like milk making factories. So, when you are asked, “How is your supply?” it is actually a pretty complicated question. Ironically, the first two weeks of nursing, which are usually the most challenging, are also the most critical for laying the groundwork for your supply. After the first month, your supply is mostly set. It is possible to increase your supply after that, but it is difficult and limited. Regular, efficient emptying and non painful latching are key factors.

When considering your potential milk supply, two variables are constantly in play: your breast’s ability to produce milk and your baby’s ability to transfer it out efficiently. These two forces must act in sync to sustain your supply for as long as you want to breastfeed. Even if you have the capacity to produce ample milk, if (you or) your baby does not remove it effectively and efficiently, you can lose your supply or never develop it in the first place.

In terms of milk supply, there are a number of parameters to consider:

  1. Capacity – how much each breast is actually able to make and store at a given point in time. Breasts are made up of glandular, or milk making, tissue and fatty tissue. The ratio of each is specific to each individual mother, and breast size does not reflect milk making capacity. Unfortunately we  don’t have an effective, scientific way to see determine how much milk a particular breast can make, so we are left with guesses.
  2. Production rate – how quickly your breasts make milk. This depends on:
    •  quick breast emptying in around 10 minutes. Anything more than that is a waste of time.
    • complete breast emptying to remove Feedback Inhibitor of Lactation (FIL). FIL is a hormone produced by the breast that prevents milk production when high enough concentrations collect. It is meant to safeguard against engorgement.
    • allowing at least two hours for your breasts to fill up again
  3. Milk flow – how fast milk comes out of your breasts. This depends on how much milk your breasts can store at any given time. Most of the time, your breasts have more milk than than your baby needs.
  4. Letdown reflex – how much milk your breast squeezes out around 45 seconds after your baby starts sucking, when oxytocin is released. Usually half of your stored supply is pushed out with the first letdown, and there can be several letdowns in each nursing period.

NOTE: Not even the best pump can pull out as much milk as an appropriately latched and nursing baby. So if you are struggling with supply issues and only able to use the pump, there is probably a lot more milk left in there than you realize.

Oversupply

While the focus of most breastfeeding interventions is to prevent a low milk supply, it well known that some mothers make a lot of milk. In fact, some women produce such huge amounts of milk that the recommended patterns of milk removal don’t apply. If you are one of these women, you will produce milk almost no matter what your baby does. You will also have a greater likelihood of engorgement, plugged ducts and mastitis if you aren’t adept at managing your supply.

No one knows why oversupply happens, whether it is due to more glandular tissue or the way your hormones are regulated (or both). In fact, there is no real objective definition for oversupply. No one even knows how prevalent it is. Yet, it is described and discussed with defined symptoms and treatments based on one paper written by a Canadian physician in 1996.

Dr. Livingstone reported on his clinical experience working with 8,000 breastfeeding families. He described overproducers as women who produced more than 60 ml/hr of breast milk. In his practice, he noted an incidence of 15% and coined the diagnosis, Maternal Hyperlactation Syndrome. Many mothers with a large supply had more problems with milk stasis, mastitis, plugged ducts, and breast abscess. He also noted that their infants experienced excessive colic, frequent and rapid feedings, choking and coughing at the breast, diarrhea, and sometimes weight loss, despite the excess supply.

However, not every mother with an oversupply suffers from these issues and neither does her baby. It is more likely that Maternal Hyperlactation syndrome is just another outcome of restricted infant gape. But since mothers are producing so much milk, the manifestation is different.

If you have an oversupply, your excess milk can mask issues your baby is having with the latch because they may still gain weight despite all the struggles. In these cases, it is important to be aware of the experience of nursing, not just your baby’s weight gain.