Breast Milk: Facts, Tips and Supply

madeleinerowat
Sep 7
9 min read

Breastfeeding is a natural and vital process that offers incredible benefits for both mothers and infants. With over 1.5 million lives saved yearly due to breastfeeding-related health advantages, understanding the facts about breast milk, its unique composition, and ways to maintain a steady supply is essential for new mothers during their postpartum journey. This post will hopefully provide important information and practical tips for breastfeeding, helping mothers navigate this significant phase of motherhood.

In this post we will discuss colostrum, beginning lactating, inducing lactation, addressing supply concerns. I also want to preface this blog for everyone - choosing to breastfeed or to formula/donation milk feed is your complete decision! Do not ever feel guilty for choosing one method over another. And most of all do not feel guilty if you tried and it did not work how you planned. In modern times we have such amazing options for all parents.

The Composition of Breast Milk & Facts

Breast milk is often called "liquid gold" because it contains the perfect blend of nutrients that are crucial for a baby's growth and development. For example, it includes:

Carbohydrates: Mainly in the form of lactose, which provides energy and boosts calcium absorption, vital for bone health.
Proteins: Containing about 60-70% whey protein, which is easier to digest compared to cow's milk. This helps support a baby's immune system by providing necessary antibodies.
Fats: These are essential for brain development, with about 50% of breast milk's caloric content coming from fat.
20 calories per ounce approximately.
Producing breastmilk can burn up to 25% of your body's energy!
The right breast often produces more milk than the left, even if you are a lefty.

Breast milk is also adaptable. For instance, colostrum, the thick, yellowish first milk produced after birth, is rich in antibodies. Over the first few weeks, the milk's composition evolves to meet the baby's growing nutritional needs. With only a few teaspoons worth of colostrum you can protect your baby from E. coli and RSV.

Close-up view of a bottle filled with breast milk — A bottle filled with breast milk, showcasing its creamy texture.

Benefits of Breastfeeding

Breastfeeding provides many advantages for both mothers and infants. For babies, it is the ideal source of nutrition that promotes healthy growth. Studies show breastfed infants have:

Lower risk of obesity and diabetes later in life. Research indicates that breastfeeding can reduce obesity rates by 15-30%.
Fewer allergies and infections, which is attributed to the antibodies present in breast milk.
It adapts to illness in real-time: If you or your baby gets sick, breast milk ramps up specific antibodies and white blood cells within 20 minutes of exposure. For example, if baby has a cold, saliva backwash during nursing signals your body to produce targeted immune cells (like leukocytes) that pass back to baby, helping fight the exact bug. This "spit backwash" phenomenon can spike immune factors by up to 90% during infection.
Day vs. night milk for sleep cycles: Evening breast milk has higher levels of melatonin, tryptophan, and serotonin precursors to promote sleep—helping baby (and you) wind down. Daytime milk spikes with energizing nucleotides and amino acids for alertness. Studies show breastfed babies sleep 40–45 minutes longer per night on average in the first three months.
MicroRNAs and epigenetics: Tiny RNA molecules in milk influence baby's gene expression, potentially programming metabolism, immunity, and even brain development long-term. Preterm milk has unique profiles with more sodium, protein, and IgA for fragile babies, reducing NEC risk by 80%.

For mothers, breastfeeding can support postpartum recovery. It helps in uterine contraction, reducing the risk of postpartum hemorrhage, and it can burn around 500 calories a day, potentially aiding in weight loss. Furthermore, breastfeeding fosters a unique bond between mother and child, enhancing emotional connection.

Tips for Successful Breastfeeding

To make your breastfeeding journey successful, keep these strategies in mind:

Start Early: Initiate breastfeeding within the first hour after birth. Research shows early initiation can significantly increase milk supply. If you wish to, you can even express colostrum starting 37 weeks onwards in pregnancy. Saving syringes of colostrum for after delivery if you wish.
Ensure Proper Latch: A good latch is crucial. Make sure that your baby's mouth covers not just the nipple but a good portion of the areola to avoid nipple pain and ensure adequate milk intake.
Feed on Demand: Allow your baby to feed as often as they show signs of hunger. Feeding frequently, around 8-12 times a day, helps regulate milk supply.
Stay Hydrated and Nourished: Consume plenty of fluids and maintain a balanced diet. Water, electrolytes, bone broth. Focus on foods high in protein, healthy fats from animal based sources or nuts, veggies such as avocado.
Seek Support: Don't hesitate to reach out for help from lactation consultants, breastfeeding support groups, or healthcare providers. They can offer valuable guidance and encouragement.

How to Increase Milk Supply

If you're experiencing low milk supply, consider these effective strategies:

Frequent Nursing: The more often you nurse, the more milk your body will produce. Aim for at least 8-12 feedings in a 24-hour period to build and maintain a good supply. Aim to nurse or pump during the night - the peak milk production time is between 2-6am.
Pump Between Feedings: If your baby does not nurse effectively, pumping can stimulate milk production and help you build a milk stash.
Skin-to-Skin Contact: Spend time holding your baby against your skin. This contact can enhance bonding and stimulate milk production.
Consider Herbal Supplements: Many mothers find that herbal supplements like fenugreek or blessed thistle help increase milk supply. Ensure you consult a healthcare provider before starting any new supplements. For medical intervention, there is domperidone.
Limit Pacifier Use: Avoiding pacifiers in the early weeks encourages your baby to nurse more, which can help increase milk production.

Common Challenges in Breastfeeding

While breastfeeding is natural, it can come with challenges. Some common issues include:

Nipple Pain: This can arise from an improper latch or sensitivity. Make sure your latch is correct and consider using nipple creams to alleviate discomfort.
Engorgement: When breasts become overly full, frequent nursing or pumping can relieve this pressure.
Low Milk Supply: Address this through regular nursing sessions and adequate hydration.
Mastitis: An infection of breast tissue can cause pain and flu-like symptoms. Prompt medical attention is important if you suspect mastitis.

Inducing Lactation

Inducing lactation is the process of stimulating breast milk production in someone who hasn't gone through pregnancy and childbirth or perhaps someone who previously lactated but has not for many months or years. This is commonly done by adoptive parents, non-gestational parents in surrogacy situations, or LGBTQIA+ individuals (such as transgender women or nonbinary people) who want to breastfeed.

It's possible through hormonal simulation, pumping, and sometimes medications or supplements, but success varies—some achieve a full milk supply, while others produce partial amounts and may need to supplement with donor milk or formula using tools like a supplemental nursing system (SNS). Always consult a healthcare provider, such as a doctor or International Board Certified Lactation Consultant (IBCLC), before starting, as this involves medications with potential risks and should be tailored to your health history.

Common Protocols for Inducing Lactation

The most established method is the Newman-Goldfarb Protocol, developed by Dr. Jack Newman and Lenore Goldfarb to mimic pregnancy hormones and prepare the breasts for milk production. There are three main versions based on your timeline and circumstances: Regular (for 6+ months prep), Accelerated (for shorter timeframes), and Menopausal (for those post-menopause or without reproductive organs). These involve a combination of hormonal prep, pumping, and galactagogues (milk-boosting substances).

Regular Protocol (Ideal for Long Lead Time, e.g., Planned Adoption or Surrogacy)

This aims for a substantial milk supply and is best started 6 months or more before the baby's arrival.

Step 1 (Months 1–5 before due date): Take an "active" combined birth control pill (BCP) daily (e.g., Ortho 1/35 or Microgestin, with at least 1 mg progesterone and no more than 0.035 mg estrogen; skip placebo pills for continuous use). Pair with domperidone: Start at 10 mg four times a day for 1 week, then increase to 20 mg four times a day. This simulates pregnancy hormones to develop breast tissue. No pumping or herbs yet.
Step 2 (6 weeks before due date): Stop the BCP (expect possible withdrawal bleeding; rule out pregnancy if fertile). Continue domperidone at 20 mg four times a day. Begin pumping with a hospital-grade double electric pump every 3 hours (including once at night between 1–5 a.m. when prolactin peaks): Pump 5–7 minutes on low/medium, massage/stroke/shake breasts, then pump another 5–7 minutes. Add supplements: 3 capsules each of fenugreek (610 mg/capsule) and blessed thistle (390 mg/capsule) three times a day with meals.
Step 3 (1 month before due date): Maintain pumping, domperidone, and herbs. Focus on diet: Eat oatmeal 3+ times/week and drink 6–8 glasses of water daily; avoid caffeine.
Step 4 (After baby arrives): Breastfeed on demand (10–16 times/24 hours for newborns). Pump 10 minutes after each feed to build supply. Continue domperidone and herbs until supply is established (may taper domperidone slowly later). Use skin-to-skin contact and an SNS if needed for supplementation while nursing.

Accelerated Protocol (For Limited Time, e.g., 1–3 Months or Post-Arrival)

This is for shorter prep or if the baby arrives unexpectedly; milk yield may be lower.

Step 1 (30–60 days prep): Take BCP daily (as above) plus domperidone at 20 mg four times a day until breasts show significant changes (e.g., 1+ cup size increase, fullness/pain indicating glandular growth).
Step 2: Stop BCP, continue domperidone, and start pumping every 3 hours (same routine as above, plus nighttime). Add fenugreek and blessed thistle (same doses).
Step 3 (If <4 weeks or baby already here): Start BCP and domperidone immediately (expect fatigue). After 30 days and breast changes, shift to pumping/herbs phase.
Post-arrival: Same as Regular—feed on demand, pump after, maintain supports.

Menopausal Protocol

Similar to Accelerated but adjusted for those without a uterus/ovaries (natural or surgical menopause). It uses the same BCP + domperidone combo for 30–60 days, then pumping/herbs. Hormonal prep may take longer due to lower baseline estrogen/progesterone.

For LGBTQIA+ individuals, protocols are similar but may involve higher doses of estradiol (up to 12 mg) and progesterone (up to 400 mg) for trans women to mimic pregnancy, combined with domperidone and pumping. Mechanical stimulation (e.g., TENS units) or herbal-only approaches can be options if hormones aren't suitable.

Medications and Supplements Needed

No drugs are FDA-approved specifically for inducing lactation, so these are used off-label. Work with a provider for prescriptions and monitoring.

Medications

Birth Control Pills (e.g., Ortho 1/35): Used initially to elevate estrogen/progesterone. Continuous active pills only. Side effects: Nausea, weight gain, mood changes; avoid if history of blood clots.
Domperidone (Motilium): Primary galactagogue; increases prolactin. Dose: 20 mg four times a day (or 10–30 mg three to four times daily). Not available in the US (FDA warning on cardiac risks like QT prolongation/arrhythmias, especially with heart issues); source from Canada (e.g., via pharmacies like Murray Shore). Side effects: Headache, dry mouth, cramps; rare cardiac issues. Safest option (L1 lactation risk).
Metoclopramide (Reglan): Alternative to domperidone; 10 mg three times a day. Higher risk of depression, anxiety, tardive dyskinesia (avoid >12 weeks or if mental health history). Not ideal for induced lactation due to emotional toll.

Supplements (Herbal Galactagogues)

These are over-the-counter; evidence is mixed but commonly used.

Fenugreek: 610 mg/capsule, 3 capsules three times a day. May cause maple-syrup smell in sweat/urine; avoid if peanut allergy.
Blessed Thistle: 390 mg/capsule, same dose as fenugreek.
Others: Goat's rue, fennel, shatavari, milk thistle, or malunggay. Start after pumping begins; monitor for GI upset.

Additional Tips and Warnings

Pumping Essentials: Use a high-quality double pump. Sessions: 15–20 minutes total, 8–12 times/day initially. Combine with hand expression/massage for better results.
Timeline and Expectations: Milk may start as drops, building over weeks. Full supply isn't guaranteed (e.g., 50–100% possible); track with weighed feeds via IBCLC.
Lifestyle: Prioritize rest, nutrition (e.g., oatmeal boosts supply), hydration, and support networks. Emotional prep is key—it's empowering but demanding.
Warnings: Meds can have serious side effects (e.g., cardiac with domperidone, depression with metoclopramide); get EKG if at risk. Not suitable for everyone (e.g., avoid hormones if cancer history). Induced lactation doesn't work for all; focus on bonding over quantity.

Embracing the Breastfeeding Journey

Breastfeeding is a meaningful experience that provides essential nutrition for infants while creating a strong bond between mother and child. By understanding the facts about breast milk, recognizing the benefits of breastfeeding, and applying practical tips to ensure a steady supply, mothers can feel empowered in their postpartum journey.

Every breastfeeding experience is unique, and facing challenges can lead to growth and stronger connections. Remember, seeking support can make a significant difference in successfully navigating this beautiful experience.

If you have been following all the tips and tricks above but still feel like you aren't able to produce enough breastmilk - please know you are not alone! It is very common for women to not produce enough or share donated milk or use formula. Do not beat yourself up if this is not working out as seamlessly as you hoped. I recommend assessing your supplement dosages, DOM dosages or nutrional intake as well. Seeking help from a lactation consultant or your doctor could be beneficial - have your thyroid, hormone panels and other labs completed in case there is other medical needs at play.