Increasing Breast Milk Production

Breast milk production is a physiological process, and it can look very different from one breastfeeding or expressing journey to another. Some caregivers want to increase their milk production because their baby is feeding frequently, while others may be expressing because their baby cannot currently breastfeed directly, they are separated from their baby, their baby is unwell or they simply want to have more milk available. There is no single reason for wanting to increase milk production, and there is no single approach that works for everyone.

Understanding how milk production works can make it easier to work out what might be happening when milk production feels lower than expected. It can also help to separate the physiology of milk production from the pressure to produce a particular volume.

Breast milk production is a physiological process

Milk production begins during pregnancy. During the first stage of lactation, known as lactogenesis I, the breasts develop the capacity to produce colostrum. After the placenta is delivered, hormonal changes allow lactogenesis II to begin, often described as milk "coming in". Prolactin has an important role in milk synthesis, while oxytocin helps the milk-ejection reflex that moves milk towards the nipple (Neville and Morton, 2001; Wambach and Riordan, 2021).

The timing and experience of this transition can vary. Prematurity, significant blood loss, retained placental tissue and some maternal health conditions can affect the establishment of lactation. Birth by caesarean section or other interventions do not automatically prevent breastfeeding or mean that milk production will be poor. The wider picture matters, including hormonal health, breast development, previous breast surgery, feeding or expressing patterns and how effectively milk is being removed.

This is why milk production is not simply a matter of "trying harder". It is a physiological process involving hormones, breast tissue, milk removal and the individual circumstances of the breastfeeding or expressing caregiver.

Milk production and milk removal: use it or lose it

Once established, milk production is strongly influenced by milk removal. When milk is removed from the breast, the breast receives a signal that milk is being used and that continued production is needed. When milk remains in the breast for longer periods, local mechanisms can slow the rate of milk synthesis (Wilde et al., 1995; Knight, Peaker and Wilde, 1998).

This is where the familiar "use it or lose it" idea comes from. It does not mean that every feed needs to be followed by another feed or that a caregiver should spend their entire day expressing. It means that regular, effective milk removal helps maintain the physiological signal for ongoing milk production.

Milk removal can happen through breastfeeding, expressing or a combination of both. If a baby is unable to remove milk effectively, or if a caregiver is separated from their baby, expressing can provide an important alternative way of maintaining that stimulation.

Softer breasts after 4–6 weeks are a good thing

One of the most common worries about milk production is the change that can happen during the first few weeks. Early on, breasts can feel very full, heavy or leaky, particularly as milk production is becoming established. Around four to six weeks, many caregivers notice that their breasts feel softer and that they no longer leak as much. That change does not necessarily mean that milk production has decreased.

As lactation becomes more established, regulation becomes increasingly local to the breast. Milk that remains in the breast can provide signals that slow further synthesis, whereas effective milk removal signals that more milk is required (Wilde et al., 1995; Knight, Peaker and Wilde, 1998).

In other words, softer breasts can be a sign that milk production has become more closely matched to what is being removed. Soft boobs can be good boobs.

Can expressing too much in the early weeks cause oversupply?

More milk is not always better. In the early weeks, repeatedly adding extra expressing on top of what the baby is already removing can increase milk production beyond what the feeding dyad needs. For some caregivers, this can contribute to hyperlactation, which may bring its own difficulties, including breast fullness, leaking, forceful milk ejection and recurrent inflammation (Johnson et al., 2020).

This does not mean that early expressing is harmful or unnecessary. Expressing may be essential when a baby is premature, unwell, unable to breastfeed effectively or separated from their caregiver. It may also be part of an individual feeding plan for many other reasons.

The important point is that expressing should have a purpose. Increasing milk production should not automatically mean adding more and more expressing sessions without considering what the breastfeeding or expressing caregiver and baby actually need.

A forceful let-down on its own does not necessarily mean hyperlactation, either. Milk ejection can be powerful in people with a range of milk production levels.

Ineffective milk removal needs attention

If milk is not being removed effectively, simply increasing pump suction or expressing more often is not always the answer. When milk removal is poor, breasts can become increasingly full and uncomfortable, and persistent inflammation can develop. This can contribute to the mastitis spectrum, including inflammatory mastitis and, in some circumstances, breast abscess (Mitchell et al., 2022).

Pain, swelling, redness, heat, a persistent tender area, fever or flu-like symptoms should not simply be managed by trying to remove more and more milk. Significant or worsening symptoms need appropriate clinical assessment, particularly if they are not improving.

The same principle applies to breastfeeding. If a baby is struggling to remove milk effectively, it is worth looking at why rather than assuming that the solution is simply more frequent feeding.

How a baby removes milk from the breast

Effective breastfeeding is not simply about a baby attaching to the nipple. A baby needs to take a substantial amount of breast tissue into their mouth, with the nipple drawn towards the junction of the hard and soft palate. This allows the tongue and jaw to work together to create the movements and pressure changes needed for milk removal.

"Nipple feeding" can therefore be quite different from effective breastfeeding. If a baby attaches primarily to the nipple rather than taking sufficient breast tissue into the mouth, milk removal may be less effective and the nipple can become compressed or distorted. This can contribute to soreness, pain and nipple trauma, including broken skin.

A comfortable, deep attachment is therefore about much more than preventing sore nipples. It is part of the mechanics of effective milk removal.

Breastfeeding involves suction and vacuum

Breastfeeding involves coordinated tongue, jaw and oral movements, together with changes in intraoral pressure. Research using ultrasound and vacuum measurements has demonstrated that babies use complex tongue movements and vacuum during breastfeeding to help remove milk from the breast (Geddes et al., 2008; Geddes et al., 2012; Geddes et al., 2016).

This is one reason why a baby who appears to be "sucking" is not necessarily removing milk effectively. A baby can make sucking movements without achieving the coordinated attachment, tongue movement and pressure changes needed for efficient milk transfer.

The quality of milk removal matters more than simply counting how often a baby is at the breast.

Breastfeeding and swallowing

Swallowing is also a coordinated physiological process. It is commonly described in four broad phases: oral preparatory, oral, pharyngeal and oesophageal. These phases involve different structures and functions as milk moves from the mouth through the pharynx and into the oesophagus.

The negative pressure or vacuum generated during sucking is part of the milk-removal process rather than one of the four swallowing phases. Sucking, milk removal and swallowing work together, but they are not the same thing.

A baby may therefore need assessment of the whole feeding process rather than simply being described as a "good" or "poor" sucker.

A small pumping volume does not necessarily mean low milk production

The amount collected in a pump bottle is only one piece of information. It is not a direct measurement of how much milk a breast is capable of producing.

Pumping is a skill, and milk ejection can be affected by many things, including flange fit, pump type, pump settings, timing of the expressing session, when milk was last removed, breast fullness, oxytocin release, comfort, stress and familiarity with the pump. Some people also respond much more easily to a baby than to a pump.

The priority is effective breast stimulation and milk removal rather than chasing a number on the collection bottle. A small expressed volume can still represent useful stimulation, and a larger expressed volume does not automatically tell us that milk production is "better".

There is also variation in milk composition during milk removal. Fat concentration tends to increase as the breast becomes progressively emptied, meaning that a single expressed sample does not necessarily represent the composition of all the milk available in the breast (Daly et al., 1993). This is another reason not to judge the quality or adequacy of milk production from one bottle alone.

For more information about expressing, see Expressing breast milk and Breast pump flange fitting: size, shape, comfort and milk removal.

Increasing milk production through milk removal

When milk production genuinely needs to increase, the physiological principle is relatively straightforward: the breasts need an effective signal that more milk is required.

That signal can come from a baby feeding effectively at the breast, expressing after or between feeds, or expressing instead of a breastfeed when the baby is unable to feed directly. The appropriate approach depends on why milk production needs to increase in the first place.

This is why a proper feeding assessment is usually more useful than simply being given a list of things to eat, drink or buy. The question is not only "How often is the baby feeding?" but also "How effectively is milk being removed?"

When someone else feeds the baby

Having another caregiver give a bottle of expressed milk can be a really important part of family life. It can allow a partner, father or another caregiver to take part in feeding, and it can be particularly helpful when a breastfeeding caregiver needs rest, has to return to work or study, or simply wants someone else to feed the baby.

At the same time, if a breastfeed is regularly replaced by a bottle and the lactating caregiver wants to maintain the same level of milk production, the milk that would otherwise have been removed from the breast may need to be replaced by expressing.

This is not because bottles are inherently a problem. It is because the breasts respond to milk removal. If breastfeeds are replaced without another form of milk removal, the body may receive a reduced signal that milk is needed. Over time, this can contribute to a reduction in milk production for some people.

The practical workload therefore remains with the lactating caregiver if maintaining milk production is the goal. That is worth recognising when families are planning how feeding will work day to day.

Protecting the caregiver's health matters too

Milk production does not happen in isolation from the person producing the milk. Recovery from birth, sleep deprivation, pain, illness, work, study, caring for other children and the practical demands of expressing can all affect how sustainable a feeding plan feels.

Support does not have to mean telling someone to "rest more" when they have a baby who needs feeding and a life that still has to happen around them. Practical support can make a much bigger difference.

A large bottle of water within easy reach can be useful for the breastfeeding or expressing caregiver, alongside easy snacks and meals that do not require much preparation. Keeping expressing equipment, muslins, tissues, a phone and charger close by can reduce the amount of getting up and down. Someone else might take responsibility for school runs, older children, shopping, cooking, laundry, cleaning, appointments or washing expressing equipment.

Sometimes the most helpful support is simply reducing the number of things that the caregiver is expected to manage while feeding their baby.

Rest is part of the feeding plan

There is a temptation to think that everything else should continue as normal after a baby arrives, with feeding somehow fitted around it. For some families that works. For others, particularly during the early weeks or when expressing is intensive, reducing outside demands for a while can make feeding more manageable.

A "babymoon" period, accepting fewer visitors, asking other people to bring food rather than expecting the caregiver to provide hospitality, or temporarily lowering household expectations can all create more space for feeding and recovery.

Skin-to-skin contact can also be a useful part of the feeding relationship and may support oxytocin release and milk ejection. Babywearing or using a sling can allow some caregivers to stay close to their baby while having their hands available for other tasks, provided the baby is positioned safely and the relevant sling safety guidance is followed.

The house does not need to be perfect. Feeding the baby and looking after the person doing the feeding are more important than keeping everything else running exactly as it did before.

Feeding the baby is the priority

When milk production is lower than expected, it can be easy to become focused on increasing supply while forgetting that the immediate priority is making sure the baby is adequately fed.

If supplementation is clinically indicated, it does not mean that breastfeeding goals have to be abandoned. Depending on the circumstances, expressed breast milk, donor human milk or infant formula may all have a role while the underlying feeding issue is being assessed and supported.

A feeding plan can therefore hold two things at the same time: making sure the baby receives enough milk now, while also protecting and supporting the breastfeeding or expressing relationship for the future.

Begin with a feeding and health assessment

Before trying to increase milk production, it is useful to understand when the concern began and what has been happening around feeding.

This might include the birth history, significant blood loss, retained placental tissue, previous breast surgery, thyroid or other health conditions where relevant, separation from the baby, the baby's gestation and age, weight trajectory, feeding history and any previous supplementation or expressing.

A feeding observation can also provide valuable information. Looking at positioning, attachment, comfort, swallowing, pauses, milk flow, breast softening and the baby's behaviour during and after feeding can help identify whether milk is being removed effectively.

The baby's overall health matters too. A baby who is difficult to wake for feeds, increasingly sleepy or unwell, developing worsening jaundice, having fewer wet nappies or not gaining weight as expected needs prompt assessment.

The aim is not to find someone to blame. It is to understand what is happening so that the feeding plan can be adjusted appropriately.

When milk transfer needs closer attention

Painful feeding, clicking, slipping off the breast, repeated loss of suction, very long feeds, frequent feeding without signs of effective milk transfer or concerns about weight gain can all be reasons to look more closely at feeding.

There can be many possible explanations. Positioning and attachment, milk flow, oral function, prematurity, illness, fatigue, neurological or developmental factors and other health issues can all affect feeding.

A restrictive lingual frenulum can sometimes be one factor, but its presence alone does not establish that it is causing a feeding problem or that a procedure is required. Assessment needs to consider the whole feeding dyad and the baby's function rather than focusing on anatomy in isolation.

Anatomy provides information. Function provides context.

The tongue does not function in isolation, and conservative feeding support can be appropriate. If a frenulotomy is being considered, families should be given balanced information about the potential benefits, limitations, alternatives and risks so that they can make an informed decision based on their individual circumstances.

Foods, drinks and galactagogues

There is a huge amount of advice online about foods and drinks that are supposed to increase milk production. Some foods may be comforting, culturally important or simply enjoyable, but there is not good evidence that drinking excessive amounts of water, eating special biscuits or following restrictive diets reliably increases milk production.

Drinking according to thirst and eating nourishing, varied meals is generally more useful than trying to follow a special milk-making diet.

Galactagogues are another area where the evidence needs to be handled carefully. Some caregivers may not be able to produce or remove the volume of milk they would ideally like, despite doing everything they can within the realities of their lives. Work, study, caring responsibilities, separation from a baby, neonatal care and individual medical or physical circumstances can all affect what is practically possible.

Galactagogues may help some people, but they are not a substitute for assessing why milk production is lower than desired. The evidence for different agents varies, and not everyone responds. The Academy of Breastfeeding Medicine has published guidance on galactagogues, while UK prescribing guidance provides specific information about domperidone, including the need to consider underlying causes, potential contraindications, interactions and cardiac risks before it is prescribed (Brodribb, 2018; Foong et al., 2020; Specialist Pharmacy Service, 2024).

Domperidone is used off-label in the UK for low milk supply in some circumstances. It should be considered on an individual basis with an appropriate healthcare professional rather than treated as a universal solution.

Donor human milk may also be an option in some circumstances, particularly within neonatal care. Availability and eligibility vary, so families should discuss this with their clinical team or local milk bank.

When expressing becomes part of everyday life

Expressing can work very well for some caregivers and become a comfortable, familiar part of everyday life. For others, particularly when frequent expressing is needed alongside recovering from birth, caring for other children, travelling to neonatal services, working, studying or managing their own health needs, the practical workload can become demanding. Supporting milk production therefore needs to include supporting the caregiver too.

If expressing is becoming a significant part of everyday life, it can help to make the routine as comfortable and sustainable as possible. The right flange size and shape, comfortable pump settings, accessible equipment and a realistic expressing schedule can all make a difference.

It is also worth thinking about what can be removed from the rest of the day. Someone else may be able to take over meals, laundry, shopping, school runs, cleaning or caring for older children. Friends and family may be able to bring food rather than expecting a visit to be hosted. Workplaces and educational settings may be able to provide suitable time and space for expressing.

There is no prize for making an already demanding feeding plan harder than it needs to be.

Feeding support should reduce pressure, not add to it

Breastfeeding, combination feeding, exclusive expressing, donor human milk and formula feeding can all be part of a responsive feeding plan, depending on the circumstances of the baby and caregiver.

Milk production is physiological. Milk removal provides the signal. Pump yield is one piece of information, not a verdict on someone's ability to produce milk.

If milk production needs to increase, the most useful place to start is usually with understanding what is happening: how milk is being removed, how effectively the baby is feeding, whether expressing is comfortable and effective, and whether there are health or practical factors that need attention.

Supporting feeding should make things clearer and more manageable, not leave families feeling that they need another product, another target or another thing to achieve.

References

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Foong, S.C., Tan, M.L., Foong, W.C., Marasco, L.A., Ho, J.J. and Ong, J.H. (2020) ‘Oral galactagogues for increasing breast milk production in mothers of non-hospitalised term infants’, Cochrane Database of Systematic Reviews, 5, CD011505.

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