EP Troubleshooting

If you are here, it is most likely for one of two reasons.  Either you are in physical pain, which you suspect is associated with pumping, or you believe your milk supply is low and you are trying to understand why.  Both of these concerns are common to new mamas.  I’ve explored these topics in more generally below and, where available, have provided links to posts on the topic.

For help troubleshooting issues related to milk supply, click here to jump down to that section of the page.

Troubleshooting: Pain

While you may feel discomfort or tenderness the first week or so of pumping, if you are experiencing pain in your breasts whether you are actively pumping or not, please contact your healthcare professional.  Even if you only have pain while you pump, it is still a good idea to contact your healthcare professional.  However, if your pain is occurring only while you are pumping, it’s likely an easily fixable issue!

The following is a non-exhaustive list of potential sources of pain while pumping:

• • You are pumping at too high of a level of suction
  • You are feeling discomfort from friction
  • You are not using the correct flange size
  • You are experiencing sensations associated with your let-down
  • You may have thrush
  • You may have previous nipple damage that has not yet healed
  • You have elastic nipples
  • You are experiencing nipple blanching or nipple vasospasms
  • You may be allergic to the type of plastic the breast flange is made from or the soap used to clean the flanges

For more information on any of these issues, click here.

If you are feeling any kind of pain at all times (yikes!) you should contact your healthcare professional.  Here are some conditions or complications that may result in constant physical pain or emotional pain:

• • Milk bleb
  • Nipple blister
  • Ductal Narrowing due to inflammation (commonly referred to as “plugged ducts”)
  • Mastitis
  • Breast Abscess
  • Engorgement
  • Vasospasm
  • Yeast Infection
  • Baby Blues
  • Peripartum Depression

For more information on any of these issues, click here.

Troubleshooting: Milk Issues

Three of the most common issues mamas have involving their milk is (1) little or no milk flow, (2) a perceived or actual low milk production, or (3) a desire to understand how to increase their milk supply in order to start storing milk.

Little To No Milk Flow

If you are putting on your breast pump only to find you have little or no milk flow, it may be due to one of the following reasons:

• • Your milk has not come in yet
  • You are struggling to get a let-down
  • You may not be using the correct flange size
  • You may need to massage and compress your breasts while pumping to effectively remove milk
  • Your pump parts are not connected properly
  • Your pump is not cycling as well as it used to
  • It may be time to replace your pump parts
  • Your emotional state—such as grief, anxiety, or stress—is inhibiting milk ejection

If you have an ongoing milk ejection issue that you have been unable to resolve after considering the list above, it may be worth talking to your healthcare professional about a milk ejection aid such as a synthetic oxytocin nasal spray.

For more information on your supply the first few days postpartum, click here.
For more information on let-downs, click here.
For more information on flange-sizing, click here.
For more information on pump parts and when to replace them, click here.
For more information on massaging and compressing, click here.

Low Milk Production

You may be surprised to learn that if the amount you pump is equal to the amount your baby eats, your milk supply is not considered “low.”  If that sounds like you, but you would like to encourage an increase in milk production, you may want to skim this section and read the following section on increasing milk supply.

Many things contribute to your milk supply.  The three main categories that impact your supply are:

• • Your pumping habits
  • Your health
  • Your anatomy

Your Pumping Habits

If you ever felt like you had a lot of milk at some point in your pumping journey but now produce less than what your baby eats, your low production may be attributable to the need to replace your pump parts or ineffective pumping habits.  You will want to make sure you are using the proper sized flange, pumping often, effectively, and for a sufficient amount of time.  Additionally, stress and other strong emotions can inhibit your let-downs, making it seem like you have low milk-production.

For more information on replacing pump parts, click here.
For more information on flange-sizing, click here.
For more information on how to pump, click here.
For more information on how often to pump, click here.
For more information on how long to pump, click here.
For more information on massaging and compressing, click here.
For more information on let-downs, click here.

If you noticed a dip in production prior to or around 12 weeks postpartum, it’s possible that you did not pump enough during the first few weeks postpartum to encourage the development of the prolactin receptors needed to allow the hormone prolactin to move into the milk-making cells and stimulate milk production.  Current research suggests that frequent milk removal during the early postpartum weeks may increase the prolactin receptor sites.  If there are more receptor sites, then more prolactin can pass into the milk-making cells and increase milk production. By pumping less frequently, you may have signaled your body that you need not need as many receptor sites.  If you suspect this has happened to you, you can increase the amount of times you pump a day and try a galactagogue (under the guidance of a healthcare professional!).

For information on galactagogues, click here.

Your Health

If you have already reviewed the proper way to pump and are confident you are using the right sized flange, pumping often enough, long enough, and achieving a few let-downs each pump session, then consider your health.  Make sure you are taking care of yourself by getting as much rest as possible and consuming plenty of water and food.  If your basic health needs are not the issue, consider the following:

• • Have you addressed any new or preexisting hormone or endocrine issues with your healthcare professional since you gave birth?  Are there other health concerns that may be contributing to your low milk supply?
  • Are you taking any medications that can affect your supply?
  • Have you resumed taking birth control?
  • Has your menstrual cycle returned?
  • Are there any herbs you regularly ingest that could be affecting your milk production?
  • Are you pregnant?

For more information on medications and milk production, click here, for more information on herbs and milk production, click here.
For more information on your menstrual cycle and its effect on milk supply, click here.

Your Anatomy

It is possible your physiology, whether natural or due to an accident, disease, illness, or surgery, has impacted your ability to produce milk.  If you believe your milk production is low for one of these reasons, talk to your healthcare professional about your concerns.

Increasing Milk Production

The techniques to increasing your milk production can be divided into physical techniques and galatogogues.  However, before you spend time learning additional techniques or spend money on galatogogues, it is worth making sure that you are pumping properly.  Simply put, there is no substitute for good pumping habits.  Good pumping habits mean you are:

• • using the correct size flanges
  • pumping until you achieve 2-3 let-downs
  • pumping for a total of at least 120 minutes a day
  • pumping frequently enough that you do not slow milk production because your breasts are “full”

If you do not have good pumping habits, you may not notice any benefits from the suggestions provided to increase your milk supply.  

For more information on flange sizing, click here.
For more information on let-downs, click here.
For more information on how to pump, click here.
For more information on how often to pump, click here.
For more information on how long to pump, click here.

Physical Techniques

Milk removal is typically the best—and cheapest!—way to increase your supply.  Physical techniques to assist with increasing your milk production include: 

• • pump more frequently and on a schedule
  • power pumping
  • breast massage and compression while pumping, 
  • hand expression after pumping to ensure the most milk removal
  • warming the breasts just prior or during pumping with heating packs 
  • Pumping for 2-5 minutes after your milk flow stops

Additionally, it is thought that milk removal from both breasts—double pumping—may encourage a higher prolactin surge and thus additional milk production. 

For more information on power pumping, click here.
For more information on massage and compression while pumping or hand expression, click here.

Galactagogues

Galactagogues are foods, herbs, and medications that stimulate milk production.  Galactagogues are not a replacement for frequent and effective milk removal; they are most effective when used together with good pumping habits to maximize your milk production.  

If you have good pumping habits and have tried the physical techniques discussed above to increase milk production, it may be time to consider talking to your healthcare professional about what galactagogues may be appropriate for you.  Galactagogues are not an immediate fix; while some mamas may see results within forty-eight hours, some may not see results for a week or longer.

Common galactagogues include:

• • quick or old fashioned oats
  • barley
  • chickpeas
  • almonds
  • fennel
  • blessed thistle (herb)
  • goat’s rue (herb)
  • Domperidone (medication)
  • Metoclopramide (medication)

Some mothers may use a combination of galactagogues to achieve increased milk production.  As with anything you ingest, talk with your healthcare provider.  While available without a prescription, certain herbs are known to have a negative effect on your thyroid, which may be dangerous if you already have a thyroid condition.  Other herbs, such as fenugreek, increase milk production in some mamas, but have the opposite effect on other mamas.  Some of the companies marketing tinctures or pills that are intended to boost your milk supply disclose the name of the herbs used and any known negative interactions prominently, others may list the herbs used but do not list the negative interactions.  So it is always best to consult your healthcare professional before trying any galactagogues.  Additionally, a healthcare professional will likely be able to help you target which galactagogue is right for you and suggest the length of time to use or stop taking the galactagogue.

For more information on increasing your production of milk, click here.
For information on medical galactagogues to ask your healthcare professional about, click here, for information on herbs to consult with a professional about, click here.