Successful breast-feeding relies upon the breast’s ability to secrete – and release – milk. At birth, milk production is regulated by prolactin and oxytocin. When infants suckle, they stimulate the release of oxytocin receptors around the nipple and areola. Effective attachment with supportive positioning is important for stimulating the areola and nipple to trigger the milk ejection (let-down) reflex, and the synthesis and flow of milk. Skin-to-skin contact stimulates the oxytocin and prolactin receptors, and uninterrupted maternal infant contact encourages milk secretion.1Initiation of milk production can be delayed for psychological (e.g. fear, anxiety, embarrassment) or clinical reasons. For example, elevated stress levels during or after labour (e.g. due to unplanned Caesarean section, assisted delivery or postpartum haemorrhage) can delay the onset of lactation.2Physiological causes of delayed or reduced milk production include history of cystic fibrosis, epilepsy or diabetes.3 Breast reduction or augmentation surgery can damage the breast structure, causing the action of hormones on milk ducts to be insufficient to move milk towards the nipple and areola. Prolonged or severe engorgement, retained placenta and hormone or endocrine imbalances (e.g. hypothyroidism) may also delay lactation onset; stimulants (e.g. tea, coffee or alcohol) may inhibit milk production. 

Stimulating the let-down reflex, boosting supplyTo facilitate and improve the let-down reflex, establishing a calm environment with privacy is very important. Feeling confident and receiving appropriate support and encouragement may help to facilitate a healthy milk flow. Gentle breast massage, applying a warm compress, performing relaxation exercises or trying different breast-feeding positions may help, as may frequent feeding or breast-milk expression (expression can be scheduled in the morning, halfway between each feed or from one breast while the baby feeds from the other).
However, increasing the vacuum level of a breast pump will not help to increase milk flow; it will likely only result in nipple and breast tissue soreness. Similarly, increasing maternal fluid intake will not increase milk flow.

References1. UNICEF (2008) Baby Friendly Initiative.

2. Chen DC et al. Stress during labour and delivery and early lactation performance. Am J Clin Nutr 1998; 68: 335–344.

3. Ostrom KM, Ferris AM. Prolactin concentrations in serum and milk of mothers with and without insulin dependent diabetes mellitus. Am J Clin Nutr 1993; 58: 49–53.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6).