Lactation (Breast Milk Production)

Last Updated: November 30, 2023

Lactation is the process of milk production and secretion from the mammary glands. To learn about breastfeeding as an intervention (e.g., in comparison to using infant formula), see our breastfeeding page.

Lactation (Breast Milk Production) falls under thePregnancy & Childrencategory.

What is lactation?

Lactation is the process of milk production and secretion from the mammary glands, which are exocrine glands located in the breasts. In female adult humans, milk production begins during pregnancy, and lactation continues throughout the postpartum period. Initially, hormones (like progesterone and prolactin) regulate milk production. Milk removal takes on a greater role in stimulating ongoing lactation by four days postpartum, and by ten days postpartum, ongoing lactation is entirely stimulated by removal of milk from the breasts. Lactation insufficiency occurs when the parent does not produce enough milk to meet the nutritional needs of their infant.

How does physical activity affect lactation?

Moderate levels of exercise do not appear to affect milk production or impair infant growth.[1][2][3] However, intense or exhaustive exercise may temporarily alter milk composition (e.g., increased lactic acid and decreased secretory IgA concentrations), but milk composition usually returns to baseline within one hour postexercise. Moreover, infants can safely drink milk produced immediately postexercise despite the change in composition.[4]

Have any supplements been studied for lactation?

Many supplements have been studied for lactation, including fenugreek seed, Coleus amboinicus (torbangun) extract, and moringa leaves. However, there is no robust or consistent data to support the effectiveness of supplements in increasing milk supply for lactating parents. Some trials examining single or multi-ingredient supplements and teas have reported positive findings, like increased milk volume and higher infant weight. However, other trials have found no effect on lactation, and the evidence is too limited to make strong conclusions about efficacy.[5][6][7]

It is important for lactating parents to speak with a healthcare provider who is knowledgeable about lactation medicine before using a supplement while breastfeeding. Some herbal supplements may suppress lactation, including jasmine, licorice extracts in high doses, peppermint, and sage, although the evidence for this is limited and sometimes anecdotal.[8]. It is also possible for supplements to pass into human milk and change its taste, color, and/or composition.[9][10] Some of these changes may affect the infant.

How can diet affect lactation?

Although diet can affect lactation, human milk volume and composition are resilient and remain relatively consistent across a wide variety of diets.[11][12] Eating enough calories and staying hydrated builds an important dietary foundation for milk production. The additional energy demand of lactation is estimated at about 450 to 500 kcals per day (see below). Lactating people also have an increased requirement for protein, choline, many vitamins (including A, C, E, and most B vitamins), and the minerals iodine, selenium, and zinc.[13][14] However, if a parent’s diet is deficient in the nutrients required to make milk, their body will mobilize and (if necessary) deplete fat, vitamin, and mineral stores to meet the demands of lactation, even at the expense of the parent’s health. A balanced, nutrient-dense diet can protect the parent from dietary deficiencies while also supporting ongoing lactation.

Which other factors can affect lactation?

The primary driver of lactation past 10 days postpartum is milk removal. If the breasts aren’t emptied (i.e., the stored milk is removed to the point that the breasts feel soft and/or hand-expressing more is difficult) at feedings, the body makes less milk to compensate. Optimizing breastfeeding techniques is therefore important for sustained and bountiful milk production (see below).

Stress/anxiety, medications (e.g., oral birth control), menstruation, fatigue, hormonal conditions, genetics, and breast surgery can also affect lactation.[15] Many prescription and over-the-counter medications and recreational drugs, including alcohol, can be expressed in human milk, but not all of them are expressed at levels that could be harmful to the breastfeeding infant.[16][17]

If planning or needing to take medications or recreational drugs while breastfeeding, it’s wise to check with a knowledgeable healthcare provider, such as a doctor or pharmacist.

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Update History
2023-11-30 00:30:02

Cross-link to breastfeeding added

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We added a link to the breastfeeding intervention page into the overview of this page.

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References
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Examine Database References
  1. Milk Production - Atena Mohammadpour, Mahboubeh Valiani, Alireza Sadeghnia, Sedigheh TalakoubInvestigating the Effect of Reflexology on the Breast Milk Volume of Preterm Infants' MothersIran J Nurs Midwifery Res.(Sep-Oct 2018)
  2. Milk Production - Seyhan Çankaya, Gülay RatwischThe Effect of Reflexology on Lactation and Postpartum Comfort in Caesarean-Delivery Primiparous Mothers: A Randomized Controlled StudyInt J Nurs Pract.(2020 Jun)
  3. Milk Production - Ping Lu, Zhi-Qi Ye, Jin Qiu, Xiao-Yu Wang, Juan-Juan ZhengAcupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sectionsMedicine (Baltimore).(2019 Aug)
  4. Milk Production - Mitra Savabi Esfahani, Shohreh Berenji-Sooghe, Mahboubeh Valiani, Soheila EhsanpourEffect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in TehranIran J Nurs Midwifery Res.(Jan-Feb 2015)
  5. Milk Production - Vida Ghasemi, Masoomeh Kheirkhah, Mohsen VahediThe Effect of Herbal Tea Containing Fenugreek Seed on the Signs of Breast Milk Sufficiency in Iranian Girl InfantsIran Red Crescent Med J.(2015 Aug 15)
  6. Milk Production - Siew Cheng Foong, May Loong Tan, Wai Cheng Foong, Lisa A Marasco, Jacqueline J Ho, Joo Howe OngOral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infantsCochrane Database Syst Rev.(2020 May 18)
  7. Milk Production - Reena Ravi, Jasmine JosephEffect of fenugreek on breast milk production and weight gain among Infants in the first week of lifeClinical Epidemiology and Global Health.()
  8. Milk Production - Francesco Di Pierro, Alberto Callegari, Domenico Carotenuto, Marco Mollo TapiaClinical efficacy, safety and tolerability of BIO-C (micronized Silymarin) as a galactagogueActa Biomed.(2008 Dec)
  9. Milk Production - Peila C, Coscia A, Tonetto P, Spada E, Milani S, Moro G, Fontana C, Vagliano L, Tortone C, Di Bella E, Bertino EEvaluation of the galactogogue effect of silymarin on mothers of preterm newborns (<32 weeks).Pediatr Med Chir.(2015-Dec-29)
  10. Milk Production - Mradu Gupta, Badri ShawA Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus WilldIran J Pharm Res.(Winter 2011)
  11. Milk Production - S Sharma, S Ramji, S Kumari, J S BapnaRandomized controlled trial of Asparagus racemosus (Shatavari) as a lactogogue in lactational inadequacyIndian Pediatr.(1996 Aug)
  12. Milk Production - Rizal Damanik, Mark L Wahlqvist, N WattanapenpaiboonLactagogue effects of Torbangun, a Bataknese traditional cuisineAsia Pac J Clin Nutr.(2006)
  13. Milk Production - S. Manjula, Arshiya Sultana, Khaleequr RahmanClinical efficacy of Gossypium herbaceum L. seeds in perceived insufficient milk (PIM) supply: A randomized single-blind placebo-controlled studyOriental Pharmacy and Experimental Medicine.()
  14. Milk Production - Corazon P. Estrella, Jacinto Bias. Man taring, Grace Z. David, Michelle A. TaupA double blind randomised controlled trial on the use of malunggay (Moringa oleifera) for augmentation of the volume of breastmilk among non-nursing mothers of preterm infantsThe Phillipine Journal of Pediatrics.()
  15. Pain - Kee WH, Tan SL, Lee V, Salmon YMThe treatment of breast engorgement with Serrapeptase (Danzen): a randomised double-blind controlled trialSingapore Med J.(1989 Feb)
  16. Nipple Cracks - Manizheh Sayyah Melli, Mohammad Reza Rashidi, Abbas Delazar, Elaheh Madarek, Mohammad Hassan Kargar Maher, Alieh Ghasemzadeh, Kamran Sadaghat, Zohreh TahmasebiEffect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trialInt Breastfeed J.(2007 Apr 19)
  17. Thyroid-Stimulating Hormone - Mulrine HM, Skeaff SA, Ferguson EL, Gray AR, Valeix PBreast-milk iodine concentration declines over the first 6 mo postpartum in iodine-deficient womenAm J Clin Nutr.(2010 Oct)