September 08, 2007,
M.S. asks from Doylestown, PA on January 29, 2007
Low Milk Supply... Will It Come Back?
Hi, I successfully breastfed my son for 3.5 months, and then my milk supply started to dwindle... a lot ( I used to get 5 oz when I pumped and now I only get 1/2 oz... I even got a new pump because I thought that it was the pump and not me... but no luck, I still get nothing! (in the last month he only gained 3 oz... and he is waaaaay off his growth curve... (was at 75% and now is on the 25% graph :-(.... I started taking fenugreek, blessed thistle and fennel... drinking a lot of water, eating well... feeding him as often as he'll nurse... I am just worried that my milk won't come in... and that I should supplement with formula... I don't want to do him any harm by not giving him enough food... I get so worried every time he fusses that he is hungry and underfed.... I don't get much if anything whenever I try pumping after feeding him... I called the La Leche Leauge and they were great... very helpful, but I am still worried...
If I give him formula can I still keep breastfeeding as well?
our dr. and the person at LLL said to keep trying, but I have this voice in the back of my head that keeps saying "give him formula"....
He sometimes fusses when I offer him the breast, but he still sucks on his fingers, so I think he is hungry still.
Otherwise he is in great spirits, he smiles a lot, can lift his neck to 90 degrees when he is on his belly... seems very happy...
Last night and today he fed great a few times, but since 11 AM this morning he hasn't fed well and is a bit fussy and won't take my boob... ??? I just don't know why... just losing my confindence :-( big time....
I would love to keep nursing... but I want to do what is best for him.
Any advice would be great!
C.P. answers from York on January 30, 2007
Hi! I am a mom of two - a 2 year old daughter and 12 week old baby boy!!! I nursed Leah for 11 months and plan to do the same for John.
I'm sure the LLL told you all this already, but I'd thought I offer it too - just for support.
Keep offering him your breast - he'll eat when he is hungry. Babies needs change dramatically from week to week over the first year - there are some days my son wants to eat 5-6 times and other days I have to beg him to eat cause I am about to explode - all depends on his mood.
Know that you have done the best for your son by nursing - you will do no harm by offering formula if you honestly think he is still hungry after nursing. Might be worth a try just to see if he is more accepting of a bottle then you - baby's do have preferences and sometimes you can't deny them.
The other suggesion I can offer is to consider a thyroid issue - my sister-in-law had a very similar issue with low milk supply and no matter what she did, just couldn't increase it - her obgyn check her thyroid and (I can't recall exactly) but she has an underactive thyroid - and apparently that can contribute to your body's ability to produce milk.
So, to keep her hungry baby happy she supplemented with formula - any breast milk you can give is great - but again - your baby is NOT worse off because you supplement with formula or switch entirely to formula - your baby already has a great start because you've breastfed him for 3 months - think of all the babies that never get breastmilk.
I am a huge proponent of breastfeeding - but one thing that I think makes my logic a little different is unlike the LLL or your pediatrician - I think the the only way breastfeeding is great is if it is GREAT for BOTH mom and baby - mom should NEVER feel guilted into breastfeeding - those feelings will transfer to baby and may do more harm then good.
No matter what - you will do the right thing for your baby. You know him and his needs best 'cause you are with him 24/7.
1 mom found this helpful
H. answers from Pittsburgh on January 29, 2007
I nursed my first 2 for 13 and 18 months. They are only 17 months apart so my second pregnancy overlapped the first one nursing. I'm pregnant again and plan to nurse this one as well. One thing that happened with both of my little one's growth curve is that they spiked in weight fairly early and then dropped off significantly. My ped commented that that pattern was typical of breastfed babies - to gain quickly and spike higher on the charts and then settle into a lower percentile. My first hit her highest at 2 months and was around 70% I think. By 1 year she was 5% - she didn't reach 20 pounds and get to turn in her carseat until 18 months!! They sent her for bloodwork and found nothing. She ate everything in sight, but they said she was just a tiny thing and weren't concerned as long as she stayed on the charts and continued to thrive. My son hit his high point at 6 months - 75% I think (19 pounds). He's nearly 2 now and only 25 pounds and about 25%. Both are healthy and eat well.
It sounds like your little guy is doing pretty well between attitude and skills. Are you watching his diapers? That is probably the best way to know what is going in...It will help you to know if he's getting enough fluids to stay hydrated and urinate regularly.
Others mentioned stress. I definitely "let down" better when I was relaxed. This was really obvious when I pumped. If i tried to pump in a rush to get some place, I'd have minimal if any luck. Other times I'd have all the time in the world and would be relaxed and I'd fill a bottle in minutes. I also found that as my babies got older, I tended to pump less often and my success when pumping would drop dramatically. The baby wouldn't have any trouble getting enough milk to be content, but it just wouldn't happen if I'd pump. If he's happy and he's producing plenty of diapers, then maybe he's having more success with nursing than you realize. If he seems hungry after feedings or he doesn't have as many wet diapers or you are just concerned, you could try breastfeeding and then offering a couple ounces of formula to help fill his belly and give you peace of mind. It's definitely important to offer the breast and get him to nurse as often as possible to help increase your supply.
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C.C. answers from Dover on January 30, 2007
hi! i am a breastfeeding peer counselor. i support, encourage and educate breastfeeding moms. i work with IBCLC's.
first i would see a lactation consultant, not your OB (they aren't trained in breastfeeding) and your LLL is probably not professionally trained either.
secondly It's important to note that the feel of the breast, the behavior of your baby, the frequency of nursing, the sensation of let-down, or the amount you pump are NOT valid ways to determine if you have enough milk for your baby.
one thing i want to touch on what other moms suggested. if you drink TOO MUCH water it will LOWER your supply, yep that's righ it will lower your supply. drink to thirst and eat to hunger.
is your son getting a pacifier or any bottles? if so i would say to stop using them and let him do ALL his sucking at your breast. do not watch the clock or time him, watch your son and how he feeds.
are you taking at LEAST 6 capsules a day of fenugreek until your sweat and urine smell like maple syrup? some moms can stop using fenugreek after they smell like maple syrup, some moms have to continue taking fenugreek to keep their supply up.
one hour after he has nursed pump, this one of the best ways to increase your supply.
try to avoid formula, use it as a last resort. do you know about supply and demand? if you give your son formula that is LESS breastmilk he will demand. he is WAY too young to give solids, the APP recommends NO solids before 6 MONTHS.
is he having at least 7 wet diapers a day?
here is a link to determine if you really have a low supply and how to increase your supply http://www.kellymom.com/bf/supply/low-supply.html
Hidden Hinderances to a Healthy Milk Supply
Most moms understand that not nursing their babies often enough or supplementing with anything too frequently can compromise milk supply. But there are several "hidden" possibilities as well that should be considered:
All of the following have been associated with lowering milk supply: anthistamines and some decongestants, some weight loss medications or appetite suppressants, very high doses of vitamin B-6, diuretics, etc. There are other medications - both prescription and over-the-counter, that, although they may pose no significant risk to your baby, may adversely affect your milk supply. For this reason, it's always a good idea to check with a board certified lactation consultant (IBCLC) when beginning a drug you have never taken before.
HORMONAL BIRTH CONTROL
It's a well-established fact that birth control options containing the synthetic hormone, estrogen, can result in a diminished milk supply, sometimes quite rapidly. While most women can use the progesterone-only contraceptives, caution should be used when choosing this birth control option as well. No hormonal birth control should be started before the 6th-8th week postpartum. This allows the body plenty of time to fully establish a milk supply before any hormones are introduced that could compromise this process. Also, the baby's liver is too immature before this time to adequately metabolize the hormones in the contraceptive. After the 6th-8th week, if a hormonal birth control is desired, begin with a progesterone pill (mini-pill). This way you can quickly stop taking it if you notice a drop in milk supply. Most lactation experts advise avoiding the Depo-Provera injection while breastfeeding since it lasts three months and thus cannot be stopped if a drop in milk supply is noted. Estrogen-containing contraceptives should be avoided till at least after the 6th month and once the baby is well-established on solid foods.
Some women can develop this conditition for the first time during pregnancy and lactation. A test to check the thyroid function is always a good idea when a low supply does not respond to the usual methods for increasing it. Other symptoms of low thyroid include excessive hair loss, dry skin, increased sensitivity to cold, loss of appetite, extreme fatigue, depression, and a swelling in the neck area. If a low thyroid is diagnosed, the medication to increase its activity is compatible with breastfeeding.
Just as with a dysfunctional thyroid, anemia should be ruled out when a low supply does not respond to measures to increase it or if another cause cannot be found. Mothers with anemia are also at greater risk for plugged ducts and breast infections.
Mothers who smoke more than 20 cigarettes a day often experience a lower milk supply. Their babies also tend to gain weight more slowly than the babies of mothers who smoke fewer cigarettes each day or those who do not smoke at all.
RAPID WEIGHT LOSS
When lactating it's recommended that you not lose weight more rapidly than one pound a week or about 4 pounds a month. Losing weight more quickly than this can reduce the quantity of your milk as well as pose certain risks to your baby. Exercise wisely and try to take in at least 1800 calories a day while breastfeeding. Avoid weight loss medications, drinks, or other fads.
HISTORY OF HORMONAL PROBLEMS
The mother who has difficulty conceiving or carrying a baby to term may experience problems with establishing a full milk supply; although this does not appear true for all moms who fall into this category.
Women who have previously had breast augmentation or breast reduction surgeries are at greater risk of never fully establishing a milk supply. This is more likely if the milk ducts were cut during the surgery and have not grown back, or "recanalized". Surgeries in which the nipple is removed and relocated tend to result in more of the milk ducts and nerves being severed. When deciding upon either of these surgeries, plan to fully discuss with your doctor preserving the possibility of future breastfeeding. Get a second opinion if your doctor says that the surgery will in no way affect breastfeeding. This is most always not true! While many mothers who have had these surgeries do go on to at least partially breastfeed, if a woman strongly wants to nurse her future babies, the decision to have either of these surgeries should not be entered into lightly. Women who have experienced some type of breast injury (burning, trauma, through radiation therapy, congenital defect, etc.) are also at greater risk for many of the same reasons stated above. They, like those women who have had elective surgeries, should still be encouraged to breastfeed. Most are able to at least partially provide milk for their babies.
If the placenta was not able to be removed intact or if postpartum bleeding occurs for more than 6 weeks, this is a possible hinderance to a healthy milk supply. Excessive postpartum bleeding (hemorrage) has also been related to low milk supply.
Very rarely, a mother's breasts will not be able to produce an adequate milk supply for her baby. Simply put, the milk ducts and glands have not developed well enough to properly work. Mothers with this condition typically report that their breasts did not change in size or shape during pregnancy. There may also be a marked difference in the size or shape of the breasts. There is no note of the "milk coming in" during the early days postpartum and the breasts never feel full or engorged. These mothers should still be encouraged to breastfeed. While their babies will need to be supplemented in order to receive enough milk, the amount of mother's milk received will still be invaluable.
OVERUSE OF PACIFIER
Babies all need to suck and it is this desire that often ensures that the baby is at mother's breast frequently enough to maintain her supply. Avoid using a pacifier if possible. Along with compromising milk supply, pacifiers have also been linked to greater incidence of ear infections and thrush and premature weaning. If you choose to use one, use it only after a feeding and watch your baby for signs that he is loving his pacifier too much. Limiting pacifier use is one effective way of increasing milk supply if needed.
EARLY INTRODUCTION OF SOLIDS
When babies are introduced to anything other than mother's milk before the 6th month or later, there is an increased risk that the mother's supply will drop. There are other risks as well. Solids displace the breastmilk in the baby's diet. He in turn nurses less frequently; thus reducing the amount of stimuation his mother receives. Delay introducing any solids (cereal included) before the 6th month and breastfeed BEFORE offering the solids until closer to the end of your baby's first year. This will ensure that he nurses frequently and that the bulk of his calories still come from your milk as they should for most of the first year. Continue feeding on baby's cue even after solids have been introduced. Limit water and juice intake to mealtime and from a cup. Limit overall juice intake to 3-4 ounces.
ENCOURAGING BABY TO SLEEP THROUGH THE NIGHT
Often babies are encouraged or "trained" to sleep through the night too early. This can often compromise the mother's milk supply. If your baby decides to sleep through the night on his own and your milk supply is adequate then let him sleep. But avoid the temptation to sleep "train", especially if your supply is of concern. Night feedings are the most beneficial for increasing milk supply.
FAULTY LATCH OR SUCK PROBLEM IN THE BABY
Both of these can adversely affect milk supply since the milk will not be removed from the breast well. Inadequate milk removal tells the body to reduce the supply over time. If either of these are a concern, an assessment by a board-certified lactation consultant is in order.
LIMITING TIME AT BREAST
Allow your baby to completely finish one side before you offer the other by waiting until he falls asleep, pulls off himself, or stops actively sucking and swallowing. Always offer both breasts at each feeding. Your baby may not always want or need the second side, but it should always be offered. Start each feeding on the side the baby finished with (or took the shortest period of time at the last feeding) or the breast he did not take at all. Nursing in this way will ensure that both breasts receive adequate stimulation.
Using a nipple shield decreases the amount of stimulation to the breast and the amount of milk transferred. Both can adversely affect supply. If a nipple shield is required, choose a silicone one that will allow for more stimulation and use only under the direction of a board certified lactation consultant.
Most mothers notice a drop in milk supply about halfway through their pregnancy. This is due to changing hormone levels.
Returning to work, especially before the 6th-8th week. Delay your return to work as long as possible to give your body time to adequately establish your milk supply. Once back at work, arrange to pump for missed feedings regularly, using an effective pump. Both not pumping regularly and using an ineffective pump can cause your supply to quickly decrease. When home with baby make it a rule to only nurse. No bottles during the evenings and on weekends. Even allowing your baby to comfort nurse at your breast - instead of using a pacifier - will help maintain your milk supply with more ease.
Additionally, both excessive caffeine and alcohol use have been attributed to letdown difficulties. While not directly related to supply, a delayed or inhibited letdown can lead to supply problems. Try to limit your caffeine consumption to less than that contained in 4-5 cups of coffee a day. Limit alcohol use to one drink or less a day on average. Extreme stress and fatigue have also been noted as hinderances to a fully functioning letdown response.
still nursing @ 16.5 months
R.G. answers from York on January 30, 2007
God Bless you for wanting the best for your baby. It is completely possible that you are doing just fine in the milk department. I was never able to use a pump with consistent results. Much the way you're describing. As for the fall off of your child from the charts... forget the charts. All my babies went from being in the top percentages to falling well below the 25% mark at or shortly after their 4 month birthdays. However, they are ALL thriving and growing proportionately. Checking the diapers is the first place to start ... next definitely try the scale trick ... before and then after a regular feeding. The results can be amazing.
Mothers Milk tea is wonderful. Another wonderful product is Motherlove More Milk Tinctures - <http://www.motherlove.com/products_extracts.php>. These tend to provide a better delivery of the necessary herbs. Eat oatmeal every morning. I'm sure the LLL ladies gave you lots of great advice. Just know that the drop in growth is completely normal in many cases. It's also possible that he's developed a sensitivity to things in your own diet. Pasteurized liquid milk is a killer (literally). Try eliminating that first ... may take up to 8 weeks to notice a difference.
Wishing you luck and praying for your little one's health and well being. Just remember you are doing what's best for your baby.
Wife, Mother, Friend
T.A. answers from Philadelphia on January 29, 2007
It's a little hard to make suggestions when I'm not completely sure what your situation is. Are you home all day with your baby or do you work outside of the home?
Babies R Us sells baby scales or maybe you can rent them. I think you should weigh your baby before you feed him and then weigh him again afterward to see how much bm he is actually getting. It is possible that your milk supply has gone down a bit due to hormones? Have you had your first PP AF yet? If not, it could be on it's way. Another thing is your baby could be having a growth spurt and is wanting to nurse more. He may be getting more bm than usual and you are just not aware. If you just continue to feed on demand, your body should catch up to his appetite.
Are you getting enough rest? Sometimes if we are stressed or tired, milk supply can decrease. I have heard of women having breastfeeding weekends where all they did all day was drink water, eat good, rest and feed their babies. Just until things got back to normal.
I'm not sure what suggestions La Leche or your dr gave you so hopefully I've been able to help you.
My oldest DD had a very poor suck and I had to supplement with formula and then totally give up breastfeeding when she was 3 months old because she wasn't thriving. I went on to have another DD who I bf exclusively until she was 5 months old and then I went back to work so I started supplementing with formula until she was 8 months old. My DS I bf until he was 1 year - I started supplementing with formula after I returned to work when he was about 4 1/2 mos old.
M.L. answers from Harrisburg on September 08, 2007
Hey get the SNS System from La Leche...its a tubing system that you tape to yourself and can fill it with formula or pumped breast milk. He will latch on and nurse from you, increasing your milk supply..but you will feel better knowing he is getting a little something extra until your milk comes to the level he needs. I did this with my daughter and it worked pretty well for us.
* SNS is the Supplemental Nursing System
L. answers from Philadelphia on January 29, 2007
My milk supply dropped off when I went back to work--my son was three months old at the time. I've been drinking fenugreek and milk thistle tea ever since to bring it back up. (The milk thistle works best for me.) Drinking lots of water and eating a high-protein diet also helps. But even though I'm doing all of that, I've still started supplementing with formula. I probably don't *have* to, but my son was constantly hungry and I had the same little voice in the back of my head telling me he needed more food. I breastfed him exclusively for about six months. Now, at almost seven months, he takes two six- to seven-ounce bottles of breastmilk at daycare, plus two solid meals a day, plus nursing in the morning and the evening, plus 4 ounces of formula in the early evening just before I pick him up from daycare. The formula makes both of us feel better, and he's still nursing happily every chance he gets.
I guess my advice would have to be to do what you can to improve your milk supply, and if it doesn't help enough, start supplementing with formula slowly. There's no reason you can't continue nursing and feeding formula at the same time--I have a number of friends who have done it, and I'm doing it now.
Good luck, and congratulations on your new mommyhood!
C.J. answers from Harrisburg on January 29, 2007
Hi M.....Call the Breastfeeding Hotline at 1-###-###-####.They are WONDERFUL!!!!!
Also, drink Mothers Milk Tea by Traditional Medicinals.Drink lots of water(I drank 90oz a day when breast feeding).I also ate 7 small meals a day.Make sure you are eating protein. You do what you feel is best for your baby. Supplementing is ok if that is what you feel you need to do.Are you getting enough rest? Are you stressed? These both can have a huge impact on your milk supply. Put him on the brest every 2 hrs, for 10-15 min on each to see what happens. He may unlatch himself, when he does switch to the next breast. Then if he is still searching, give him 2 to 4 oz of formula. If he drinks it great, but if he only drink half of what you are giving him, he may be satisfied with the breast. He is also prob going through a growth spurt, and your body will prob try and meet his demand as best as it can if not fully. Please call the hotline, and explain your concerns, and hopefully they will help you figure out your supply. Have your ped weigh him weekly or you can buy a scale. Good luck