Re: Reduced production
When you say she is 'frustrated...is t possible she is just done? Full? Not interested in nursing right then? In other words, is it possible your baby’s behavior and your pump out put are not exactly in sync nor explain each other?
Because a baby this age will very typically nurse for short amount of time some of the time ,and be distracted/fussy/popping on and off etc. Many times the 'best' as in longest nursing sessions happen only when baby is nursing to sleep, at night, or having ‘good morning’ nursies in bed. If a mom is concerned about low production, the distraction at other times may look very much as if baby is 'frustrated' when it is in fact normal. Also weight gain ‘velocity’ typically starts slowing down at this age, sometimes quite dramatically, which also tends to get everyone worried, unnecesarily.
It can be quite difficult to maintain adequate production when pumping instead of nursing part of the day, and it sounds as if you have a very demanding job, so I am not doubting you, it's likely your production has gone down somewhat and what you are able to pump may not be adequate. Certainly your pump output has gone down. But wasn’t it extraordinarily high at it’s best? 25 ounces per day is what a mother who is eping – not nursing at all-would love to see. But you were nursing at the same time, at least part of the day, or am I not understanding?
It sounds as if your baby's weight gain has been normal and your baby is not acting like baby who is hungry-a hungry baby will nurse and nurse, trying to get another letdown, desperate for more milk.
might it help to consider some quality of life things here? Many mothers find that, if possible, they do best with a less demanding work scedule in those short months of young babyhood. And/or, what about making that time at home more relaxed? All this pumping when you are home with your baby may be cutting into time you could be spending sleeping with, snuggling, playing with and yes, nursing your baby. Some mothers find that what works best for them is to have baby get formula as needed when mom is at work-you could still keep up your current pump schedule at work, take galactagogues as you like, but when you are home, relax and love your baby, even if that meant slightly more formula than expressed milk for baby the next day.
Re: Reduced production
Hi, thanks for the lengthy response. There are a few things that I can clear up. You are so right about the quality of life issue. In the interest of brevity, I did not get into my work schedule but I try to average 2 days a week. Sometimes it's three and sometimes it's more if my boss is off.
I totally agree about not fretting over not being able to feed breast milk exclusively. We've had to supplement with formula. It started in the hospital when the neonatologist strongly pressured us to do so and I felt backed against a wall. I think this made our bf start a bit rockier than it had to be. I long ago made peace with having to use some formula.
However, I am enjoying bf much more than I would have ever thought and my fear is that if my production falls off drastically, I would in effect wean before we are mutually ready. Thus, the pumping. I've had to work hard to get the production I've had and it seems to fall off quickly. I'm very impressed with all I've learned about the benefits of bm and hope to continue well past a year or at least until IVF from frozen embryos with baby #2, when the dr. said weaning is a must, sadly, owing to the hormones.
When she is fretful about nursing it seems to be when my supply is low. My supply is always highest in the wee hours up until early am. She nurses best in the early morning. I do offer at other times during the day when I am home. Sometimes she will nurse, other times she is hungry but frustrated and will eagerly take a bottle. She is also teething off and on and I can tell that affects her latch. She even frets with one silicone nipple but takes the Madela slow flow when her gums hurt.
When I had my peak 20-25 ounces per day, it was with one or no nursing sessions that day. I'm hoping my production is on the way up again. I got 6.5 ounces about midnight, 4 oz at 5:30 only 1 at 8:30 but that is 11.5 in the first three pumpings today. I'm pumping now and it looks like this one will hopefully be at least 2 or 3 ounces.
Re: Reduced production
OK, you love to nurse and want to keep nursing as long as possible. That is good to know because it helps me understand your goals. Also, I am so happy that this is your experience despite your struggles. Yes nursing a baby can truly be a joy, even when it’s hard.
Here is what I keep thinking-Your pump output variations (edit) sound entirely normal to me. 4 ounces is a lot to pump, and 1-2 ounces is normal. Many mothers have to pump 2-3 times to get enough for a bottle feeding, which for a 5 month old baby would vary from 1-5 ounces at a time! Our bodies are made to make milk differently at all different times of the day, and output also varies from day to day. When left alone (unscheduled and unlimited) an infant’s feedings at the breast result in exactly what baby needs at that time-and it is NEVER the same. Fat content and volume of the milk available and extracted thus NORMALLY varies quite a bit from nursing session to nursing session, day to day, and over time as baby grows-all by natures brilliant design. We don’t even know exactly or entirely why this happens, but it is normal for it to happen. This is one of the very many reasons why measuring milk production from pump output is extremely problematic.
You had struggles early on and you (I assume) had a sick or weak baby in the NICU, or that was not gaining? That is very different than what I assume is the situation now- a healthy, strong, thriving 5 month old baby. This is not a baby who is going to allow you to inadvertently starve her! You will know if you don’t have enough milk long before there is any danger to your baby. But fussyness at the breast is not a reliable sign of low production or even slow letdown. Nor is baby ‘eagerly’ taking the bottle a sign. Your baby, like all babies who are combo fed, has been trained to find a quick fix in the bottle, paced bottle feeding aside. For some babies this causes more than the usual difficulty at the breast. Many mothers with normal and even overproduction experience exactly the same thing!
I am not even sure how much milk a 5 month old baby actually "needs" each day. Do you? You say your doctor says your baby is not being "overfed" but by what is he/she measuring that? By what a formula fed baby typically eats? Or by what a breastfed baby eats? And what age breastfed baby? If there is a chart of what a 5 month old breastfed infant typically eats at the breast, I would love to see it, I am not saying it does not exist I just truly would love to see it! Also is the doctor looking at how much your baby is being supplemented via the bottle, and then guestimating what nursing sessions at the breast result in?
I could be way, way off, obviously. So please ignore all I said if it simply does not apply. You have been doing a great job under some difficult circumstances and of course, increasing your production may be all that is needed, in which case I think you have a pretty good handle on various techniques and mommal covered the possibility of pump issues which I hope you consider. But if you are interested, I do have a few suggestions you can consider trying, if you have not already. You can do all, one, none, whatever.
1)So right now, you are working 2 to 3 (quite long) days per week. So you are with baby 4-5 days and 7 nights (about.) If your production has gone down, it has gone down while doing all this pumping. So even with all the pumping, you are seeing this fall off-maybe it makes sense to experiment with a different approach. Maybe consider a week (or two-a week may not be long enough) of allowing uninterrupted, unscheduled access to the breast by baby on your days and nights off, while NOT supplementing baby with bottles during that time. Is that possible, feasible? It depends on a few things, mostly, how much (how many ounces) baby is being supplemented right now when you are with her. If it’s a lot, you might need to take weaning off the supplements slowly.
2) When baby fusses while nursing, and you think it is due to there not being any milk, try some other things besides the bottle right away. you can try breast compression. if that does not work, try switching sides (a few times, if needed-sometimes I have to switch my fussy girl 5 or 6 times before she ‘settles.’ You can try taking baby off, comforting her some other way for a few minutes (rocking, moving around, making her laugh, etc,) and offering the breast again when baby is calm. If baby does not want to nurse but stays calm, don’t worry about it, and just nurse again later. If baby still fusses, give her a little milk/formula in the bottle (an ounce) and bring her back to the breast. Repeat as needed.
3) Try using an at the breast supplementer for supplemental feedings
4) read or reread the book Making More Milk
5) see your lactation consultant again for a ‘tune up.’ If you have never seen one, or did not have a good experience before, see someone new. Make sure they are experienced with helping mothers with babies this age, and helping mothers wean off pumping/supplements. (You need not be interested in weaning entirely off supplements, I am just trying to get you with someone who will be able to help you with your specific goal-NURSING your baby, at the breast, as long as you can/wish to. It sounds as if you don’t want to simply have domperidone ‘prescribed’ or eping ‘prescribed’ and sent on your way-pumping and galactagogue use may of course need to be part of the equation, but they need not be the entire answer.
6) make sure your caregiver is cue feeding as well as doing paced bottle feeding when you are at work. http://www.llli.org/docs/00000000000...astfedbaby.pdf
7) Read or re-read these articles: http://kellymom.com/bf/got-milk/supp...es/low-supply/
Re: Reduced production
Thank you very much for the thoughtful, detailed reply. My supply seems to be rebounding. Monday I pumped 19.5 ounces. A bit less yesterday but today in the first 3 pumps I've gotten a total of 15. The big pump is still MOTN. That's where 10 ounces came from. I got none in the last two pumps of the evening-it's like I'm just out at the End of the day, but overall feel much fuller again at my good pumps and am having let down/leaking again. (I know that is not a reliable indicator of supply but I can definitely tell when they are soft vs. full.).
I will definitely be referring to your post and other suggestions. I have the More milk book and have read it twice.