Trying to get rid of pumped breastmilk bottle top-offs
My daughter is almost 11 weeks old. She has been EBF but was a lazy, sleepy breastfeeder so for most of the last 11 weeks our nursing setup has been that she would attempt nursing (with varying degrees of success) and then topping off with a bottle of expressed milk. We started the bottles because of jaundice which made her too sleepy to nurse on her own, she she would get a bottle and I would pump. The pediatrician and LC advised not to stop the top-offs because she is/was a slow weight gainer, so at every appointment they would sympathize with how difficult it must be to keep up that routine but advise us to continue what we were doing until she at least regained her birth weight and in the meantime we would work with the LC to try and get her to be a better breastfeeder. We saw the LC every week. In all our many visits, she has consistently gained only around 1/2 ounce per day. She didn't regain her birth weight until 6 weeks, so we had checkups with the doctor every week too. At her two month appointment, she had gained almost 3/4 ounce per day in the two weeks prior, so the Dr. & LC were satisfied that she is gaining well enough and this is just her pattern and the LC gave some ideas for slowly weaning from the top-offs. In the past 2 weeks or so, she has been making a lot of progress and we have slowly dropped bottles. We started with the night time ones, and now she hasn't had any night time bottles for five days. Instead she wakes up a lot sooner, about every 2.5-3 hours, and nurses well and then falls asleep (though we switch nurse to keep her actively swallowing, but she used to nurse some but not fall asleep again until taking 1-2 ounces by bottle.)
I am trying to keep weighing her to make sure we are not digging ourselves into a hole by weaning from the supplementing too quickly - and her diaper output has still been well above the baseline. I will of course keep monitoring those things to make sure we are not eliminating top offs too quickly.
In the past 4 days, I have started to try and fiddle with the day time top offs. On the first day, I tried nursing as long and as often as she wanted without top offs, and around 4-5 hours into it she wanted to nurse after 30 minutes, then again after 15 minutes and eventually was crying and wouldn't attempt to latch at all, which is when I got a bottle ready and she drank 3 ounces (about her max, it seems.) The second day I tried a more structured approach, giving her top-offs at every other feeding, where she took between .5 and 1.5 ounces. The third day I had what I thought was a brilliant idea and took a dose of Mother's Milk Plus, which I had used during the first month with some success in establishing a full supply. I thought since she was now pretty effective at milk transfer, if I could just have a little milk supply boost to make sure there was enough there for her without her having to work too terrible hard at it, perhaps she wouldn't want the top offs at all anymore. I do think that's what happened as that day she took only 2 ounces by bottle total all day. Today was a bit of a hitch in the road as I had a weirdly scheduled day that meant she had to be left with a relative and have a feeding by bottle without me (and I pumped instead.)
My concern about using the Mother's Milk Plus is that I might cause more problems that I think I'm solving. Since I already pump a bit extra every day (which I freeze), I worry that increasing my supply could lead to fore milk imbalance problems. Or perhaps it could mean that my breasts become too full, she is not able to empty them, and I could end up teaching my body to make less milk as a result - the opposite of what I was trying to achieve!!! I already have a full supply, she drinks only breastmilk and there is enough to freeze a little each day, it's just that she doesn't drink it all from the breast as I would like her too.
Do you think the Mother's Milk Plus boost is a good idea or a bad idea? If you think it's a good idea, should I take it regularly - I took only two capsules each night and have already noticed an increase to about the level I'd like - so should I keep taking the two capsules every night to maintain that level or just stop taking it now that I've seen the boost I wanted? If you think using the Mother's Milk Plus is a bad idea since I already have a full supply, what else should I be exploring to try and get rid of these top-offs? Any suggestions welcome. Thank you!
Re: Trying to get rid of pumped breastmilk bottle top-offs
I think you should feel free to continue on with the MM capsules. They are very unlikely to cause any of the problems you're worried about, since the boost they provide is generally minor.
Foremilk/hindmilk imbalance is almost always a problem that is related to significant oversupply. Not just a little bit of extra milk- we're talking a LOT of extra milk! Now, if you did end up with an oversupply and baby wasn't emptying the breast as completely as before, that wouldn't be a problem. Your body would "read" the difference between what you're making and what baby is taking, and adjust supply to match demand a lot more precisely. But your supply wouldn't dip too low. It would just return to the break-even point. Finally, while having an oversupply can be problematic for nursing- it can cause fast letdowns and gassiness, which can make baby uncomfortable- it is generally pretty good for weight gain. Moms with oversupply often find that their babies gain weight rather quickly. So in your situation, a bit of versus ply might not be such a bad thing!
Kudos to you and to your healthcare professionals for working through the early challenges! I am really impressed.