6 months... milk supply seems to be dwindling

[@llli*martymarello]

I have been exclusively breastfeeding for 6 months... Did not have a milk supply problem initially. Went back to work at 8 weeks, been pumping 2 times a day in a 13-hr workday (because there just never seems to be enough break time for a third pumping session). Used to bring home 16-18 oz, now I'm bringing home only 9-11 oz. Baby drinks 24 oz. (four 6 oz. bottles) while I am at work, and then I usually nurse her again when I get home. Tried to introduce solids (rice cereal and oatmeal) 2 weeks ago, and she cut down to nursing only 4 times a day instead of 5. Then baby got really constipated and pediatrician recommended stopping the solids and going back to strictly breastfeeding, which I did. Her bowels still are not moving like they should be, which has me worried. And I don't know why my milk supply seems to be going down... is it because of not pumping enough at work? Or maybe because of introducing the solids for a week? I am worried... I'm a first-time mama, and I really want to nurse all the way to 12 months. Thanks in advance for any help or advice.

[@llli*mommal]

Welcome to the forum and congratulations on making it to 6 months!

It's very common for moms to have a big supply drop after they have been back at work for a while and also after they introduce solids. It's the old supply = demand equation coming back to bite you. Less demand due to less nursing or limited pumping time will eventually translate into reduced supply. Usually moms do fine when they first return to work because milk supply is generally overabundant in the early weeks/months of breastfeeding. But unfortunately for working moms, that overabundant supply doesn't last.

The best way to increase supply is to increase stimulation to and milk removal from the breast. That means nursing more and pumping more, and also using the best pump possible. That may mean getting your pump reconditioned (even the best machines wear down with use), or simply purchasing a better machine. You may also want to check your shield size, since that sometimes changes with time and poorly sized shields reduce stimulation to the breast. I think you really need to find a way to fit more pumping sessions into your workday. 2 pump sessions in a 13 hour period is just not enough unless a mom is vastly overproducing milk. If you can pump while you are with your baby, in addition to nursing, that will also help. Does your baby nurse at night, or is she sleeping all the way through? Nursing her in the night is another great way to boost supply- though I feel bad even suggesting it to someone who is working outside the home!

Poop issues when solids are first introduced are really common. Your doctor gave you very good advice about ditching the cereals and going back to exclusive nursing. When you reintroduce solids, keep the quanitities small (a teaspoon or two per day is all a 6 month old baby needs- remember, at this age solids are just for fun and are not necessary for nutrition)- and also skip the cereals and go right to the fruits and veggies, since those are less constipating (with the exception of bananas and apples, which you should avoid for now).

When you say your baby's bowels aren't moving like they should be, what do you mean exactly? A 6 month old exclusively breastfed baby may poop as little as once per week, and that's okay. Only if an EBF baby is producing hard, dry, pellet-like stools, seems to be in pain when pooping, or is pooping less than every 2 weeks is there evidence of constipation.

[@llli*chicas]

I agree with PP...I too work 12 hour shifts and even though I pump every 3 hours/20 min. My milk supply has dropped as well. I also introduced solids at 6 months, baby was not interested at all, so I backed off and reintroduced them at 8 1 /2 months, with much more success. My only concern is that you mentioned baby is drinking four 6 oz bottles??? the usual rule of thumb is 1-1.5 oz per hour you are away, not to exceed more than 4 oz. at a time. www.kellymom.com.

[@llli*martymarello]

Thanks so much to you both. I have been really stressing about this, and I actually heard that stress can decrease milk supply, too! I am going to try to pump more at work... somehow! Also, she is sleeping through the night, but I am not averse to getting up in the middle of the night and pumping to try to increase the milk supply. I have a Medela Pump In Style, and judging by how much it cost, I think it is a very good model. I will try to change the size of my shield. And how do you get your pump checked to see if it needs to be reconditioned? I have been using it heavily for almost 6 months, so I guess it's possible that it's wearing out.

Also, I think I will wait a while to reintroduce solids. My baby used to poop at least once a day, and ever since I introduced the cereal, she will go days without pooping, and then when she does the consistency is drastically different than it used to be. She has not shown signs of being really uncomfortable though, and it is not hard poop... just not as liquid as it used to be. I'm hoping that by taking the solids away and going back to strictly nursing, her little bowels will be fine.

I am interested in the 1-1.5 oz of milk per hour you are away rule... I NEVER heard that! I had NO idea how much milk to put in each bottle, and how many bottles to give her, so I sort of let my babysitter tell me what to do. So you are saying she should really only be drinking five 4-oz. bottles, or thereabouts? Do you know why they say that is the rule? I am just worried because she's been drinking 6-oz. bottles for at least a month now. I had no idea I was doing it wrong!

Again, thank you. I wish I could give you both a hug! It is such a relief just to have some advice.

[@llli*mommal]

Call Medela and ask. They may have a local dealer who can look at it, or you may need to send it in.

As for where the recommendation on bottle size comes from... I think it's based on the amount that a breastfed baby typically takes in when nursing at the breast, determined by before and after weights. There's a big difference in the amount a breastfed baby takes in at the breast and the amount a bottle-fed baby will drink. A bottle-fed baby will take in a large amount relatively infrequently, whereas the breastfed baby will take in smaller amounts more frequently. I would speak to your caregiver and ask for smaller, but more frequent, feedings.

[@llli*chicas]

www.kellymom.com is the link that has all the evidence-based information on how much is suggested to bottle feed a baby. It also has a pamphlet on "How to bottle-feed a breastfed baby" that is very good to give to your care giver. As a last note, the new American Pediatric Association guidelines, does not recommend that any baby (breast or formula) be fed more than 5 oz at any one time feeding.

[@llli*martymarello]

Interesting! Thanks for the good info about the bottle feeding.

A follow-up question about milk supply... Do you think that if my baby is not fussy in between feedings, and she is sleeping through the night, that she is probably getting enough milk? Is that a reasonable way to measure it? Or should I go by how many wet diapers she has (usually 4 to 5, but they're not really, really wet)? Or something else? I am trying to pump after every time I feed her when I am home because my sister told me that is supposed to be a way to increase your milk supply. Also I am going to work tomorrow and have made a committment to myself to pump three times

I am planning on going to my first LLL meeting this Thursday evening and I'm really looking forward to talking to some people, but thought I would ask y'all as well.

Thanks again. This new mama really appreciates the input from experienced mamas

[@llli*chicas]

Sometimes we miss "wet" diapers because of the super absorbent disposable diapers that are out in the market...unless you are using cloth diapers? also, baby may wet and then poop, so once again, the wet part is not very accurate. I personally will go with how baby is acting. If is not fussy between feedings and her gain wt is adequate, then her intake is good.

[@llli*mommal]

I think the one thing that would concern me is that your LO is drinking 24 oz of milk at daycare. That's a huge amount of milk, and she may be tanking up so much at daycare that she's not that interested in nursing at home. And not being all that excited about nursing when at home could be part of the reason why your pumping output has taken a hit.