Almost 4 weeks and still not working

[@llli*maxcookie]

Due to preeclampsia, I was induced almost 4 weeks ago when the baby was only 34 weeks. Everything was so sudden. I had complications and needed blood transfusions, my blood pressure was going crazy - everything was a mess. I didn't even see the baby for a day. I started pumping at the hospital two days after he was born and then after about a week of pumping 6 to 8 times a day I was getting a total of about two ounces of milk, which we would bring to him in the NICU.

Now he's been home for two weeks and I'm still not getting any more than that. My breasts are the same size as they were before I even got pregnant, I have no sensation of them filling up or letting down. The only way I can even tell that I'm making milk at all is when I can see it in the pump. I've been trying to stimulate more production, so I'm trying to nurse every time he's hungry, but I don't think he's getting anything. He then drinks a full bottle of formula afterwards, and when he's really hungry he refuses to nurse altogether. I'm taking Fenugreek. I really don't know what else to do.

I asked my doctor about it and she said that if it has been this long and nothing has happened that it probably isn't going to. I just feel terrible. I left a message with the lactation center at the hospital but based on past experience I don't think that they are going to be helpful either. I don't know what else to do. I feel terrible. Is there anything I can do?

[@llli*mommal]

Welcome to the forum and congratulations on the new baby! I am sorry she had to come so early, and that you had to go through the absolute nightmare of pre-e. So glad you and baby made it through, though!

You are making milk, so it's not like "nothing has happened". at your doc for putting it that way and discouraging you! There are several possible explanations for supply issues in a mom in your situation:
1. Not pumping often enough. 6-8 times is good, but when you're trying to bring in a milk supply you want to pump at least 8 times a day, with 10-12 being preferable. You'd be aiming to pump as often as a newborn would nurse, which is generally 10-12 times in 24 hours.
2. The wrong equipment. You want to be using a hospital-grade pump and correctly sized breast shields to ensure maximum milk removal and breast stimulation.
3. Retained placenta. If there's a piece of placenta still hanging out in the uterus, the body behaves as if it is still pregnant, inhibiting milk production. Talk to your doc about this possibility.
4. Thyroid problems. Very common postpartum, and both hyper- and hypothyroid conditions can cause issues with supply.
5. PCOS. About 30% of women with PCOS have trouble with supply.
6. Magnesium sulfate. I assume this was part of the treatment for the pre-e. There are anecdotal reports of MgSO4 delaying the onset of milk production.
7. Breast hypoplasia or insufficient glandular tissue. Very rare.
8. Breast surgeries, including augmentation and reduction.

Some of the things you mention are normal.
- Baby drinking a full bottle of formula after nursing: normal. Babies love to suck, and even if they eat well at the breast they may chug down a large supplemental bottle, because the bottle produces a swallow of milk with every suck. When the baby sucks on a bottle, he needs to swallow or he will choke.
- No sensation of filling up or letting down: normal. Not all moms feel either one of those things.

Here's what I would do, in your shoes:
1. Talk to your doc about possible medical explanations for the low supply (PCOS, thyroid conditions, retained placenta)
2. Find an independent lactation consultant, preferably an IBCLC, and ask for a second opinion.
3. Make sure you have the right equipment- hospital grade rental pump, correctly sized shields- and use it frequently.
4. Try the herbal supplements which may increase supply: fenugreek, blessed thistle, oatmeal.
5. Talk to you doc and LC about Reglan and Domperidone, prescription drugs which can increase supply. Both have side-effects in addition to increased milk production, and are not safe for all moms.
6. Consider renting a professional baby scale, accurate to the 1/10 of an oz. You can do before and after feeding weights on the baby, and use those to determine how much milk baby took in while nursing, which can help you determine if and when baby needs a supplemental bottle.

[@llli*lehall]

The short answer is YES! there are lots of things you can be doing. The best starting point is to get as much skin-to-skin contact as possible with your baby and offer the breast pretty much constantly. If you need to supplement, there are breastfeeding friendly ways to do that. Other mamas here know lots more details than I do, but I just want to let you know you do not need to despair. Try to take some time to enjoy your baby, even with the challenges.

[@llli*djs.mom]

I wouldn't give up yet. 1st of all your baby isn't really due for another 2 weeks. And if the baby was taken from your surgically your body and your baby isn't latching as often as he normally would your body still may not know you have given birth. Also if you truly want to make it work, you HAVE to pump more often. I understand that it's time consuming and overwhelming, but the truth is if you were ebf you would be doing so WAY WAY MORE than 6-8 times a day. A newborn as at the breast all day. You need to up your pumping sessions from 6-8 to 10 12 times in a 24hour period. You need to demand the way a newborn really would for your body to get the message that a baby is there!
I know that is confusing but a child who is drinking mostly formula simply won't give you the same number of ques that an EBF child would to eat. So you have to que your body yourself. I DO think it's a good idea to always start at the breast because you want your baby to remember how to latch. And then begin to move away from bottles. But 1st things 1st. Let's get your body to recognize that the baby is here!

Also where do you live? Can you get Domperidome?

[@llli*maxcookie]

I have a hospital-grade pump. How do I know if the nipple shield is the right size? Everyone keeps mentioning this to me and I've tried both the sizes that it came with and I can't really tell the difference.

[@llli*maxcookie]

Oh, and thanks for getting back to me so quickly!

[@llli*maxcookie]

Thanks for the responses. My doctor said that there was no medication I could take. Please tell me more about Domperidome.

[@llli*mommal]

Shield too big: nipple will shoot in and completely out of the tube, mom will experience feeling of loss of suction

Shield too small: nipple will rub painfully against the sides of the collection tube

Often the way to tell the difference between a properly fitting shield and one that isn't is to look at output: if you get more milk with one size versus another, then use that one, even if the fit doesn't look perfect.

[@llli*djs.mom]

I don't know where you are. There are issues with getting in the the US. But you can get it in Canada and...pretty much ever other country that is civilized.

[@llli*djs.mom]

And there is tons of natural things you can do to boost supply. Beside Fenegreek you can eat oatmeal every morning. There is mothers milk tea, and I believe reglan also can be used. Dandelion supplements are also used in Asia. Which you can get at any health food store. But the most important thing you can do and that you NEED to is demand the milk. 6-8times in a 24hour period is not enough demand this early to maintain supply. You have to up the demand.