Re: Almost 4 weeks and still not working
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.
Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
Coolest thing my little girl sang recently: "I love dat one-two pupples!"