Low supply last time

[@llli*mamalump]

Hello all, I'm 30 weeks pregnant and trying to think ahead and get ready for baby #2. I struggled with low supply and an itty bitty guy (although he never fell off the charts). I ended up on domperidone from about 7 months until 12 months when I stopped taking them. He weaned while I was pregnant at about 17 months, but from 12-17 months it was mostly comfort nursing because when I stopped the drugs my supply was almost non-existent. Its funny, he is almost 23 months now and occasionally asks for "boobie" but as soon as I take it out he says, "all done boobie"

Anyway, I do not want to have supply issues again. The only thing that really saved us is that my son would only drink about 8-12 oz during the day at daycare, so with the help of domperidone and a hospital grade pump, I could keep up with that. However, if this babe takes the bottle better, I'm really frightened about being able to keep up. And honestly, I DO want her to take the bottle better. Waking to feed every 1.5-2 hrs from 6 months 1 year was exhausting. We did cosleep, but I couldn't sleep while he was nursing.

I know the standard advice is not to pump until your supply regulates. So, I didn't pump on a regular basis until my son was 6 months when he went to daycare. I'd like to have a better supply this time, so am considering pumping from the very beginning at least once per day while still only EBF, but only to freeze. Then later on (maybe 8ish weeks) twice a day, with one pump going into the freezer and the other to help babe #2 learn to use a bottle. She will start daycare full time at 6 months as well, but because my son had such a hard time with the transition, I'm going to send her for a couple hours every other day starting at 3 months. I haven't worked out the details of that arrangement yet, so I don't know if she will take a bottle or I will just feed her, leave for 2ish hours and feed on pick-up.

Anyway, what do you think? Would pumping at least once a day from the start be ok to start a freezer stash/help with low supply?

[@llli*mommal]

Congratulations on the baby to come!

I think the first thing to remember is that every nursing experience is different. You had issues with low supply last time, but this time you could end up with oversupply. Don't laugh- it happens! I had low supply with my first and a monster oversupply with my second, in part because baby #2 was a much better nurser and in part because supply tends to improve with subsequent babies (since your body has had more opportunities to experience the hormonal changes of pregnancy which prepare you to breastfeed).

The second thing to remember is that you and your baby want to master breastfeeding before you introduce bottles or the temptation to use bottles into the equation. Nursing a newborn can be super-frustrating, and when you have the option to use a bottle... Even the most pro-breastfeeding parents will sometimes yield to the temptation "just this once".

So I would not pump at all in the beginning. Give yourself at least 4-6 weeks to master breastfeeding, to make sure your supply is more or less in line with baby's needs, and then start pumping.

ETA: I totally understand the fear that comes from having struggled with supply. When I was pregnant with my second, I considered pumping right from the beginning, too, since I didn't want to have supply problems again. And I am SO GLAD that I didn't, thanks to what I had learned about oversupply on this forum. Because the second time, I had oversupply and that was without even having a pump in the house. If I had pumped, as I considered, things could have been much, much worse.

[@llli*koms1016]

I'm in the same boat! I was actually planning to pump in the beginning but don't know what to do now. My doc said to pump after feeding the baby yesterday to avoid the supply issues I had first time, so all this advice is very confusing.

So...what is a mother trying not to fail the 2nd time around supposed to do? Pump? No pump? Feed on demand? Feed on schedule? Supplement? Take meds?

[@llli*mamalump]

Congratulations on the baby to come!

I think the first thing to remember is that every nursing experience is different. You had issues with low supply last time, but this time you could end up with oversupply. Don't laugh- it happens! I had low supply with my first and a monster oversupply with my second, in part because baby #2 was a much better nurser and in part because supply tends to improve with subsequent babies (since your body has had more opportunities to experience the hormonal changes of pregnancy which prepare you to breastfeed).

I do think he didn't have the best latch, and while the doc said there was no real tongue tie, when he stuck his tongue out it forks slightly. My friend mentioned that she could see her daughter's tongue when she was nursing, and I could never do that. So, it could've been a latch issue. Which would make sense to why he skyrocketed in weight in the beginning when my milk first came in and then it tapered off after it regulated.

The second thing to remember is that you and your baby want to master breastfeeding before you introduce bottles or the temptation to use bottles into the equation. Nursing a newborn can be super-frustrating, and when you have the option to use a bottle... Even the most pro-breastfeeding parents will sometimes yield to the temptation "just this once".

I'm not worried about that. My family DH, MIL, FIL, and my mother (essentially everyone except my dad who is totally hands off) are very very pro-breastfeeding. I have no intention of introducing the bottle until I feel like she needs to learn how use one and breastfeeding is well established. I never even gave my son a pacifier out of fear of nipple confusion. All milk pumped in the beginning would go directly into the freezer or if it turned out to be lots, I'd donate.

So I would not pump at all in the beginning. Give yourself at least 4-6 weeks to master breastfeeding, to make sure your supply is more or less in line with baby's needs, and then start pumping.

But, if I wait until my supply regulates to start pumping, isn't that dangerous since at least last time I didn't respond as well to the pump, and babe will need all the milk I do pump? Doesn't that lead to a vicious cycle?

I don't want to end up with a huge oversupply problem, but enough that when I go back to work the decrease in my supply that always comes from switching from feeding at the breast to pumping 3 times a day during the day will still be enough to cover her needs without meds or renting an $$$$ pump.

[@llli*mommal]

So...what is a mother trying not to fail the 2nd time around supposed to do? Pump? No pump? Feed on demand? Feed on schedule? Supplement? Take meds?

Feed on demand, or at least 10-12 times per day in the early weeks. Because milk supply = demand, on-demand nursing is really all that almost all moms and babies require in order to be successful at nursing. Schedules are generally the enemy of nursing success, unless you have a very sleepy or non-demanding baby who nurses less than he/she should.

I know pumping is suggested by many, many people, but I personally think that early pumping is one of those "booby traps" that tends to undermine breastfeeding rather than support it. When a mom pumps, she runs the risk of stimulating an oversupply problem- and I have dealt with both undersupply and oversupply and while I would much rather have the latter than the former, oversupply is no fun for mom or baby! You end up with a baby who struggles with fast letdowns, spits up even more than average, hates comfort nursing, levers off the breast during letdowns leaving your milk squirting into the air (which is great fun when nursing in public), and has green poop and lots of gas. The other problem with pumping, IMHO, is that it encourages a mom to measure her breastfeeding success based on her output at the pump, and not by the baby's weight gain, diaper output, health and happiness, etc.

I do think he didn't have the best latch, and while the doc said there was no real tongue tie, when he stuck his tongue out it forks slightly. My friend mentioned that she could see her daughter's tongue when she was nursing, and I could never do that. So, it could've been a latch issue. Which would make sense to why he skyrocketed in weight in the beginning when my milk first came in and then it tapered off after it regulated.

I think you should see an otolaryngologist, speech pathologist, pediatric dentist, or simply a different pediatrician. A baby whose tongue "forks" and who has difficulty getting his tongue to protrude past the gum line- that sounds like a tongue tie to me. Not only can tongue ties impact nursing, but they can also impact speech- which is why I would see someone about this even though your difficulties with nursing this particular baby are in the past.

It's normal for weight gain to be very rapid in earliest infancy, when milk supply tends to be highest and the baby does nothing but lie around and pack all his milk intake on as fat. Once a baby gets more mobile, more and more calories go into things like reaching/rolling/crawling/standing, so the rate of weight gain tends to decline with time. If it didn't, a lot of babies would reach their first birthdays too fat to move- literally. My second kid would have been... OMG, she would have been around 61 lbs on her first birthday! Never calculated that before.

I'm not worried about that. My family DH, MIL, FIL, and my mother (essentially everyone except my dad who is totally hands off) are very very pro-breastfeeding. I have no intention of introducing the bottle until I feel like she needs to learn how use one and breastfeeding is well established. I never even gave my son a pacifier out of fear of nipple confusion. All milk pumped in the beginning would go directly into the freezer or if it turned out to be lots, I'd donate.

Awesome.

But, if I wait until my supply regulates to start pumping, isn't that dangerous since at least last time I didn't respond as well to the pump, and babe will need all the milk I do pump? Doesn't that lead to a vicious cycle?

There's regulating and then there's regulating. Most moms start out with some degree of oversupply. That's nature's way of making absolutely sure a newborn gets fed- your body figures it's better to have too much milk than too little. By a few weeks in, most moms are still making more milk than their babies need- not so much that they're getting engorged on a daily basis, but enough that they will likely have extra milk to pump out. Her supply has "regulated", but it's not as "regulated" as it's going to get. By the time a mom has been nursing for several months, her supply is going to be extremely well-matched to the baby's demand- and if you wait until that point to start pumping, you're more likely to struggle because you're unlikely to have more than a tiny bit of "extra" milk to pump.

I don't want to end up with a huge oversupply problem, but enough that when I go back to work the decrease in my supply that always comes from switching from feeding at the breast to pumping 3 times a day during the day will still be enough to cover her needs without meds or renting an $$$$ pump.

I really don't think you need to worry. You're in the extremely enviable position of being able to stay home for 6 months. So let's say you start pumping at around 4 weeks, maybe once or twice a day, producing a few oz per day. For the sake of argument, let's say you get 3 oz per day. You feed 2 oz to the baby so she can get used to the bottle, and you store just 1 oz in the freezer. By the time you go back to work, you have around 150 oz in the freezer, just from storing one single oz per day!

[@llli*maddieb]

Did your low production concerns start after your return to work or before? It may help to be aware that 6 months can in some cases be a tricky time for maintaining good milk production for other reasons, such as baby starting solids and (maybe) sleeping longer at night or for some other reason nursing less often overall than is optimal when with mom. There are ways to lessen the impact of these changes as well as the impact on production of the return to work.

I am confused where mothers are getting the idea they should induce overproduction in themselves via extra pumping before they return to work in order to be able to maintain adequate production once back at work. While I understand the reasoning, I see lots of issues with this approach-

in the main, that 1) overproduction causes many breastfeeding issues and 2) if, once mom is back at work, mom is not able to maintain an appropriate pumping schedule, or is not using a 'good enough' pump (good enough meaning, one that works well for that mom.) or has any other issues with pumping effectively once back at work, or for some reason baby is nursing much less often than baby 'should,' then her production will possibly go down to 'not enough' over time no matter if she started with 'enough' or 'too much!'

But I certainly can be wrong. Is there a book, website, article somewhere advocating this approach someone can direct me to?

Also even if you do decide it is best for you to pump extra to create more production, it need not happen in the first 6 weeks. The first 6 weeks or so are vitally important in establishing an adequate milk production which is done by nursing frequently. But this production is not totally set with no room to move up or down at that particular time. Typically, If you demand more, your body will make more.

[@llli*mamalump]

I think you should see an otolaryngologist, speech pathologist, pediatric dentist, or simply a different pediatrician. A baby whose tongue "forks" and who has difficulty getting his tongue to protrude past the gum line- that sounds like a tongue tie to me. Not only can tongue ties impact nursing, but they can also impact speech- which is why I would see someone about this even though your difficulties with nursing this particular baby are in the past.

I'm not worried anymore. His articulate is actually quite good (for a 2 year old that is.) He can protrude his tongue now. But, just because we should, we will be getting an appointment for a pediatric dentist soon for a teeth cleaning, so I will ask then.

It's normal for weight gain to be very rapid in earliest infancy, when milk supply tends to be highest and the baby does nothing but lie around and pack all his milk intake on as fat. Once a baby gets more mobile, more and more calories go into things like reaching/rolling/crawling/standing, so the rate of weight gain tends to decline with time. If it didn't, a lot of babies would reach their first birthdays too fat to move- literally. My second kid would have been... OMG, she would have been around 61 lbs on her first birthday! Never calculated that before.

Ha! My little guy was 5lbs 12 oz at birth with discharge weight of 5lbs 2 oz. At his ONE week check he was 6lbs!!! With that kind of gain he would be a monster!!! However, it tapered off to the low end of normal within the first 2 months.

There's regulating and then there's regulating. Most moms start out with some degree of oversupply. That's nature's way of making absolutely sure a newborn gets fed- your body figures it's better to have too much milk than too little. By a few weeks in, most moms are still making more milk than their babies need- not so much that they're getting engorged on a daily basis, but enough that they will likely have extra milk to pump out. Her supply has "regulated", but it's not as "regulated" as it's going to get. By the time a mom has been nursing for several months, her supply is going to be extremely well-matched to the baby's demand- and if you wait until that point to start pumping, you're more likely to struggle because you're unlikely to have more than a tiny bit of "extra" milk to pump.

That makes sense!

I really don't think you need to worry. You're in the extremely enviable position of being able to stay home for 6 months. So let's say you start pumping at around 4 weeks, maybe once or twice a day, producing a few oz per day. For the sake of argument, let's say you get 3 oz per day. You feed 2 oz to the baby so she can get used to the bottle, and you store just 1 oz in the freezer. By the time you go back to work, you have around 150 oz in the freezer, just from storing one single oz per day!

4 weeks sounds reasonable, I thought you meant I shouldn't pump at all until 6 months.

[@llli*djs.mom]

Unless you have a deep freezer separate from your fridge pumping now or for 6months of now is literally a total waste of your time. Because you are only supposed to keep milk in your regular freezer for 3 months anyway. And I think depending on how long you were AWAY from your child, his demand was totally normal as was your production. Meaning if you were only away from your child for 8hours a day. 8-12 oz of milk IS the recommended amount.

[@llli*mamalump]

Did your low production concerns start after your return to work or before? It may help to be aware that 6 months can in some cases be a tricky time for maintaining good milk production for other reasons, such as baby starting solids and (maybe) sleeping longer at night or for some other reason nursing less often overall than is optimal when with mom. There are ways to lessen the impact of these changes as well as the impact on production of the return to work.

They started before. DS was always small, which of course is not a concern. He pretty much stayed at the 5% in weight. However, there was some concern when he dropped off his own height curve (also low). I think that was around 4 or 5 months. Neither my husband or I are considered short, so this was unexpected. This was right around the time that I started trying to up my supply by pumping in the mornings and freezing the milk. I believed that by freezing the milk he would nurse more (which he did spend more time on the breast) and my body would respond by making more milk. Apparently though, this didn't happen for me. After trying all the normal herbs, I started domperidone at around 5 months, and he was back on track, even jumping up to 8% in weight. My fat boy! Haha!

2) if, once mom is back at work, mom is not able to maintain an appropriate pumping schedule, or is not using a 'good enough' pump (good enough meaning, one that works well for that mom.) or has any other issues with pumping effectively once back at work, or for some reason baby is nursing much less often than baby 'should,' then her production will possibly go down to 'not enough' over time no matter if she started with 'enough' or 'too much!'

But I certainly can be wrong. Is there a book, website, article somewhere advocating this approach someone can direct me to?

While I know of no book, website, or article, I can explain why I was thinking about this. No matter how good of a pump you have, it is never as efficient as a well nursing child. So, if you go from EBF to pumping after your supply has really really regulated, then at each pumping session you are telling your body you need slightly less than it did prior. Like, maybe babe is able to get out 4 oz at the breast, but the pump is only able to get out 3.8 oz. If you are working full time, then you start making less milk during the day, despite keeping up a solid pumping schedule. I think in the 6 months I pumped at work I only missed 1 pumping session, and I was pumping with a hospital grade pump. However, because if you do have a "good" pump, the difference is slight, while the amount you pump will start to decrease, if you start with a slight oversupply, then you prolong the time before you need to dip into your freezer stash to make full bottles. Not to mention that you'd also have more milk in the freezer to dip into, making the possibility of pumping enough through the first year more realistic. So yes, while eventually you won't make enough, the idea I was thinking of is that you push that time further into the future, hopefully beyond 1 yr. (I don't plan to pump at work after 1 yr, but do continue to nurse on demand at home.)

Also even if you do decide it is best for you to pump extra to create more production, it need not happen in the first 6 weeks. The first 6 weeks or so are vitally important in establishing an adequate milk production which is done by nursing frequently. But this production is not totally set with no room to move up or down at that particular time. Typically, If you demand more, your body will make more.

Typically, yes. See above about what happened when I tried that last time.


I am just trying to explain my reasoning, I promise that I am taking your suggestions to not pump early to heart and will do more research. I haven't made up my mind.

[@llli*mommal]

No matter how good of a pump you have, it is never as efficient as a well nursing child. So, if you go from EBF to pumping after your supply has really really regulated, then at each pumping session you are telling your body you need slightly less than it did prior.

I think that's absolutely reasonable. Another issue is that a working mom can never pump as frequently as her baby would nurse, were they home together. Even if you have a really laid-back, non-demanding baby, some days that baby will nurse 5 times instead of 3 because he wants to bump up your milk volume. You just can't do that at the office- "Oh, I'm going to pump 5 times today, boss. So I won't make the noon meeting." Forget it!