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Thread: low milk supply - have to supplement with formula

  1. #1
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    Default low milk supply - have to supplement with formula

    Hi everyone,

    Ive read and read everything. My baby is 5 weeks old and basically at week 2 and 3 she wasnt up to birth weight, so doc told me to give formula to top her off - so i did and she went up 8 oz. in one week. Her diapers were and still are fine. I was "topping her off" after breastfeeding about 2 oz., but got uncomfortable because i figured i would make less milk. I've tried pumping but never have made more than half an ounce in one sitting. It would take 2 days to get 1 oz. Now i have been taking fenugreek, lactation supplement tablets by Gaia, domperidone, more milk plus tincture, and mothers milk tea. I basically feed around the clock, but baby is only satisfied in the am, when my breasts are fullest. Now i only "top her off" 2 times a day (about 12pm, and 3pm) when my breasts arent making much, and i give her only 2 oz. I have seen a bit of an increase in my supply as sometimes baby gets fussy because milk sprays on her, but then other times she just falls asleep sucking ang sucking (w/o swallowing). Anyway, I've tried it all...anything else you suggest?

    Thanks in advance for responding!

  2. #2
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    Default Re: low milk supply - have to supplement with formula

    What sort of pump do you have and how often do you pump? Also, how does nursing feel? Any discomfort?
    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!"

  3. #3
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    Default Re: low milk supply - have to supplement with formula

    milk sprays on baby enough to upset baby? That does not sound like low production to me.

    Aside from mommals questions, I know you said you basically feed around the clock but can you be more specific--how many times in a 24 hour day does baby nurse and 'about' how long each time, (I am sure it varies) do you end the feeding, or does baby?
    When you say baby is not satisfied...what are you seeing?

    Falling asleep at the breast is normal. Baby wanting to nurse pretty much constantly and acting fussy is normal. you say output and weight gain are now normal. So, aside from the fact baby was not back to birth weight be week 3, you are supplementing baby a small amount, and taking many supplements yourself, everything else sounds normal.

  4. #4
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    Default Re: low milk supply - have to supplement with formula

    Well, in the AM, my LO is satisfied (smiling, happy), but as the day progresses she gets more fussy and less satisfied with the milk, whining and crying. She'll take one breast (which is soft by that time) then take the other (still be looking for more) and obviously there isn't much on the other, etc. I'm sure i nurse her 8-12 times a day - whenever she wants. The natural schedule has simply been about nursing every 2-3 hours (but that all depends on her). So, after I started giving formula regularly about week 2-3 I stopped giving it to her because i was feeling bad about my inability to make more, and when I went to weight check her this past week she had only gone up 2oz - leaving the Lactation Consultant to say that i've still got to give her a little bit of formula (but just a "top off").

    I think that my breasts don't fill enough for her when she is ready to eat again. At night there is no problem because she sleeps between feedings (at least 2-3 hours), but during the day she wants more and my breasts just don't have that much for her I think.

    As far as pumping...I just don't pump anymore because I would get very close to nothing. But I do have a Hygeia double breast electric (the only one that is supported by LLL)

    I have no discomfort nursing (she latches really well). Also, her feeding ends when she falls asleep (because she doesnt finish really, just nibbles), but i try to give her one breast entirely then the other. She just doesnt stay awake/happy very long - like no long pauses between feeding (15-20 minute max really).
    Last edited by @llli*marissa.basch; May 27th, 2013 at 04:07 PM.

  5. #5
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    Default Re: low milk supply - have to supplement with formula

    I did not realize you had seen an IBCLC. What else happened at that appointment? did she observe a nursing session, do any test before and after nursing weight checks, work on latch with you, check baby to see if there is some reason baby might not extract milk efficiently, that kind of thing?

    Did you show her your pump or pump when with her? Pump performance can be affected by improper flange fit, a torn or worn membrane, or a bad motor although the last is unlikely if it is a new pump.

    According to kellymom.com, normal pump output after about two weeks of age would be 1/2 ounce to 2 ounces per session, if baby is nursing as well. If baby is not nursing and mom is exclusively pumping, she would get a bit more per session. But some mothers just do not get much when pumping. Others need a hospital grade rented pump. Others find it helps to hand express before or after pumping, or do breast compressions while pumping.

    You say output has been the same although weekly weight gain has fluctuated dramatically? What about babies other growth, appearance, hydration…all normal? Have all weight checks been on the same scale, baby only in dry diaper or naked?
    Did baby have a big drop in weight after birth?
    I think that my breasts don't fill enough for her when she is ready to eat again. At night there is no problem because she sleeps between feedings (at least 2-3 hours), but during the day she wants more and my breasts just don't have that much for her I think.
    It is normal for a baby to want to nurse very frequently, even every hour or more for part of the day in the early weeks, and yes, if baby is nursing with high frequency, the breasts tend to feel soft and even 'empty." But a lactating breast is never truly empty. And it is the frequent nursing that will help milk production. There is no need to have time in between nursing sessions in which the breasts fill up. Milk production does normally fluctuate over the day, but I would be surprised if a mother can be making enough milk for her baby some of the day and not enough the rest of the day. While there may be exceptions, as far as I am aware, either mom makes enough milk overall on a given day or week, or she does not. The only exception is that some mothers find baby only takes the breast in the first place if she is very full and thus has a very fast flow-but that is not what you are seeing, or is it? Does baby typically refuse to nurse?
    Even if your production is a little low, you are supplementing so very little at this point, (and I assume that is enough for baby now?) I think there is a good chance you will be able to get your production where it needs to be for baby.

    Even if you do not express much milk when you pump, it is important to trouble shoot your pump and pump (or hand express, or both) for about 15 minutes per side every time you give baby a supplement, if you possibly can. (it does not have to be at the exact same time of course.) Otherwise you may be teaching the breasts to make less than baby needs, the opposite of what you want! Also some moms find it helps to increase milk production if they pump for a few minutes after nursing sessions.
    I am sure you are nursing very frequently. I did not mean to imply you are not. But a very common cause of slow weight gain is baby not nursing often enough or long enough for that particular baby. Going by a healthy babies feeding cues is usually going to mean baby nurses enough, but sometimes, it helps if baby is encouraged to nurse a bit more often.
    Last edited by @llli*lllmeg; May 27th, 2013 at 05:39 PM.

  6. #6
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    Default Re: low milk supply - have to supplement with formula

    When I was with the IBCLC she observed me feeding - and noticed that my LO swallows a bit but not much, did weigh her and she went up 2oz at the time. She also helped with the latching. I didnt show her the pump, and havent pumped in days, cause it really hasnt been effective at all - but i can do it when i give her formula.

    Basically the doc suggested I give her formula every other feeding, but i dont always feel she needs it. Its usually the day time hours when she could use more and is fussier. She is typically on the breast hourly during the day unless napping and she ends up falling asleep at the breast.

    My LO doesnt refuse to nurse but she gets fussy when little comes out and she just sucks and sucks. I guess my overall concern is her level of satisfaction. While nursing from me she rarely seems satisfied and therefore constantly on the breast, therefore also leading to not enough weight gain.

  7. #7
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    Default Re: low milk supply - have to supplement with formula

    2 ounces for a before and after nursing check is reasonable-right? Of course, this only measures what happened at the one nursing session, nevertheless, this indicates pretty good milk extraction- What did your IBCLC say about it? When was this btw?

    Have you seen improvement with any of the galactagogues? were these suggested by your IBCLC? Have you read the book Making More Milk?

    It's the possibly inadequate weight gain that indicates there is a possible problem. Not your baby's behavior, which is normal. Might they be related? Of course. But they also might not. Babies who are gaining tremendously will also have periods of the day where they fuss and fuss and never appear satisfied. Even babies whose mothers have obvious overproduction will act this way.

    I can see that pumping is frustrating, but I don't know what else to tell you-it is just a basic rule of lactation management that if baby needs supplemental feedings or partial feedings that they get with a bottle, cup or syringe, that is 'missed' time at the breast, so mom needs to then pump or hand express in order to maintain or increase production levels. Is it doing anything if literally no milk comes out? I don't know, but then the question becomes why is nothing coming out. Is it the pump or what?

    I just thought of something that might help...Have you considered or tried a lactation aid for giving supplements? see this article... http://cwgenna.com/smartnothard.html

    Do you plan to see LC again, doctor, have another weight check soon? I look at it this way-you do make milk. Maybe not quite enough. But pretty close. Your baby seems to be able to nurse ok. So you are very close to exclusively nursing.
    Formula supplements treat the symptom. Sometimes, that is all that is needed, and mom and baby figure out breastfeeding and go off the supplements in a few weeks and that is that. But sometimes it is important to figure out what the underlying issue is, so that interventions can be targeted to you. That is the detective work you and your IBCLC could be doing together. You might need blood tests (could you be anemic?) or hormone levels taken, or thyroid function tested, etc. This is stuff that is over my head but your IBCLC should be able to walk you through.

  8. #8
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    Default Re: low milk supply - have to supplement with formula

    with LLLMeg. Just one more question- birth control. Are you using any, and if so, what kind?
    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!"

  9. #9
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    Default Re: low milk supply - have to supplement with formula

    So, I'm not on birth control. I've been eating galatagogues like oatmeal, pineapple, quinoa, etc. I also did get my blood checked and all is good. Most days I feel like my LO is fine with just my milk, but then i have dips in the day when she nurses so often i get drips of let-down and other times when i have an overactive letdown that makes her cry and detach. I did pump one breast while giving her the other and I got just about 1 ounce from it (but I was nice and full). I'm just letting her feed each and everytime she gets fussy and wants more (even if nothing comes out). Lactaction aids are a major investment (but thank you so much for the suggestion). I was just wondering if there was something else I could do to make more milk.

    As far as weight gain in concerned, two weeks ago Thursday she weighed 8.0, then last Friday she was at 8.2 (which is when the LC told me to continue with the formula because I hadn't that week-which showed in the low weight gain). This Tuesday I weighed her, and she was at 8.7 (and that's only 2oz of formula being given a day). I love bonding with my LO, but this breastfeeding is incredible.

  10. #10
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    Default Re: low milk supply - have to supplement with formula

    The best way to make more milk is to increase frequency of milk removal from the breast, and to drain the breast more completely. If the baby isn't doing the job, then you use the pump. Ideally, you nurse and then pump for 10-20 minutes. The more you pump, the more you'll make, so you want to aim to maximize the number of pumping sessions in your day. When I was pumping to increase supply, I did so every 2 hours during the day and every 3 at night. Exhausting. But it did the trick!
    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!"

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