Help, Low Supply?? Ped asked to supplement.

[@llli*ykmom]

Hi,

New to the forum and a first time mom and really need some advice with my situation. Here's my background info:

Son's age: 15 weeks
Feeds: approx every 1.5 to 2 hours daytime, unless he naps then about 3 hours & about 4 hours at night
Feeding sessions: last about 40 mnts to an hour
Generally breastfed
Wet/soiled diapers: about 5 a day with morning diaper being extremely wet (same diaper about 8 hours - would that count as 1 wet diaper or 2??). Poops once in two days since about 3 months of age.

Birth weight: June 6 - 3.78kg June 6
@ 2 weeks: 3.79kg
@ 1 month - July 6 - 4.27kg
@ 2 months - August 15 - 5.4kg
@ 3 months - Sept 4 - 5.78kg
@ a week later, Sept 13 weigh in: 5.95kg

So due to Sept 4th's lower weight gain (always same scale) I was told by my Ped to supplement as much of 90ml 4 times a day for a week to get weight up to 6kg as "3 month olds should weigh at least that" and to come back a week later for weigh in. And at the same time to give as much breast milk as possible. I was very reluctant to give that much formula for fear of my already low supply dipping and tried to up it as best i could by nursing more frequently, often on the hour, switching sides, doing compressions, drinking fennel tea and non alcoholic malt drinks throughout the day. Two or three times I caved in and topped up with formula after almost an hour of breastfeeding when baby seemed like he was still hungry; drank almost all of the 90cc on all occasions and several times would do a huge huge poop after. Especially worried during the evenings when he usually wants to feed more and am not able to meet his needs and maybe causing him to fall asleep hungry.

A week later he had put on 170gm and Ped said my supply was low and to definitely supplement as mentioned. Again, following that weigh in, I am not giving him formula and would only top up if he seemed like he hadn't had enough although i find this hard to tell and I end up feeling bad that I may be letting him go not satisfied. He does not usually unlatch himself but tends to fall asleep a lot at the breast which is why our sessions are so long and I am never quite sure if he's full. I switch sides to wake him up and if he cries i take it he wants more. After feeding if he is not crying or fussing, I take it that he's had enough.

Possible causes of low weight gain between the two months?:
- approx 4 weeks ago baby started putting his fists to mouth and sucking them. at times right after feeding but it never crossed my mind that he would still be hungry because he never cried or fussed and was content sucking fists. did i misinterpret this? would this be a sign of the 3 month growth spurt? i feel bad that i might have missed it and maybe caused my supply to dip and cause his low weight gain??
- during this time i also had consecutive blocked ducts over the course of 10 days on right, lesser producing breast and it affected my supply to the point where baby would cry, refuse or fall asleep straight away each time i put him to it. these ducts have now cleared and milk has somewhat returned and baby will feed off it most times.
- baby started sleeping longer hours throughout the night to about 5 hours, and once for 6 hours. previously slept 2-4 hours between feeds. we are now waking him up every 4 hours for a feed and not letting him go longer without one (he usually wakes up anyway these days around these times).

Also my left breast is the larger and produces much more milk and baby generally nurses more and longer on this side. I try to offer the right breast as often as i can . Sometimes he fusses on the left breast towards the later part of nursing by repeatedly unlatching then latches back on, sometimes cries sometimes not - is this due to low supply or milk finishing and him wanting more? He does this too sometimes on the right smaller breast and at the beginning of feed after one or two sucks. Also at night, the left breast gets fuller much more quickly than the right breast does which generally feels soft throughout the day.

Sorry for the long post as am not sure what to do and wanted to get as much info in as possible. Is my supply low? What should I do? Supplement? I don't usually get much when i pump (very happy if I even get to 20ml mark) or get to do so often because his feeds are so close (should they even be this close at this age??). Recently I had to be away for about 5 hours and missed two feeds and pumped only about 40ml after. How do i know when he's hungry other than the obvious too-late cry?

His monthly check up and weigh ins are totally stressing me out.

[@llli*krystine]

Just a few ideas and somebody else will I'm sure chime in with better ideas. But sucking and rooting are both hunger cues. Crying is a very late hunger cue. Try to catch your baby before he gets to crying.

I don't think there's a rule about how much a baby should weigh at a certain age, although I know there's low birth wt babies (I have one) etc. but you're looking for a pattern of wt gain, from what I understand and I believe 4-7 oz or 120-210g/week.

I have to go, sorry this is so short!

[@llli*mommal]

I converted all your kg into lbs for the non-metric mommies:
Birth: 8.33 lbs
2 weeks: 8.33
1 month: 9.41
2 months: 11.9
3 months: 12.7
3 months 1 week: 13.1

Based on the above, I don't understand why your doctor thinks there's a problem. Your baby is basically maintaining the same curve he was born at, falling down slightly between the 2 and 3 month checkups. But it's normal for babies to wiggle around on the charts- normal growth often occurs in spurts rather than at a constant rate! His nursing frequency is normal, his diaper output is normal. And of course there is no real "should" when it comes to how much a baby weighs at a given age- there are healthy babies in all percentiles! There are huge 3 month olds and tiny ones, and it's all normal. This chart for breastfed babies gives a sense of the normal variation: http://kellymom.com/images/growth/growthcharts.gif

Other than the doc being so discouraging, why do you feel that your supply is low? And do you happen to be taking any form of hormonal contraception? Any medical issues which could explain low supply- PCOS, thyroid issues, retained placenta fragments?

[@llli*still.here]

I agree with mommal, I don't really see a problem with that weight gain. I think your doc jumped the gun telling you to supplement.

[@llli*lllmeg]

Have you told your doctor you have low production or did he tell you? Was breastfeeding ever assessed by an IBCLC?

Can you seek a different medical opinion?

the weights seem fine to mommal and still.here (I am in a hurry and cannot double check but I trust their judgment) However, we do have to remember the doctor has examined baby and may be basing his recommendations on something other than weight gain.

But even if baby is not getting enough milk, it is important to understand completely, why. Low production is only one possible explanation. There may be another reason or at least other contributing factors.

For low supply issues, I strongly suggest the book Making More Milk.

[@llli*iliesmum]

I agree with mommal and still.here. The weight gain seems fine, slight variations from the growth curve are normal. There is no normal weight for a 3 months old, or for any other age, for that matter. I don't see why your doctor wants you to supplement with formula. Was it only based on the weight gain or did he give you any additional explanation?
If I were you, I wouldn't supplement yet, I would wait a little and see how things evolve. I would offer the breast very often, look for hunger cues, maybe even try to weigh him more often for a month (like once a week?) - I know this could be stressfull and maybe unnecesary, but , personaly, I would do it. Not at your pediatrician, though. Do you have any family doctor/nurse/ midwife where you could weigh him a few times on the same scale? Maybe someone with an open mind towards breastfeeding?
About the pumping :
- my son had approximately the same schedule as yours at 3 months. I didn't get a lot of milk either when I was pumping back then. But I think this is normal with such frequent feedings. However, I remember that I was pumping more in the morning than in the evening. When and how often a day do you pump?
- what kind of pump do you have? An electrical, graded pump can be much more efficient than a manual one.
-always keep in mind that a healthy baby is better at milk removal than any pump, so your son gets more that what you pump.
Good luck!

[@llli*mommal]

However, we do have to remember the doctor has examined baby and may be basing his recommendations on something other than weight gain..

An excellent point. I'd want to have a second opinion- and maybe a third or a fourth- before accepting that there's a problem with the baby's weight gain or your supply. Is seeing a different pediatrician a possibility for you? If they all pick up on the same things, then maybe there is a problem that we're just unable to "see" over the Internet!