New momma having major supply issues

[@llli*chrissy.renae]

Hello everyone. This is my first time here, but not my first time trying to find some answers. Five weeks ago I gave birth to my son, who was 26 weeks and 4 days gestationally. He was born at 8:10 a.m., was whisked immediately to the NICU, and an LC finally came to see me at 6:30 p.m. to show me how to pump.

My problem is that in 5 weeks, the greatest amount I've been able to pump is 3.8 oz in a day. I am using a Medela Symphony at home and a Medela Pump In Style Advanced at work. I have been trying to pump every 2-3 hours for 15 minutes with hand expression afterwards. I massage before and during, I eat oatmeal every morning, drink at least 64 ounces of water a day, and take 2440 mg of fenugreek three times a day; I tried mother's milk tea three cups a day before the fenugreek, but there was no improvement. I have also tried looking at pictures of him and thinking about him, but that doesn't trigger a response. I started back to work October 1st, and because of my job (high school teacher) I can only pump during my conference period and after school in my classroom, and those times are usually 4-5 hours apart. I have watched all of the Stanford videos, and I've noticed that my breasts do not react to the pump the same way as those of the women in the video. I cannot hand express into the bottle as the milk just dribbles down my breast, so I have to collect it with a syringe, and when I do, I usually get .5-2.5 mL more. I also have never been able to distinguish when my breasts are full or empty as I have never felt a difference in my breasts pre-pregnancy vs. post-pregnancy and they certainly have not grown any since I got pregnant nor since my milk came in.

I am now extremely concerned with my supply after what has happened over the last few days. Since October 2nd, my daily supply has dropped down to barely over an ounce. I had a breakdown Thursday evening due to being overwhelmed with work responsibilities and frustrations with pumping. I have since calmed down, but there has been no improvement, and yesterday, even though I stuck with the every 2-3 hours and got 6 sessions in (that includes waking up in the middle of the night to pump), I got my lowest amount expressed (1.3 ounces). I am afraid that something that I did during my breakdown (massaging too hard) may have messed something up. Does anyone have any insight? I really don't want to give up as I am holding on to the possibility that I will respond better once he is able to nurse, but I am so afraid of drying up. He will still get fed donated breast milk while in the NICU, but I want him taken care of when he's ready to come home.

[@llli*mommal]

Welcome to the forum and congratulations on the new baby and on making it this far despite what sounds like a very difficult start.

Don't worry about your breasts not responding like those of the women in the videos. Sometimes I think that nursing/pumping videos should come with a warning label that says "Your breasts probably don't look like the ones in this video." Basically, when it comes to how our breasts look and act, we're all our own special snowflake.

Questions for you-
- When you pump, how does it feel? Do you feel like your nipple is getting scraped along the side of the tube, or is it shooting in and out accompanied by a loss of suction? Is the pump drawing in some areola, or just nipple? Is it drawing in a huge amount of areola?
- Are you taking any medications, or hormonal contraception? If so, which ones?
- Any pre-existing medical conditions? PCOS? Thyroid problems?
- How was the birth? Did the placenta come away normally? How has the postpartum bleeding been?

Basically what I am thinking is that either you're not responding to the pump (maybe it doesn't fit, maybe you're just not that responsive to pumping) or there's something holding your production back (a hormonal condition, a drug, a birth control pill, a fragment of retained placenta). But a lot of your difficulty in producing may simply stem from being at work. Most newborn babies nurse about 10-12 times a day. That frequent and complete draining of the breast is what creates and maintains supply. If you're going 4-5 hours without pumping, that's giving your body the message to throttle back on production. This is not my way of saying that you shouldn't go to work! We do what we have to do. But it would explain the decline in production that you're seeing.

Just to be clear, the most milk you have ever gotten in an entire day is 3.8 oz? Not 3.8 oz per pumping session. Correct?

[@llli*chrissy.renae]

Thank you for responding!

When I pump, I just feel the suction. It starts off like a tug, but then I don't really notice it. I have tried three different flanges (24, 27, and 30) because I was afraid that what I was using was too small. My nipple shoots in and out with the rhythm of the pumping, but I'm not sure about loss of suction. I do know that I almost always have milk pooled in the bottom outer edge of the flange, no matter what size flange I use. My nipple also swells and draws in more areola through the pumping process. This has also happened with all flange sizes.

I am taking two medications for blood pressure--labetolol and hydrochlorothiazide. Both of these are safe for breastfeeding for pre-existing hypertension. That is the only pre-existing condition I have. As far as the birth experience, it was a vaginal birth, I only had partial delivery of the placenta, but the team took the rest of it out and checked afterward via ultrasound. My discharge went from red to pink over the course of three weeks and now any discharge I have is clear. I did suffer the after effects of pre-eclampsia and had to be in the ICU two days after he was born, and during the 24 hours I was on bed rest I was unable to pump. Afterwards I was unable to establish a pumping routine in the hospital due to various people coming in to speak to me or take my vitals. I am currently not on any birth control, and I haven't had my period.

I did say that the most I have ever gotten was 3.8 ounces in a day, and that has only been twice since he was born. Most of the time I was around the 2-2.5 ounces perday range. I have tried ggetting in 8-10 sessions, but have never been able to do so. The most I've gotten in a day is 6.

[@llli*krystine]

Could you have a LC watch you pump and make suggestions? I will try to write more later.

[@llli*chrissy.renae]

Since I'm up in the NICU for most of the day, I've asked to have an LC come by, so hopefully she will before I leave today.

[@llli*krystine]

good. I had twins in NICU this summer and saw a LC almost every day. Probably should have every day but they did stop by and check in on me, watch me pump, watch me nurse, etc. That's what they're there for.

[@llli*chrissy.renae]

Well, the NICU that my son is in is over an hour away one way, so getting up there every day when I couldn't drive, my husband was working, and I had to make lesson plans, grade papers, and enter grades didn't make it feasible. We normally can't make it up to the NICU until later in the evening, and by then the LCs have gone home.

[@llli*krystine]

Are their any RN's who work night shift who are also LCs? One of my babies' nurses basically did RN duties but was also a LC. Can you ask? I'm sorry it's so far away, that sure makes it harder.

[@llli*chrissy.renae]

If there are, we haven't been told. When I called the hospital's milk bank a few weeks back and asked when the LCs left, she did not make any mention of any RNs who are also LCs. One of our nurses did tell me that I needed to have a snack or something to eat every 3 hours, but that is also difficult at work as we are not allowed to have food or drink in the classrooms.

[@llli*krystine]

Hmm, well, they should have some with training. At least it's the weekend so do you catch them then? Can you talk to your principal about allowing you something? When I worked in the public high school I know some of the pregnant teachers would just have to eat and drink in class to not get sick. Or I know resident MDs who put granola bars in their pockets and eat in the bathroom, gross as that may be.