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Thread: Low Milk Supply seeking help!

  1. #1

    Unhappy Low Milk Supply seeking help!

    7 1/2 weeks ago, I delivered a beautiful baby girl (2 weeks late) via caesarian. After 42+ hours of labor, the already ridiculously slow progression stalled completely & I developed an infection and renal failure. During the caesarian I lost greater than normal blood (1400 units), but did not require the doctors giving me blood. This did, however result is pretty severe iron deficient anemia (iron level was 26 with a range of 50-70). Doctors suspected a lack of proper Oxitocin and Prostiglandin release for the uber-slow labor, but this was never checked or confirmed.

    Right now, I average 20-30 mL of breast milk total (between both breasts) per pumping (30 minutes). The baby has been a perfect latch from day one. But early on I was struggling to produce even 5 mL total milk per 20 minute pumping session. We originally fed her via Supplemental Nursing System, so that she could still feed at the breast even though she was mostly consuming formula. After nearly 8 weeks, we have switched to mostly bottle feeding formula with the occasional breast milk addition or breast milk-only feeding (depending on what supply I have extracted). I do put her to breast at least once a day. And she still sucks as best she can, but there is very little swallowing going on - usually one swallow to every 3-5 sucks. When I pump and when I have hand extracted, the milk comes out in very slow drips. I'll get one drop every 2-5 pumps or tugs.

    Other important history notes:
    • I have Hashimotos Thyroiditis. It is well controlled. In fact I just had lab work done & my THS was a little low, meaning I could cut back a bit on my thyroid medication.
    • At my 6 week post partum appointment, by uterus had not shrunk down as much as should have. I am going back next week (8 weeks post-partum) to follow up & see if it has shrunk down yet. If it has not (and I don't feel as though it has), I go for an ultrasound to see if there is any placenta fragments remaining or to see any other reasons why it has not shrunk.
    • Recently baby has developed a milk allergy. I have cut out dairy from my diet.
    • It did take me some time to find an iron supplement that I could tolerate. The first one I was on, wreaked havoc on my system and killed my already low milk supply to virtually nothing (1-5 mL total per pumping after having gotten up to 10-15 mL average).


    We feed/I pump every 2-3 hours with the occasional 5-6 hour break depending on what baby's feeding is like.

    What can I do to help increase my supply?

  2. #2
    Join Date
    May 2006
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    Default Re: Low Milk Supply seeking help!

    Welcome to the forum, and congratulations on the new baby!

    I think that if you can push that ultrasound forward ahead a bit, it might be to your advantage to do so. One thing retained placenta fragments can do is convince your body that you're still a bit pregnant- and as long as your body is in that mode, milk production is going to be inhibited. I would also talk to your doctor about backing off on the levothyroxine or Synthroid or whatever it is you take- having low TSH (i.e. being on the hyper end of the spectrum) can cause supply problems, just as being on the hypo side can. Basically, I'm suspicious that something medical is inhibiting your supply. Your baby had a great latch from day 1- that, plus frequent nursing, is generally all that is required to generate a sufficient milk supply.

    Let's talk pumping- you're pumping frequently, which is great, but what sort of pump are you using and are the shields correctly sized? Is pumping comfortable for you?

    I'm really glad you are still putting the baby to the breast 1x per day. That's a great way to keep your options open for the future. You might want to consider doing more nursing than 1x per day, if you can find the time/energy for it, just because it's good for the baby to practice at the breast and because it should be good for supply- potentially even better than pumping, if the baby is good at nursing.
    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

    Default Re: Low Milk Supply seeking help!

    I forgot to mention that I just saw my Endocrinologist today... That's when I found out my TSH was slightly low (.17 in a range of .3-3.3 for normal - MY optimum has always been .75-1.0). And we are adjusting my Synthroid to compensate for that.

    I use the Ameda Truly Yours pump. I have had a lactation consultant watch me pump to make sure I was doing it right. She said that the shields looked right for me. But today I was noticing that my right might not be. The nipple and a good portion of the areola (almost all of it, but not quite) were getting sucked up into the shield. The left seems to be OK, but I get a much lower volume from the left than I do the right (usually 1/3 of total is from left and 2/3 of total is from the right). Pumping has not be super comfortable. It feels fine during, but I notice my nipples get more raw from pumping than they do from her breastfeeding. I tried playing with the suction. If I go low enough that it is more comfortable, my volume goes way down (and I don't go very high on the suction to begin with - only about 1/4 of the range the machine can go). I keep the speed at the highest setting (which actually still seems very slow to me - slower than what she sucks when she is at the breast).

  4. #4
    Join Date
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    Default Re: Low Milk Supply seeking help!

    The APY is probably not the pump you need. It's a lighter weight machine made for a working mom with an established milk supply, who is pumping a few times a day and nursing often. It's not a good pump for a mom who is relying on it full time or almost full time. Also, the fact that you're having pain with pumping- that points to something not being quite right about the fit between you and the machine.

    I'd contact the LC and ask about renting a hospital-grade pump. Hopefully that- plus the adjustment in your meds- will get you more milk. Though I'm still very curious to know what the ultrasound will say about the possible placenta fragment.
    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!"

  5. #5

    Default Re: Low Milk Supply seeking help!

    Update:

    So I had my follow up appointment yesterday... and yep... there was still some tissue in the uterus and a large amount of endometrium there as well. I have a D&C scheduled for 10/30 to have that removed. Doctor didn't seem to think this little bit would have an effect on my milk production though.

    I'll also be reaching out to my LC shortly to discuss renting a hospital-grade pump.

    My doctor also gave me a script to have my prolactin checked. She doesn't think that is a factor & wasn't too keen on writing it, but I insisted (my Endocrinologist seems very interested in this as a possibility because of my very difficult labor and excess blood-loss with my Caesarian, but didn't write the script himself because he didn't want to step on my OB's toes)...

  6. #6
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    Default Re: Low Milk Supply seeking help!

    Wow, I'd love to know why your doc thinks a fragment of retained placenta wouldn't cause supply issues. Especially when combined with the large volume of blood loss you experienced. See this link: http://www.bestforbabes.org/booby-tr...of-low-milk-pr

    I don't know your doc, but from some of the details you've posted, I have to wonder a bit about him/her. S/he's all set to blame your stalled labor on a lack of oxytocin and prostaglandins, without any data to back that up. Doesn't want to check your prolactin level, despite the fact that when there's a problem with lactation, prolactin is one of the usual hormonal suspects. And it seems to me that claiming that the placenta couldn't be causing you problems is an indicator that the doc is embarrassed that the delivery of the placenta got screwed up. Because supply inhibition due to retained placenta is textbook- when there's a piece of placenta left behind, it continues to pump out pregnancy hormones, convincing your body that you're still a bit pregnant and inhibiting milk production.

    ETA: it might be interesting to get your progesterone levels checked. Progesterone is the hormone produced by the placenta which can put the brakes on milk production.
    Last edited by @llli*mommal; October 24th, 2013 at 06:59 PM.
    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!"

  7. #7

    Default Re: Low Milk Supply seeking help!

    I am not going to be keeping this doctor. I was with another doctor and practice until only 3 weeks to my due date, when that office closed up shop and left me (and a good handful of other pregnant women) seeking a new doctor/practice to deliver. This doctor actually wasn't the one who did the C-section. She was on vacation the weeks I finally delivered.

    I had my D&C this past Wednesday. Nothing out of the ordinary. There was a bit more tissue than they saw on the ultrasound (but we couldn't see everything with the US because my uterus did that little fold over thingie that some due when retracting). The piece they saw on the US was 1.8cm. I am not sure how much ultimately was removed with the D&C.

    My husband grilled the doctor during post-op trying to figure out why they left me go so long without progression during my labor. This doc who did the D&C was only there for the first 2 hours before her on-call shift was over. So she was not familiar with my situation, but did sympathize with what my husband was saying. I don't recall everything that she said though.

    My GP called to let me know that my Prolcatin was "elevated". I don't know what the actually measurement was. I haven't heard from my OB on the lab results yet. I will probably call my Endocrinologist though for his opinion. I had the labs sent to him as well.

    So... how long after the D&C does it take for milk to come in normally? I don't want to stress myself out with too high expectations. But I also kind of need to gauge when to give up expecting my milk to increase as well. I need to mentally prepare for the worst while still hoping for the best...

  8. #8
    Join Date
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    Default Re: Low Milk Supply seeking help!

    The "when" questions are probably the hardest breastfeeding questions to answer, because every woman is different and responds differently to her baby, her pump, her hormones... The one thing that I feel like I can say with certainty is that there is never a point at which it is too late to increase supply. What you can ultimately expect is as individual as you are, but there's pretty much always hope.
    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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