Slow Let Down and Significant Dip in Supply @ 4 Months

[@llli*leemax4377]

Hi all,

This is the first post i have done so i apologize in advance if its in the wrong forum or posted the wrong way.

I am a first time mom of a 4 month old baby girl (4 months today) and have been EBF since she was born. I have had some minor issues along the way but so far so good - that is, until the last week.

My production has always been pretty good if not great and i had an overactive letdown which my daughter adjusted to nicely.

As of about a week ago my supply all of a sudden dipped (i think). I am a stay at home mom but go to school 3 nights a week so Gianna gets fed a bottle those nights and i pump when i get home to make up for the missed feeding. I was getting 6-7oz total from both breasts. Now i am only getting a few ounces. My letdown is also extremely slow from being pretty fast and it is upsetting Gianna, so much so that she keeps pulling away and crying. So at night before bed i pump and feed her a bottle and i do the same for the middle of the night feeding (except i have to pump several times before she awakes to get enough for a feeding).

I have taken Fenugreek and eat oatmeal but i have heard that the best way to increase production is to feed more often. Gianna was eating every 3-4 hours so i am trying to feed her every 2.5 hours but between the slow let down and the lack of milk Gianna gets very upset and will not stay on the breast long enough to wait for the letdown. When she does wait for the letdown she seems unsatisfied when she is done with both breasts. Mouth open looking for more. So i resort to a few ounces from a stash that i have reserved in the freezer because my production was more than she needed for the first few months.

As of yesterday i started pumping every 2 hours after she goes to sleep which means i am not sleeping much. I am nervous to pump after she eats during the day because its so little to begin with that i feel like she wont have any milk when she wants to feed.

Hope this all makes sense to you moms. Any suggestions/advice would be appreciated.

Best Regards
Elisa

[@llli*mommal]

Welcome to the forum!

6-7 oz at the pump is very much on the high side for pump output. 2-4 oz would be a much more normal amount of milk to get, for a mom who responds well to the pump. So I think what is happening here is that your milk supply has adjusted to a level which more closely meets your baby's needs.

Most moms overproduce in the early days/weeks of breastfeeding. Nature is conservative and wants to make absolutely sure that the baby gets enough to eat while mastering the art of breastfeeding. When a mom is making extra milk, she's more likely to feel full or engorged, to leak a lot, to be able to pump out a lot of milk at one time, and to experience fast letdowns. But this state of affairs does not last forever because making extra milk is a waste of your body's energy and also puts you at increased risk for nasty things like plugged ducts and mastitis. So after a while, your body "reads" the baby's demand and uses that to figure out exactly how much milk to make. When baby's demand and milk production adjust and synch up, it's normal for you to feel full/engorged much less often, to stop leaking or to leak less, and to see pump output and letdown speed decline.

Now, what happens to a baby when mom's supply goes from overabundant to just right? Well, the baby is often quite fussy. She got used to one style of nursing, where milk flowed out without much effort on her part. Now that milk isn't quite as abundant, the baby has to work for her meals- and most babies don't like that! They want everything to be easy!

So, what do you do? The best thing you can do is to not get into the "I will make things easy for the baby" trap, which often involves supplementary bottles and dipping into your stash and pumping up your milk volume and taking a ton of herbs. Instead, just engage your patience and let the baby figure out how to get the milk she wants. Let her learn a new, more efficient nursing style. Nurse her on demand, and if you have any concerns, watch her diaper output. As long as that is normal, there's no need to worry even if she is very fussy.

[@llli*leemax4377]

thanks a lot - that makes a whole lot of sense.
she does have plenty of wet diapers - but not as sopping as they used to be. the overnight ones are the same as she is sleeping longer at night than during the day. her dirty diapers are also very very scarce (not one in almost a week!)

i do have concerns still tho - i took your advice and stopped the supplementary bottles but she just will refuse to nurse (she wont even try) - she immediately starts to cry (more like scream) and its very disheartening to hear her scream. so do i just let her scream and not feed her if she will not eat? that does not seem right.
what i have been doing is using the pump to stimulate the letdown and then letting her nurse (she is still a bit fussy pulling off and on but at least she is eating)

my other concern is that when she is done nursing she is still rooting looking for more. that is why i feel like it is not enough. her naps times have lessened also so she is up wanting to eat more frequently. so i just keep trying and she keeps crying so i keep pumping and then letting her nurse. just does not seem like a happy time for either of us right now. she does not seem satiated which makes me in turn feed badly. it also keeps me from leaving the house because i cant carry the pump around with me and she just wont nurse unless there is something there for her to drink fairly quickly.

also what should i do about the bottle she gets when i am in school 3 nights a week ( i am without her for 4 hours) - and what she is getting at every feeding doesnt seem to be enough to keep her calm for 4 hours (it used to be).

lastly, that bottle 3 nights a week has been a 5oz bottle - is that just too much for her? she drinks it all and doesn't spit up and so i feel like it is not too much but maybe it is.

[@llli*mommal]

she does have plenty of wet diapers - but not as sopping as they used to be. the overnight ones are the same as she is sleeping longer at night than during the day.

As long as she continues to have enough wets in a 24 hour period, she is getting hydrated. That's great!

her dirty diapers are also very very scarce (not one in almost a week!)

This may be entirely normal. After 6 weeks, some breastfed babies will poop as infrequently as 1x per week. When they do poop, it tends to be voluminous.

i do have concerns still tho - i took your advice and stopped the supplementary bottles but she just will refuse to nurse (she wont even try) - she immediately starts to cry (more like scream) and its very disheartening to hear her scream. so do i just let her scream and not feed her if she will not eat? that does not seem right.

Well, if she won't nurse, then maybe she just isn't hungry. Babies fuss for a lot of reasons besides hunger. Does the fussiness tend to intensify at any particular time of day?

I wonder if you may not be battling some nipple confusion here. Baby has learned that acting fussy at the breast results in her being given a bottle. A lot of babies love bottles, because they deliver a lot of milk with little effort. So they learn to fuss and reject nursing until they get that easy meal.

what i have been doing is using the pump to stimulate the letdown and then letting her nurse (she is still a bit fussy pulling off and on but at least she is eating)

This is a great technique for encouraging a fussy nurser. But the less you can get away with using it, the better. Again, my feeling is that your baby is at a point where she needs to learn how to nurse, and how to stimulate a good flow of milk, without you having an oversupply and a fast letdown. Making things too easy for her could short-circuit that learning process.

my other concern is that when she is done nursing she is still rooting looking for more. that is why i feel like it is not enough. her naps times have lessened also so she is up wanting to eat more frequently.

At 4 months, she may be transitioning to a new nap routine. Newborns nap unpredictably and all the time. After a few weeks/months, a lot of babies settle into a pattern where they nap 3-4 times a day. As the first year goes on, many babies drop naps, with most babies napping just 1-2 times a day by around 1 year of age.

If your baby is still rooting after eating, just nurse her again. There's no better way to make sure supply and demand stay in sync.

also what should i do about the bottle she gets when i am in school 3 nights a week ( i am without her for 4 hours) - and what she is getting at every feeding doesnt seem to be enough to keep her calm for 4 hours (it used to be).

Can someone bring her to school with you? A 4 hour class probably incorporates at least 1 break. If not a bottle may be unavoidable. But 3 bottles a week should not unduly impact the rest of the week, so if you need to use a bottle, don't worry about it.

lastly, that bottle 3 nights a week has been a 5oz bottle - is that just too much for her? she drinks it all and doesn't spit up and so i feel like it is not too much but maybe it is.

Rule of thumb is 1.5 oz per hour of separation, so that bottle is the right size. It may be better to break it down into smaller portions, though. Maybe one 3 oz bottle and one 2 oz bottle.

[@llli*sonogirl]

That five oz. bottle is a big feed all at once. I think you'd be better off splitting into two smaller bottles. Unless you have a very large storage capacity or some degree of oversupply, it is not likely baby gets 5 oz in one nursing session with you. My daughter, for example, would never be satisfied with one large bottle over four hours--she, like most breastfed babies, wants smaller, more frequent meals. A breastfed baby will take anywhere from 1-1.5 oz per hour of separation, so 4-6 oz would be reasonable intake for that separation.

[@llli*maddieb]

There is something that is discussed in the book the Womanly Art of Breastfeeding (2010 edition). The authors call it the "4 month fussies" when a child will suddenly start 'nursing weird." This may be distractibility or changes in how fast milk flows, etc, or something else entirely. I don't think anyone really knows. The point is, it is common enough that the phrase was coined and space was given to discuss it in the book.

And many mother's suspect (incorrectly) low production at some point, usually around 3 months or a little later, due to normal changes in baby nursing behavior and how the breasts feel, and/or changes in pump output when relevant.

These things are normal and NOT a breastfeeding issue. Unfortunately they often will become serious issues that may even lead to early weaning when baby is supplemented with bottles due to them. One pediatrician/author calls this, very accurately, I think, "crisis at 3 months of age." Because it can so easily turn into a real problem.

I would agree with mommal, the best course of action is probably to stay away, far away, from bottle feeding. How long are you at school? You may even be able to avoid bottles when you are at school. But certainly, you can avoid them when you are home.

Your baby is (I assume) a healthy, normally growing four month old who has always been able to nurse fine, in general. How or why would this have changed?

You are (presumably) a healthy mother who has always made enough milk for her baby. How and why would this have suddenly changed?

Maybe something drastic has occurred to harm your ability to have adequate milk production or cause your baby to not be able to nurse. If there is, that must be figured out. But otherwise, there is no reason to not simply continue to nurse your baby, as often and as long as baby wishes. This may be less often and/or for shorter sessions than when baby was younger, or it may be that baby wants to nurse more often and/or for longer. Both are normal. (Also, this means, if baby continues to root around, baby is clearly not done. So let baby nurse some more.)

[@llli*leemax4377]

Thank you all for your posts. I really appreciate you taking the time to give me some support and advice.

We spent a lot of time yesterday practicing patience at the breast with no bottle supplementation or pump to stimulate the let down and it seems to be back to "normal" or the way it was. (I distracted/relaxed her a bit by singing to her while she was nursing). The letdown is still a little slow but not too bad that she is getting overly frustrated and not wanting to nurse.

It probably wasnt that bad a week ago but i was starting to worry and that probably made it worse.

Gianna went for her 4 month pediatrician appt yesterday (had some shots and got her ears pierced:-)) and doc says she is growing well and is healthy. I am also as far as i know a healthy mom.

In regards to the bottle while i am at school. I can prob nurse right before i leave for class and then nurse her when i get home but i cant imagine the 3 bottles a week are the reason for her not wanting to nurse. She has been receiving those 3 bottles since late August. Her grandmoms who watch her those nights also enjoy feeding her so if it doesnt cause an issue this week i am going to continue with those 3 bottles as i did in the past. I will take them away if i find it is causing a negative impact on her nursing.

Thanks again
Elisa (and Gianna)

[@llli*maddieb]

Nipple/flow confusion leading to breast refusal is not something that happens overnight. It happens over time. It can take months and months! Some babies it never happens to, some babies it does, and it does not have to be that many bottles.

Another way to look at it is what is called "tripple nipple syndrome" -this is when a breastfed baby is given bottles to drink and/or pacifiers to comfort some of the time. overtime, some babies stop seeing the breast as THE place for food and comfort, and, overtime, we see early weaning.

Certainly it is possible none of this had anything to do with your child’s issues at the breast, after all, “four month fussies” and the “crisis at 3 months” happens in cases where baby never received bottles. But it is generally accepted that bottle use over time can be a contributing factor to eventual unhappiness at the breast, leading possibly to breast refusal/ early weaning. It’s just something to be aware of, for any baby who is receiving any bottles.

If you would like or need your baby to get bottles from her grandmothers, which is certainly understandable, one way that may help prevent nipple confusion is for bottles to be given on cue and using paced bottle feeing technique. This allows feedings to be of normal frequency and amount, and for baby to have control over the pace and amount of the feeding as baby would at the breast.

Paced bottle feeding aka bottle feeding the breastfed baby
Information sheet: http://www.youtube.com/watch?v=UH4T70OSzGs
Video: http://www.youtube.com/watch?v=UH4T70OSzGs (Don’t worry about what she says about time between feeds- typically, best to cue feed whether nursing or bottles.)

[@llli*mjtony]

hi everyone

my LO girl turned 4 mos yesterday too. since 3 weeks ago, i had the same issue. see became so fussy and refused to nurse on me when i come home after work. i have a broken schedule 4 hrs at am and 4 hrs at afternoon. so must nurse and pump at same time before leaving. but nowadays to refused to nurse, she try to latch but remove easily. i suspect that she like the bottle than my breast but the problem i don't have much supply, i can also pump 2-3 oz per session not even enough while im away from her so nanny would give formula. 3 oz every 3-4hrs.last night she screamed so loud because she ask a bottle, whenever i give my breast she pushes me and i end up to formula around 12:30am. i was upset and feel bad whenever she reject me.

regarding wet diapers, before we sleep at 11pm i must change it but sometimes at 7am diaper is still clean which means she's not making pee while sleeping. so with her poop, every 2-3 days. should i bother myself on this issue since she is not doing poop daily and she's mix feed with my milk and formula?

my goal is to increase my supply so i can pump more, im even pumping at work and i hope LO would just easily adjust i mean she can nurse on me when im home and bottle when im not.