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Thread: Continuously low supply after four weeks... is there hope?

  1. #1

    Default Continuously low supply after four weeks... is there hope?

    Hello ladies, I'm new to this forum and to breastfeeding in general. My LO is now four weeks old, and unfortunately we keep having supply issues that I'm hoping I can get some advice on here.

    Here's our backstory; I'll try to give as many details as possible.

    My son was born four weeks ago at 39+2 weeks GA vaginally, no epidural, after a very quick labor (1 1/2 hours). Initially I thought he took to the breast very well, which all the midwives who saw him at the hospital seemed to agree with as well. We went home the next day and had a midwife visit us at home for the next eight days to help with issues like lactation, weight gain and my healing.

    His birth weight was 7lbs 11oz, his lowest weight was 7lbs 4oz on day 3 and 4. My milk came in on day 3, LO and I spent the first four days at home BFing exclusively. On day 5 my midwife suggested supplementing with formula because my son's weight wasn't going up, he still had transitional stools and he had spent the two nights before that nursing pretty much non-stop. Her rationale was that my milk supply was low and my son was getting too exhausted to suck efficiently.

    Well, ever since we have been supplementing both with formula and with milk I pump while my husband feeds him formula. I use a Medela Swing Maxi double electric pump 2-3 times a day after nursing LO, getting anywhere from a couple drops of milk to 2oz (on average around 1oz). I've tried to pump after every feeding, but the pump hurts my nipples so I've been slacking . We're currently supplementing around 10oz a day (usually around 6-7oz of formula and 2-3oz of breast milk). My son's weight gain is much improved, he's up to 9lbs 6oz now and gains on average 1 1/2 oz per day.

    I am, of course, happy about the weight gain, but simultaneously I feel incredibly depressed about not being able to exclusively breastfeed. I feel like I'm failing my son because my body cannot get the most natural thing in the world figured out. My husband and I have tried to cut back on the formula several times, but every time we do LO will have episodes in the afternoon and at night where he fusses and cries at the breast until he has an all-out tantrum. Not wanting to starve our baby, we end up feeding him another bottle after all.

    I've been to see an IBCLC-certified lactation consultant several times to figure out whether I was doing something wrong positioning my son when nursing or if LO had any latch issues, since my nipples are taking a beating, but according to the consultant latch and positioning are fine. She did note, however, that LO will only suck actively for about 2 minutes before he starts nibbling on the nipple. She also suggested switch nursing (have been doing that from the get-go) and fenugreek to boost my milk supply, which I have been taking for the last week. I've started leaking a lot more, but haven't noticed an improvement in pumping output or LO's hunger.

    Is there anything I can do to hopefully eventually get away from supplementation completely or is it time for me to be realistic and accept that some supplementation may always be necessary for us? I just want to do what's best for my son.

  2. #2
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    Default Re: Continuously low supply after four weeks... is there hop

    but every time we do LO will have episodes in the afternoon and at night where he fusses and cries at the breast until he has an all-out tantrum. Not wanting to starve our baby, we end up feeding him another bottle after all.
    If your baby is (currently) consistently gaining an average of 1.5 ounces per day, that is well above average gain for a breastfed baby from age about 2 weeks to 3 months. (after that it gain often slows considerably, and before 2 weeks it may not be that rapid)

    So at the age your baby is now, ONE ounce a day is considered v. good gain. So there is no way on earth you are starving your baby. Perhaps he is getting used to the flow of bottles, (and not liking having to 'work' at the breast) perhaps he is having a colicky episode, perhaps he still has difficulty latching & is frustrated . I don’t know . But I do know this behavior is NOT due to your baby starving. Not with gain like that.

    Rather, that very fast gain, suggests you may be oversupplementing.

    If your baby is being oversupplemented, then of course that means you can back off on the supplements and be that much closer to exclusively nursing. Also, if your baby is being over supplemented that is going to make baby be much less interested in nursing vigorously. Why should he?

    Pump output is not generally a very good indicator of production. How often do you pump, when do you pump, what kind of pump is it, is it new, and how much do you generally get?

    I have to be honest, I think it is possible your midwife jumped the gun with the recommendation to supplement. Many babies do not start regaining weight until after day 5, and it is perfectly normal for poops to still be in transition at that point.

    Please check all this out wiht your IBCLC but I see no reason, with such excellent gain, you cannot start pulling back on the supplements. If baby is fussy and wont nurse, have you tried the ideas in this keelymom article? http://kellymom.com/bf/concerns/child/back-to-breast/
    Last edited by @llli*lllmeg; November 15th, 2013 at 11:23 AM. Reason: added info and link

  3. #3
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    Default Re: Continuously low supply after four weeks... is there hop

    Oh sorry, I just saw you reported about your pump and output. So, that sounds like normal pump output. You are pumping AFTER nursing-right after? An hour after? What do you mean? How much milk do you expect to get?

  4. #4
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    Default Re: Continuously low supply after four weeks... is there hop

    The thing that jumps out at me is that it hurts when you pump. If pumping hurts, it may be that your shields don't fit right. And poorly fitted shields can result not only in pain, but also in lower output.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
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  5. #5
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    Default Re: Continuously low supply after four weeks... is there hop

    Wow I totally missed that about pumping hurting. Wow sorry, I am really tired this am. Does nursing hurt at all?

    I also forgot to ask how many times a 24 hour day baby nurses.

    As far as this:
    is it time for me to be realistic and accept that some supplementation may always be necessary for us? I just want to do what's best for my son.
    I think it is entirely premature to think you will never be able to exclusively nurse. But of course, should you need to continue to supplement, you can also keep nursing. Research shows that even when exclusive nursing is not possible, The more breastmilk baby can get, and the more time nursing at the breast, the better. This is why it is so important to be careful about how, why, and how much a breastfed baby is supplemented even when supplements are needed. And the first thing to figure out is if what is happening indicates low production at all, or only low production. I have my doubts about that.

  6. #6
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    Default Re: Continuously low supply after four weeks... is there hop

    Quote Originally Posted by @llli*momtonoah View Post
    Is there anything I can do to hopefully eventually get away from supplementation completely or is it time for me to be realistic and accept that some supplementation may always be necessary for us? I just want to do what's best for my son.
    I just want to address your question: is there hope? YES! I had a very traumatic induced labor that went into three days and ended with cesarean, and it took weeks for my milk to really "come in" (strangely it really happened about a month after with a bout of stomach flu and I bounced back). I started supplementation early with SNS and then bottles, but by about 5 weeks we were totally OFF formula! My DS is now 13.5 months and still nurses/drinks expressed breastmilk. And I struggled until about 7 months to pump enough for him so had to pump 4 times to get three bottles, but now past a year my supply is fully established. I agree with the PP, I think he might be being over supplemented. I get it - I was so scared to finally drop that last formula bottle but when I did and just trusted my body to make enough, it really worked. I did use a lot of different galactalogues such as fenugreek, oatmeal, etc. I don't know if those were really ever helpful but it at least helped me psychologically. My DS had slower weight gain and has consistently stayed at the 15th percentile, but he is so healthy, active, and very bright and social. All thanks to breastmilk!

    Oh - you said your nipples hurt when pumping. I think your breast shield is too small. I went up to a larger size since I'm a DD/E right now. Have you tried that?

  7. #7

    Default Re: Continuously low supply after four weeks... is there hop

    Thank you all for the replies/advice. It is really encouraging to hear that things can still turn around. I am definitely going to try everything I can to hopefully get to a point where I can exclusively breastfeed (and plan on continuing to nurse if it turns out I do have to keep supplementing, too).

    lllmeg, I usually pump around 10-15 minutes after nursing. Regarding how much milk I'm expecting to get, as a newbie to breastfeeding/pumping I don't really know what's realistic. I'm happy whenever I get around an ounce or more, it's the pumping sessions that yield only a few drops that are really discouraging for me. Thank you for the link to the Kellymom article! I've been doing some of the things listed already, but there are definitely quite a few things I can still incorporate into our nursing routine.

    mommal and garsmum, I will definitely look into larger size breast shields for my pump. I didn't even think to try that, but it makes total sense!

  8. #8
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    Default Re: Continuously low supply after four weeks... is there hop

    Have you tried using a supplemental nursing system (SNS) to offer your supplement/pumped milk directly at the breast? I used one extremely briefly after DS was born by emergency c--for a few feeds over two days--and it motivated my DS to nurse more effectively and actively. The active nursing time at my breast stimulated supply enough that I was able to abandon the SNS after a few days and EBF. He's now almost 25 months old and nurses like a newborn, so these sorts of rough starts do turn around and lead to a long and happy nursing relationship.

    The beauty of the SNS, other than the fact that nourishment is delivered at the breast, is that you can regulate the flow of the supplement by placing the container below breast level. So, you can start the feed with the SNS at an advantaged position (vertically held at or above breast level). As your little one becomes satisfied, you can gradually lower the SNS below breast level height so the milk released at the nipple flows more quickly than the supplement.

    You can do it! Given your LO's quick weight gain, I'm optimistic that you'll be able to taper the supplement quite successfully and return to EBF. Try nursing your son as much as possible while he sleeps to stimulate your supply. Given your comment about leaking, I'd even try a nursing vacation to push direct-to-breast contact. It sounds like you have the supply you need; you just need to help your son extract the milk quickly and successfully by giving him many opportunities to be successful! In your shoes, I would go into the challenge believing that EBF is all but inevitable. Confidence really does help!

    Please keep us posted.
    Last edited by @llli*alphawoman; November 17th, 2013 at 09:54 AM.

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