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Thread: True supply issue or overfeeding expressed milk?

  1. #1
    Join Date
    Mar 2014
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    Default True supply issue or overfeeding expressed milk?

    Here is our background but at the end are my questions...

    My daughter will be four months old this week. She is my first child and we live in a rural area that does have a lactation consultant at the pediatrician’s office (not internationally certified) and I do not have any friends who breastfeed their babies. This is my last hope to find out what’s really going on and what I can do. I really want to exclusively breastfeed my baby for at least her first year of life. Please help us!

    Here is a little background regarding my question. For the first couple of weeks after she was born, she ate and slept frequently, but I still was engorged often (so much so that it was difficult getting her to latch sometimes). Once she got to be two weeks old, though, it was as if a light switch was turned on as she suddenly was fussy/crying all the time and the only way she could be soothed was to put her to the breast. At her two week Dr. appointment she was gaining weight and her bilirubin was improving. I called the Lactation consultant at my pediatrician’s office several times, who attributed the constant crying/fussiness to either a growth spurt, then eventually to colic (even though she would cry around the clock every day, not just at one particular time frame during the day). Her crying would range from slight crying to loud, piercing crying. From day one, I’ve always tried to feed her as soon as I saw early hunger cues. During this difficult timeframe of her crying, sometimes she would fall asleep at the breast but then would wake up if I tried to lay her down and start crying all over again, or she wouldn’t stay latched on and acted frustrated/angry and would fight against me. This went on for about three weeks until I finally said “this has got to be something aside from colic” and went into my pediatrician’s office again to have her examined, weighed, and to ask the Doctor about her behavior. She was still gaining weight and nothing appeared to be wrong. My doctor asked about signs/symptoms of possible gas/colic and of reflux. She never arched her back or spit up large amounts when nursing. Sometimes she would have audible rumbling in her tummy and sometimes would bring her legs up to her abdomen like she was having gas, but that was only sometimes and I’d already tried Gripe Water as often as I could give it to her. The Doctor recommended I try colic calm and mylicon drops and then to start on reflux meds if those didn’t help. I did try the colic calm and mylicon drops, which didn’t make any significant difference. Desperate to find an answer not only because I was returning to work at 6 weeks postpartum but also to give my little one some relief, I finally supplemented with the little breast milk that I was able to pump and store in the freezer. This made a dramatic difference in her behavior, so it was then that I realized that, despite frequent and complete drainage from my breasts over the previous few weeks, I wasn’t making enough milk for her. This led to the last thing in the world that I would want to do- supplementation with formula. I only supplemented when she got so upset and wouldn’t possibly take my breast anymore and also gave her formula and expressed breast milk while I was away at work.

    I’ve read “The Breastfeeding Mothers Guide To Making More Milk” and I wonder now if where I messed up was not completely draining my breasts in those first two weeks (as I went from engorged to seemingly starving baby within a matter of days!). This is my first baby and I thought frequent nursing was enough. I didn’t know I should have pumped in those first couple of weeks and I was afraid to pump because I was afraid my baby wouldn’t have any milk when she would wake next to nurse. After reading “...Making More Milk” I realize that I may have inadvertently gotten rid of some prolactin receptors by doing this and it sounds like those aren’t something that you can get back. While pumping, I can get anywhere from 0.5-1 ounce if I nurse and then pump. I can get 2-3 ounces if I pump within 3 hours after nursing. My daughter has ‘slept through the night’ (8p-4 or 5 am) since about 6 weeks old and about a month ago or so I started waking up at least once during the night around 12 or 12:30 to pump, when I can get the most milk (4-5 ounces).

    The Lactation consultant told me that by 6 weeks when I went back to work, she should be eating between 4 and 6 ounces at a time. I also did not know about paced bottle feeding, so while I was away at work, I was aiming to pump 12-18 ounces per 24 hours, which I could not keep up with. I then read about Reglan and some herbal supplements, so I took Reglan 10mg three times daily with weekly tapering dosage. I drank (and still do) Mother’s Milk Tea three times daily after steeping for at least 10 minutes. I’ve tried Fenugreek three tabs three times daily along with blessed thistle three tabs three times daily. All of these don’t seem to have helped, perhaps marginally. I eat a large bowl of oatmeal every morning for breakfast. I’ve tried spending a weekend nursing as much as she wants with pumping after every nursing session. I’ve tried having her co-sleep some nights. Just yesterday, I stopped taking the fenugreek and blessed thistle and switched to Mother Love’s special blend capsules four times daily. I have had breast augmentation surgery in the past (under the muscle, incision under the fold of the breast) and had very small breasts prior to the surgery.

    About a week ago, I read in a LLL forum that babies need 1.5 ounces of milk per hour of separation http://forums.llli.org/showthread.ph...being-over-fed. I’m gone from 7:15-5:45 so let’s say 7am-6pm, but I do come home for 30 minutes to nurse her. According to the forum, I should pump 16.5 ounces! I read in “The Breastfeeding Mothers Guide To Making More Milk” that infants between 1-6 months should be receiving 2.5 ounces per pound in 24 hours, divided by the number of times they eat in 24 hours, which would tell you about how much she should be getting per session. My baby is 13 pounds at almost 4 months old, so that would mean she would need 32.5 ounces. Usually she nurses 9-10 times in 24 hours but even if I conservatitely divide 32.5 by 8, that would mean she would need 4 ounces per session. I asked a nutritionist I work with and she said that breasted babies need approximately 2 ounces per pound in 24 hours, with the average being about 25 ounces in 24 hours once they start taking in solids regularly. This would mean she would need 3.25 ounces at a time now (since she is not yet on solids). I called the Lactation consultant at my pediatrician’s office two days ago, and she said that my daughter should be taking between 4-6 ounces at a time now and she may get up to 8 ounces before she starts having solids!! She said she even checked with a pediatrician who verified these numbers. What she said is totally against what I’ve read both in the book mentioned and in the forums.

    So I either need to be able to pump 3-3.25 ounce bottles, 3-4 ounce bottles, or 3-6 to 8 ounce bottles. Right now, I pump once during my morning break, nurse during lunch then pump for ten minutes, and pump once during my afternoon break, then nurse on demand as much as she wants while I’m at home (and I pump once during the night). With this, I can pump between 10 and 11 ounces in 24 hours. I don’t know if I truly still have an insufficient supply because my baby seems pretty content now. She cluster feeds every evening, which I read was normal, but I can’t pump more than 10 or 11 ounces in 24 hours. I’m using a Medela Symphony 2.0 double electric hospital-grade pump.

    So how many bottles and how large of bottles do I need to be preparing while I’m away at work? I have Nuk slow-flow nipples/bottles that flow slower than the bottles I was initially using (The First Years, which have an inner and outer nipple). Is there any way I can increase how much I pump? I try doing breast massage and compression while I pump and try to relax. How will this amount increase as she gets older and how will it compare when she starts eating solids regularly? I’d start solids before 6 months if it meant keeping her off of formula. Thank you so much for taking the time to read my post and to help me and my baby girl. God bless you.
    Last edited by @llli*ava.smommy; March 2nd, 2014 at 03:43 PM.

  2. #2
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    Default Re: True supply issue or overfeeding expressed milk?

    Welcome to the forum!

    So, before you started supplementing, was your baby gaining weight at a normal pace? If she was, then the supplementing was probably treating a behavioral issue rather than a milk supply issue. These can be confusing to tease apart- when a baby nurses and fusses and then calms down and seems really happy after a supplemental bottle, it's easy to think that she must have been starving. But it's also possible that she just needed more time to suck. Or that she was fussy because she takes a Goldilocks approach to flow speed; it has to be "just right", not too fast or too slow. Or that she had to poop or pass gas.

    It's completely normal to go from feeling engorged to feeling fairly empty. When milk first "comes in", it is often overabundant, because that 'a nature's way of making sure a new baby gets enough to eat while mastering the tricky art of breastfeeding. But that level of production doesn't last because it's a waste of your body's energy and because overproduction puts mom at higher risk for things like plugged ducts and mastitis. When supply and demand are well-matched, it's normal to rarely if ever feel full or engorged.

    Don't worry about the prolactin receptor issue. It would have been ideal if you had pumped during the rough patch during which you were supplementing, but it's not an irredeemable error that you didn't. You can increase supply at any time by demanding more from your body. Nurse more and/or pump more using a good pump with correctly sized shields, and your supply will go up.

    Based on the amounts you are pumping, it does not sound like you have any problems with supply. Getting .5-1 oz right after nursing, or 2-3 oz within a couple of hours of nursing, or 4-5 oz in the middle of the night: all completely normal.

    It sounds like you're getting a lot of advice which is appropriate for formula-feeding moms, not breastfeeding ones. The LC is absolutely incorrect that your baby "should" be taking 4-6 oz, and could take 8 oz. Those are HUGE bottles which are not appropriate for a demand-fed, breastfed baby, who typically needs more like 2-4 oz at a time. And that applies throughout the first year! A breastfed baby's milk intake tends to peak in early infancy, then holds steady until around 6 months, and then declines slightly as she gets into the second 6 months and starts eating some solids.

    Stick with the 1.5 oz per hour standard rather than the complicated standard based on body weight and age. The latter is giving you an unreasonable expectation of how much milk you need. According to the very reliable Kellymom.com, a breastfed baby will typically take 19-30 oz of milk per day, total. 32 oz per day is above and beyond the maximum of that range.

    Here's how I'm thinking about your expressed milk needs:
    - You are gone for approximately 9 hours per day.
    - 9 hours x 1.5 oz/hour = 13.5 oz, which is approximately what you need to put in the bottles at daycare every day.
    - You can break that 13.5 oz down in a variety of ways. A lot of moms make a mix of 1, 2, and 3 oz portions. 3 oz bottles are for the big feedings. The 1 or 2 oz bottles are for snacks, or for use as chasers, offered when the baby finishes the big bottle and still seems hungry. That way the daycare provider has to pause the feeding in order to reach for the chaser bottle, allowing the baby a chance to think about whether or not she's really full. (Overfeeding is a widespread problem at daycare).

    Since you're getting 10-11 oz per day, you'd still be a bit short of your total daily needs- except that you're coming in and nursing once during the day, so you're probably spot-on when you add that into your tally!
    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
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    Oct 2012
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    Default Re: True supply issue or overfeeding expressed milk?

    I agree. Use smaller sized bottles. No way should baby need an 8 oz bottle or a 6 oz bottle - 2 or 3 oz, maybe 4 at the most. Also, for some moms and babies it really is closer to 1 oz per hour apart, so you'd be just right with the 11 oz, plus you have the midday nursing. However, if you want to pump a little more, I have a couple suggestions. One is to add another pumping session into your workday, if you can. Some moms can get by with three pumping/nursing sessions during an 11 hour separation, but others need four. Also, how long are you pumping for? Are you getting a second letdown? The other thing that jumps out at me is baby sleeping a long stretch at night. It's good that you are pumping during that stretch but it might help boost your supply more to nurse during that time as well (or instead of pumping), since nursing often stimulates supply better than the pump can (plus it's a lot nicer to nurse in the middle of the night than pump!). Do you have baby in the room with you? Are you using a pacifier or swaddling? Pacifier and swaddling can act as "sleep extenders" so that baby doesn't wake up when she otherwise would. Even if baby doesn't wake up on her own, a lot of babies will instinctively nurse in their sleep. So you could just try to offer the breast and see what happens. As I like to say, nighttime nursing is a working mom's best friend! It's tiring but does wonders for supply (and it's less tiring if you keep baby nearby - in bed with you if you are open to that).

    Don't worry about anything you did or didn't do in those first weeks. It sounds like you and your baby are doing great.

  4. #4
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    Default Re: True supply issue or overfeeding expressed milk?

    Thank you both so much for your replies.

    Mommal,

    As far as I know, she was gaining weight well. She was born at 6 lb 2 oz, dropped to 5 10 I believe, then was 6 lb 5.6 ounces at two weeks old. At 5 weeks old (when I went in concerned about her crying) she was 7 lb 13.8 oz. Thank you for clarifying how much she should actually be eating while I'm at work. That was a large difference in the amounts and no wonder I thought I had an inadequate supply with not being able to pump that much! I'm glad I didn't just stop at the erroneous information given by the pediatrician and Lactation consultant. I've had a hard time figuring out which size shields to use but I think I'm using the correct (small) sized shields. The diagrams didn't help me out because my breast/nipple doesn't look how any of the photos do in the breast shields. The tissue that creates a suction is probably about 1/3" and my nipple does move freely, with maybe only the bases touching the sides of the tunnel. My nipples do get a little discolored but when I tried using higher suction in the past (greater than 5 notches) they turned dark purple. At the areola sometimes the suction breaks at first, but it seemed worse with the medium shields. I will plan on packaging up what I pump in one day to the daycare, in 2 and 3-ounce portions. I printed off the pdf by LLL regarding how to bottle feed a breastfed baby so I will take that as well and pray that she will be fed appropriately and that she will have enough milk!

    Momof3,

    I'm a nurse and it's hard to pump 3 times during the day as it is. Sometimes I will pump for 15 minutes on my morning and late afternoon breaks, but sometimes only pump for ten. We stay pretty busy and I don't seem to get very much after ten minutes anyway. When I come back from lunch, I only pump for ten minutes. I notice more than one let down within the morning and late afternoon sessions. After lunch, I only notice one with a little bit of dribbling otherwise (total usually only get 1/2 ounce). When I get home in the evenings around 530 until about 830, I can just sit down with her on my lap as she eats, snoozes, eats, snoozes until she finally goes to bed. In the event that she finally falls asleep and I can move her without her waking up, I place her in her bassinet (next to my bed) so that she can sleep and I nurse her in bed when she wakes up around 4 or so in the morning. Lately, though, she hasn't been going to sleep when I'm ready for bed, so I have been taking her to bed with me, where she will nurse probably 3 times during the night before we get up in the morning. Here is what my schedule has been, give or take:

    530AM- Wake up, nurse
    Get ready for work
    630 or 7: "Top off"
    715: Leave for work
    9:30 or 10: Pump 15 minutes at work
    12:15: Nurse for 25-30 minutes
    1: Arrive back to work, pump for ten minutes
    3 or 3:30: Pump for 15 minutes at work
    545pm: cluster nurse for three hours
    845pm: Take baby to bed with me, nursing
    1230AM: Get up to pump unless baby is awake/nursing at that time
    (Baby will usually nurse a couple more times before getting up again the next morning)

    I don't know what happened last night, though, because about 30 minutes after going to bed with my baby nursing, she started crying/screaming and was inconsolable. I got her to burp but couldn't get her back to breast. My husband made her a bottle and she fell asleep after 3 ounces.

    I used to swaddle her when she was a newborn and have tried pacifiers but she wouldn't use them. I feel like I'm struggling to barely meet her nutritional needs and wish I could increase my supply. Would there be another possible way aside from pumping one more time at work?

  5. #5
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    Jan 2013
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    Default Re: True supply issue or overfeeding expressed milk?

    Pumping more is likely your best bet for increasing your output. If you cannot squeeze more pumping time in at work, do you think you could try pumping during your commute? Lots of moms squeeze in extra sessions that way. But honestly, 10 minute sessions sound really, really short to me. Most moms need at least 15 minutes, and moms who have a bit more difficulty pumping may need as long as 20 minutes at a time. (I know what this is like--I had to pump 4x/day for 20 minutes each to keep up for my daughter's first year, and I ALSO work in health care. It's hard, I know.) Pumping is a legal right now for moms everywhere in the country, so it may be worthwhile to remind your supervisors of this, and add time to your sessions at work.

    I also will reiterate bfwmomof3's advice that for some moms and babies, intake is closer to 1 oz/hr of separation. I personally would never have been able to keep up with 1.5 oz/hr. And I will also agree with her that night nursing is really important, too--I know I would not have been able to make it without supplementing during our first year if I didn't nurse all night long!
    Apologies for the short responses! I'm usually responding one-handed on my smartphone!

  6. #6
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    Default Re: True supply issue or overfeeding expressed milk?

    Quote Originally Posted by @llli*sonogirl View Post

    I also will reiterate bfwmomof3's advice that for some moms and babies, intake is closer to 1 oz/hr of separation. I personally would never have been able to keep up with 1.5 oz/hr.
    I was thinking of you, sonogirl!

    I was wondering whether you might be a nurse, ava.smommy. The RNs around here often seem to have trouble getting their pumping in! I think sonogirl makes a good point - whether talking to your supervisor or coworkers to figure out whether there's some way you could get just a bit more pumping in. You actually have pretty good frequency of nursing and/or pumping so maybe even an extra five minutes of pumping in your current sessions. Or pumping during your commute is a good suggestion. How many days a week do you work? Another idea would be to try to squeeze in another pumping session on the days you are not at work. I think that's great that you are doing the nighttime nursing, and cluster nursing is great too. I mean I think you're very close even with your current schedule - if you can prevent overfeeding you may be just fine with what you are currently producing. You just need to communicate well with baby's caregivers. Is there really any reason to believe that your milk supply is low? Is baby still gaining well? You don't need more than enough - you just need enough.

  7. #7
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    Default Re: True supply issue or overfeeding expressed milk?

    Hi sonogirl,

    No one has said anything to me negatively about pumping but I always feel guilty for pumping and the pressure that I need to hurry. How do I know how long to pump for? It seems after ten minutes that I may have some dribbling if anything. The streams usually have stopped by ten minutes. I plan on just taking what I pump (about ten ounces) and dividing it up into 3 or 4 bottles and praying that it is sufficient. I didn't know that pumping during a commute was a possibility and wouldn't even know where to begin!

    Sometimes if my daughter is nursing around 1230 when I usually get up to pump (I set my alarm) then I don't get up to pump at all that night. Would it still be better to have her cosleep and eat more at night (usually at least 3 times) versus sleeping in her crib, pumping for sure once during the night, and eating probably once during the night? Or should I have her cosleep every night in order to 'catch up' at night? If that's the case, and if she's nursing at the time when I usually pump, should I reset my alarm for a couple hours later? Thanks again =)

  8. #8
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    Default Re: True supply issue or overfeeding expressed milk?

    I'll talk with my supervisor tomorrow and see what I can work out for duration. She's already ok'd the frequency of me pumping twice and then for 10 minutes after nursing/lunch. So do I need to shoot for a baseline of 15 minutes or 20 minutes? Or do I go by what output I see? I've got a little under a 15 minute commute plus I wouldn't even know where to begin to pump during that time. I work 5 days per week one week then 4 days per week the next, alternating. I don't know if my milk supply is truly low now. I do have to supplement sometimes, but I think a large part of the problem was believing that I had to pump 3-6 ounce bottles which I most definitely could not do. If I could cluster feed and cosleep with her every night in order to get the most of her nutrition in, that's what I'd like to do so that she would take minimal amounts at daycare. She can 'catch up' on her feedings in the evening and night, right?

  9. #9
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    Default Re: True supply issue or overfeeding expressed milk?

    Right. It's called reverse cycling. There are babies who refuse to drink expressed breastmilk at all and will make up for it all at night! So definitely fine not to overdo it during the day, and let baby nurse lots when you are together - that's good for your supply. I think you might get the most bang for your buck cosleeping and letting her nurse as much as possible at night, compared to setting an alarm and pumping. Also it's just really tiring over time to get up in the middle of the night to pump. You work a lot of hours, use the hours you are not working to spend time with your baby and get some rest. The nice thing about nursing is that it's bonding time too.

    How much you get when you pump is more about storage capacity than it is about supply. Storage capacity is how much milk your breasts will make before they stop. So someone with a small storage capacity may make 2 or 3 oz and then that's it, the breasts will wait until they are emptied to make more. Someone with large storage capacity may make 6 oz and then stop. So that larger storage capacity mom can get by with pumping less frequently, whereas the smaller storage capacity mom cannot. But over the course of 24 hours they may make the exact same amount of milk. The key is just to make sure to nurse/pump frequently enough. Here are a couple articles from Nancy Mohrbacher explaining the concept:
    http://www.dhss.delaware.gov/dph/chs...number2011.pdf
    http://www.nancymohrbacher.com/blog/...on-part-1.html

    In terms of how long to pump, a lot of moms do find they can get a second letdown with a longer pumping time, and even if not, pumping dry can help. I don't think you know until you try it, but if you can negotiate 20 minutes for yourself, try it! Also, make sure you use your breaks efficiently. For example, you don't need to wash the pump parts each time - end of the day is fine. I pre-assembled the flanges, valves and bottles in the morning so that they I just needed to hook up to the pump. Also, you can do a hands-free setup (using a bra designed for that purpose, or simply cutting holes out of a snug cami) if you want to pump and chart at the same time - sometimes I found it less stressful to pump if I was getting work done at the same time (although sometimes pumping was a good chance to just relax and not work for a few minutes).

    What are you basing the decision to supplement on, at this point? Are you pumping when you supplement?

  10. #10
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    Default Re: True supply issue or overfeeding expressed milk?

    Good morning Momof3,

    So it sounds like maybe I have a smaller storage capacity if I usually pump 2-3 ounces at a time. Is it sufficient then to nurse or pump at least every 3 hours during the day and co-sleep at night? I've had to supplement using formula in the past because I didn't have anymore expressed breast milk. I had to supplement during the day when she'd eventually get very fussy and wouldn't take the breast after a long time of continuously nursing. I haven't had to give her any formula now for a couple of weeks, but I occasionally have to supplement her with expressed breast milk. If this happens, it's usually just once due to her getting fussy after a long period of time at the breast or because I've had to go somewhere and she gets a bottle while I'm gone. I tried in the past to pump whenever I supplemented but if I'm gone I can't pump. If I'm home and my husband gives a bottle because she acts like she's starving, then I'll pump. Either way, I try to always get up once during the night to pump because I usually get the following amounts when I pump and I need every drop to give her while I'm away:

    9 or 10AM: 3
    1PM after nursing: 0.5 ounce
    330PM: 2.5 ounces
    1230AM: 4-5 ounces

    I want her to eat as much from me as she will while we're together. I'd like to not have to get up every night to pump, but I don't want her to be hungry during the day. Will the amount she needs while I'm away continue to increase until she begins solids? Should I assume that she'll need a bottle every 3 hours? Does she still need to eat between 8-12 times in 24 hours and will that continue with solids? It's hard to keep track of how many times she eats when she cluster eats in the evenings. Will she still need to co-sleep after taking solids regularly? Does co-sleeping after a certain age make it hard for babies to sleep in their cribs?

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