very low milk supply at 6 weeks

[@llli*andrebaby]

hi I am writing this post in desperation. i had my healthy baby boy 6 weeks ago and despite all the effort I put in, I am still only producing about 10 ounces of milk daily. I am literally running out of ideas and feel exhausted and despair, pls help me figure out what I missed here or if it's still possible to increase my milk supply. Below is my basic information
1) I had my baby at 42 weeks through induction. It took 24 hours for me to fully dilate and 20min to push out the baby. No tear and any complication afterwards. I did use epidural in the process, but cut it off in the last hour right before I was getting ready to push
2) The baby was born 8 pounds and we had skin to skin for two hours right after he came out. However, he wasn't interested in breast and just wanted to sleep. The lactation consultant in the hospital told us it's very normal to have a sleepy baby in the first day. So we let him sleep. I started feeding him second day. It was soon apparent that nothing was coming out of my breast-- we tried manual expression, medela hospital pump, compression, nothing came out, not even a drop.
3) Under the recommendation of the nurse, I started supplementing him on the third day with a syringe while breastfeeding. He latched on quite good, and appeared happy with the formula, but I still didn't have any colostrum
4) I went home at the end of third day and keep pumping and breastfeeding my baby with the help of the syringe. Thought once the engorgement comes, I will be in a much better place. Sadly that day never came, I waited and waited till the 8th day, my breast never became full at all. The only improvement is I started seeing drops of milk came out when I pump, and when I squeeze my nipples hard, I can see tiny milk slowly coming out
5) I got a lactation consultant come to my house on the 9th day to check what was going on. She said the baby's latch is very good and also confirmed that the baby was getting nothing from my breast using a baby scale. She also confirmed I don't have tubular breasts based on the look of my breast and the fact that I boobs grew significantly throughout the pregnancy. She recommended me to use SNS to breast feed and also increase the frequency of pumping
6)So since day 9, I have been pumping 8 sessions per day while continuing breastfeeding my son every 3 hours. I was literally either pumping or feeding at any moment. I also started took fenugreek , blessed thistle, goat's rue, mother's milk tea to boost the supply
7)At 2 weeks mark, my supply improved from drops to about 0.2 ounces. I got a breastfeeding doctor to visit the house. She checked my thyroid and hormones, and all confirmed normal. She also confirmed my son's latch is good and I don't have tubular breasts. With all the regimen I had, she recommended me to start domperidone. I also started taking brewer's yeast and iron pills the same time.
8)so since then, I have been pumping at least 8 times and breastfeed my baby at least 5 times with SNS (my son stopped waking up at night at three weeks) every day. I am still taking fenugreek, blessed thistle, goat's rue, brewers yeast, iron and domperidone every day. I also do 1 hour power pumping in the nite session: pump 15 min, massage the breast for 10 min then pump another 15 min then massage and repeat for the entire hour. Of course, not to mention I drink tons of water and liquid all the times.
9)Fast forward to today, with the stuff I mentioned above, I am still not generating much milk. I can pump about 0.6 ounce milk per hour now, but that the rate of milk production goes down significantly if I don't keep emptying the breast. With two hour rest, I could pump about 1 ounce. With three hours rest, I could pump 1.3, and with four hour rest, I could do 1.6. I never reach the point of feeling full in my breast at all despite how long I wait to pump.
10)Tomorrow my baby will be six weeks now. I am so exhausted and despaired. Can anyone tell me if there is anything else for me to try to increase the milk production? At this point, is it still possible to increase the supply at all? Any idea what went wrong with me? Thank you so much, I am at the verge of giving up breastfeeding, pls give me some hope. Thank you again.

[@llli*maddieb]

Well you certainly are working hard, and it sounds to me as if you are making progress, but I get that it is frustrating, especially as there is no apparent 'cause' you can pinpoint. This is frustrating but not all that unusual.

As usual, I have more questions than answers.

How much is baby taking in each day of supplements? (Formula and your expressed milk?) If baby nurses 5 times a day, how are the other feedings given? A 6 week old would typically need to eat, at the very least, 8 times each 24 hour day. How long a sleep stretch is baby taking, and how is babies gain at this point? Does baby take a pacifier overnight or is baby swaddled over night?

What kind of a pump are you using? Sorry if you already said. Is pumping comfortable? Have you ever done a before and after nursing weight check since the one you mention? (Without the sns) Did LC or doctor watch you pump, check pump,. flange fit, etc?

Baby checked for tongue or lip tie?

When you say you drink tons of water- no chance you are actually overhydrating, is there?

Fast forward to today, with the stuff I mentioned above, I am still not generating much milk. I can pump about 0.6 ounce milk per hour now, but that the rate of milk production goes down significantly if I don't keep emptying the breast. With two hour rest, I could pump about 1 ounce. With three hours rest, I could pump 1.3, and with four hour rest, I could do 1.6. I never reach the point of feeling full in my breast at all despite how long I wait to pump

. I realize it is frustrating to get so little when you pump, but actually, in this situatiom you do not want your breasts to feel full. Feeling full tells your body to make LESS milk. Milk production WILL go down if the breast is not 'emptied' frequently, and normal nursing frequency would be 10 or more times a day at this age. YOu are pumping 8 times and nursing 5, so together that is good frequency. But do you have a sense that baby gets milk from the breast or is just extracting milk from the sns when he nurses?

The one herb I do not see you mention that I know some LC's I respect suggest is shatavari. Please research this & check with your LC and doctor, do not just take anything on my say so.

Is it possible you need to up the dosage of the dom?

No hormonal bc I assume?

Have you read the book Making More Milk? It sounds as if You have gotten lots of great help, but that book can be very helpful for moms in providing some interesting ideas and perspective. I think you may need to think about tweaking your 'plan' which, it sounds to me, you are finding overly exhausting.

[@llli*mommal]

Excellent post from LLLMeg, above.

Just one more question- did anyone ever check you for retained placenta? Having a piece of placenta still hanging around convinces your body that you're still a bit pregnant, and thereby inhibits milk production.

[@llli*garsmum]

Hi! Wow mama you are amazing and I just wanted to provide you with encouragement and a virtual hug. I had a really hard time too but it did get better, with a lot of focus on nursing (you've already go that!). I agree about finding somewhere you can do pre- and post- feed weighing, and also, have you thought about bringing baby to bed with you? Baby sleeping through the night is unusual, and we are IMO overly obsessed about infant sleep in our culture which is often at cost to other major needs such as mom and baby health, nursing, bonding, etc. We still co-sleep and yes it is not for everyone but I can tell you without it I likely would not still be nursing my 18 month old successfully!

[@llli*andrebaby]

Hi thanks for the replying. My baby is taking 4 ounces per feeding, mixed with the formula and whatever milk I managed to express at the moment. All the feedings are given by my breast with the help of SNS. Up to today, the baby was never bottle fed and he never used a pacifier. I spent lots of time with the baby, I am holding him in my arms or playing with him on the gym mat if I am not feeding him. The reason I do 5 feeding is because the baby stopped to wake up in the night since 1 month and the pediatrician told us not to wake up a sleeping baby. so I listened. From 7am to 7pm, he feeds every three hours. He has been gaining weight pretty steadily, about 1 to 1.5 ounce per day.

Regarding how much milk he gets from me per feeding, I think it's around 0.5 to 1 ounce currently. I did buy a baby scale to measure him every time I feed, depending on the time of day, he normally gets 1 ounce in the morning and about 0.5 in the late afternoon.

Some more information about me

1) I don't have PCOS confirmed by the doctor
2) I don't think I have leftover placenta because my progesterone is very low (below 0.5) and my bleeding has stopped since week 3
3) The pump I used is medela advanced, and I did try the hospital grade one. I felt with the help of compression and massage, these two pumps don't make much difference for me. The flange I used is standard, confirmed to be fit by the breastfeeding doctor. The doctor watched me pumping, said I have been draining the breasts pretty well
4)The baby has no tongue tie problem, checked by the LC and doctor
5)I am not on BC
6) I don't think I am over hydrated, but not very sure. I drink 20 ounce per hour on average, is it too much or too little?

Thanks for the recommendation on the shatavari, I will do some homework there and see if I can add it to my regimen.

I am currently taking 20mg domperidone 4 times a day, I guess I can certainly add another 20mg to see if it makes a difference?

I also just bought the book, reading it now... so far has been very heartwarming, thank you for recommending it.

Again, thanks everyone for coming back to me. I want to give my baby best, and have been giving all my effort so far. I am willing to do more if you have more suggestions. Pls let me know!

Well you certainly are working hard, and it sounds to me as if you are making progress, but I get that it is frustrating, especially as there is no apparent 'cause' you can pinpoint. This is frustrating but not all that unusual.

As usual, I have more questions than answers.

How much is baby taking in each day of supplements? (Formula and your expressed milk?) If baby nurses 5 times a day, how are the other feedings given? A 6 week old would typically need to eat, at the very least, 8 times each 24 hour day. How long a sleep stretch is baby taking, and how is babies gain at this point? Does baby take a pacifier overnight or is baby swaddled over night?

What kind of a pump are you using? Sorry if you already said. Is pumping comfortable? Have you ever done a before and after nursing weight check since the one you mention? (Without the sns) Did LC or doctor watch you pump, check pump,. flange fit, etc?

Baby checked for tongue or lip tie?

When you say you drink tons of water- no chance you are actually overhydrating, is there?

. I realize it is frustrating to get so little when you pump, but actually, in this situatiom you do not want your breasts to feel full. Feeling full tells your body to make LESS milk. Milk production WILL go down if the breast is not 'emptied' frequently, and normal nursing frequency would be 10 or more times a day at this age. YOu are pumping 8 times and nursing 5, so together that is good frequency. But do you have a sense that baby gets milk from the breast or is just extracting milk from the sns when he nurses?

The one herb I do not see you mention that I know some LC's I respect suggest is shatavari. Please research this & check with your LC and doctor, do not just take anything on my say so.

Is it possible you need to up the dosage of the dom?

No hormonal bc I assume?

Have you read the book Making More Milk? It sounds as if You have gotten lots of great help, but that book can be very helpful for moms in providing some interesting ideas and perspective. I think you may need to think about tweaking your 'plan' which, it sounds to me, you are finding overly exhausting.

[@llli*maddieb]

Hi andrebaby thanks for answering my questions!

So, here is what I am thinking. I wonder what would happen if baby nursed more often and was supplemented less each feeding. Because what you are basically trying to do with a regimen like this, with the pumping/nursing/supplementing, is to try as much as possible to mimic what would be happening if baby was exclusively breastfed, right? And a newborn breastfeeding infant almost universally needs to nurse at least 8-12 times a day, and normal size feedings would be much more like 1-3 ounces at a time. Sometimes a little less for some sessions is normal too. but rarely as much as 4 or 5! I am sorry you were told to never wake a sleeping baby. This is not appropriate advice for a breastfed baby, especially who has not been getting enough milk via exclusive breastfeeding.

So, baby is being fed via supplements a total of about 20 ounces per day, (5 feedings X 4 ounces = 20.) Normal daily intake by a breastfed baby at this age for normal gain would typically be something like 25-30 ounces per day, or more. So I suspect your baby must be getting something directly at the breast, because I think it is unlikely baby would be gaining so well drinking only 20 ounces a day. (A gain of 1 ounce a day at this age is considered very good, normal gain. Yes, some babies gain more rapidly, but if your baby is gaining faster than one ounce a day, I wonder if it is possible that the total amount of supplements could be decreased.)

So let's guess baby gets 1 ounce from the breast each time baby nurses. This is a low ball guess. That would mean baby actually gets 5 ounces each time baby is fed, or, 25 ounces per day. I know that some of your before and after nursing weight checks show a lower amount, but 1) fluctuations in intake amount over the course of the day are normal and 2) I wonder if baby is nursing more vigorously and/or longer when using the sns and consequently, maybe getting more from the breast when using the sns than when not(?) What do you think?

What if instead, you nursed baby 10 times a day, supplementing 1 or 2 ounces each time, and we again assume baby can get at least 1 ounce directly from the breasts each time. That would easily amount to the same amount into baby overall, right?

Or you could continue to supplement those 5 feedings, or maybe 6, but maybe 2- 3 ounces each time, and nurse without the sns for an additional 4 or 5 times a 24 hour day?

Basically, I am suggesting you consider playing around with a schedule that works for you and gives baby the supplements he needs, but with the idea of increasing the amount of time baby spends at the breast, especially in the frequency of at the breast feedings, and decreasing the size of individual feedings to something more normal. I also think it would be very helpful to have at least one or two nursing sessions each day without the sns. If baby is refusing to nurse without the sns, you can try instant reward techniques (dribbling milk onto your nipples, for example,) to get baby suckling. Because the idea is to start to move away from the supplements and pumping toward more exclusive breastfeeding. This may take time, and it is possible you will always need to supplement a little, that is unknowable at this point. But it sounds to me as if you are waiting for your pump output to increase in order to start moving toward less supplements, and I think that pump output can be misleading (many moms find they get less from pumping than baby takes in when nursing) and also that, as a first step away from supplements, it is very important to increase overall the time baby spends at the breast.

The more time baby nurses at the breast the less often you need to pump. So I know this sounds like I am asking you to do more work, but it's actually the opposite. Most moms find it easier to nurse than to pump. And we know babies who do not have latch or sucking issues are far more effective at extracting milk from the breasts than are pumps.

What do you think? Was it ever suggested to you to increase the number of nursing sessions each day? Does that seem doable to you at all?

From 7am to 7pm, he feeds every three hours.

So baby is asleep/not nursing from 7 pm until 7 am? 12 hours every day!? A 12 hour stretch every day with no feedings is highly, highly unusual, even for a much older baby. For a one month old, it is very unusual! Yes your baby is gaining well, because when he is being fed, he is getting way more than what is normal for an individual feeding. This might be why he is sleeping so long. Also, the reason I asked about pacifiers and swaddling is that these are sleep lengthening techniques. So if a baby is sleeping really long, it may help if these are not used. Also some babies do not wake with normal frequency if they sleep in a different room from mom.

[@llli*andrebaby]

Your guess was right! I was waiting for the pumping result to go up to wean off the formula as I was too scared to underfeed him. You are suggesting I take a leap of faith here to establish the breastfeeding by weaning off the formula first. I can certainly do that! A couple of questions here

1) if i choose to breastfeed him 10 times a day, do I still need to pump after each session? That will mount to 20 sessions per day, i am already not getting any sleep, worried how long I can last if I have to do 20 sessions per day.

2)I understand that the diaper count can be used to check if the baby is getting enough for a breast fed baby. But my son is only having one dirty diaper every three days, so I am afraid that would be a good enough measure. is there any other way to check if the baby is well fed? can i use the weight gain? when should i be alerted if the weight gain is used?

3)i have a very sleepy baby. he falls asleep as soon as he is not content with the milk flow of my breast. The SNS keeps him awake for at least 40 min. I am thinking to do the 5 daytime feedings with SNS (7am to 7pm), the same as the old schedule but with only 2 ounce of supplement. Then I add 5 breast only feeding sessions in between. I will also add two night sessions around 11 and 3 with SNS. This will give me 7 SNS sessions and 5 breast only sessions. Assuming he gets 1 ounce from me directly, that means i will give him 12 ounce of breastmilk, and 14 (2*7) ounce of formula. Is it this something reasonable to start? If he is still growing well with the plan, i can start to wean off the formula for each SNS sessions.

4)let's say everything goes well, i can manage to get more milk produced. I will have to go back to work around 4 month meaning pumping would be pretty much the only way to keep breastfeeding the baby ( i work 12 hours from 7am to 7pm). Would it be possible for me to pump more milk by then? i am afraid i spend two months to establish breasfeeding, then have to give it up because i will have to pump again.

Thank you again for all the help. I am already feeling much better and more confident!

Hi andrebaby thanks for answering my questions!

So, here is what I am thinking. I wonder what would happen if baby nursed more often and was supplemented less each feeding. Because what you are basically trying to do with a regimen like this, with the pumping/nursing/supplementing, is to try as much as possible to mimic what would be happening if baby was exclusively breastfed, right? And a newborn breastfeeding infant almost universally needs to nurse at least 8-12 times a day, and normal size feedings would be much more like 1-3 ounces at a time. Sometimes a little less for some sessions is normal too. but rarely as much as 4 or 5! I am sorry you were told to never wake a sleeping baby. This is not appropriate advice for a breastfed baby, especially who has not been getting enough milk via exclusive breastfeeding.

So, baby is being fed via supplements a total of about 20 ounces per day, (5 feedings X 4 ounces = 20.) Normal daily intake by a breastfed baby at this age for normal gain would typically be something like 25-30 ounces per day, or more. So I suspect your baby must be getting something directly at the breast, because I think it is unlikely baby would be gaining so well drinking only 20 ounces a day. (A gain of 1 ounce a day at this age is considered very good, normal gain. Yes, some babies gain more rapidly, but if your baby is gaining faster than one ounce a day, I wonder if it is possible that the total amount of supplements could be decreased.)

So let's guess baby gets 1 ounce from the breast each time baby nurses. This is a low ball guess. That would mean baby actually gets 5 ounces each time baby is fed, or, 25 ounces per day. I know that some of your before and after nursing weight checks show a lower amount, but 1) fluctuations in intake amount over the course of the day are normal and 2) I wonder if baby is nursing more vigorously and/or longer when using the sns and consequently, maybe getting more from the breast when using the sns than when not(?) What do you think?

What if instead, you nursed baby 10 times a day, supplementing 1 or 2 ounces each time, and we again assume baby can get at least 1 ounce directly from the breasts each time. That would easily amount to the same amount into baby overall, right?

Or you could continue to supplement those 5 feedings, or maybe 6, but maybe 2- 3 ounces each time, and nurse without the sns for an additional 4 or 5 times a 24 hour day?

Basically, I am suggesting you consider playing around with a schedule that works for you and gives baby the supplements he needs, but with the idea of increasing the amount of time baby spends at the breast, especially in the frequency of at the breast feedings, and decreasing the size of individual feedings to something more normal. I also think it would be very helpful to have at least one or two nursing sessions each day without the sns. If baby is refusing to nurse without the sns, you can try instant reward techniques (dribbling milk onto your nipples, for example,) to get baby suckling. Because the idea is to start to move away from the supplements and pumping toward more exclusive breastfeeding. This may take time, and it is possible you will always need to supplement a little, that is unknowable at this point. But it sounds to me as if you are waiting for your pump output to increase in order to start moving toward less supplements, and I think that pump output can be misleading (many moms find they get less from pumping than baby takes in when nursing) and also that, as a first step away from supplements, it is very important to increase overall the time baby spends at the breast.

The more time baby nurses at the breast the less often you need to pump. So I know this sounds like I am asking you to do more work, but it's actually the opposite. Most moms find it easier to nurse than to pump. And we know babies who do not have latch or sucking issues are far more effective at extracting milk from the breasts than are pumps.

What do you think? Was it ever suggested to you to increase the number of nursing sessions each day? Does that seem doable to you at all?

So baby is asleep/not nursing from 7 pm until 7 am? 12 hours every day!? A 12 hour stretch every day with no feedings is highly, highly unusual, even for a much older baby. For a one month old, it is very unusual! Yes your baby is gaining well, because when he is being fed, he is getting way more than what is normal for an individual feeding. This might be why he is sleeping so long. Also, the reason I asked about pacifiers and swaddling is that these are sleep lengthening techniques. So if a baby is sleeping really long, it may help if these are not used. Also some babies do not wake with normal frequency if they sleep in a different room from mom.

[@llli*tclynx]

Hi andrebaby,
I'm definitely not highly experienced here and my baby is only 5 weeks old but I wanted to say you are doing an amazing job and I can relate since I have experienced some of the things you are struggling with (though I think my experienced have been a milder form.)
I'm using an SNS and about a week ago I actually switched to the smallest tubes to make my LO work a little harder for the supplement. Perhaps use the SNS but open and close the tubes or adjust the height to provide just enough supplement to keep him interested in sucking and that way get him to stimulate your milk supply more without you having to pump so much or for as long.

My Milk supply was a bit slow to come in and my baby was rather large. I experienced 4th degree tears and the blood loss left me a bit anemic. Had a sleepy baby and too many people encouraging me to "let him sleep" a bit too much early on when my milk supply really needed the stimulation so we wound up having to supplement to deal with excessive weight loss early on and to get his weight gain back on track. Just had his one month check up and we are doing well now and I've actually been able to decrease the supplementation of formula down to 2-4 ounces now.
As for pumping, it hurts for me and I'm never able to get more than a spoon full out with the pump (I think maybe once I managed to get 1/2 an ounce combined for a pumping session.) I try to pump once for each time I use the SNS but because the pump hurts me I usually only pump for a short time now. Between nursing my LO very often, like every 1-1.5 hours during the day and then at least every 3 hours at night (actually we co sleep and he latches on at will at night but do your own research since co sleeping needs to be done safely and is not appropriate for everyone) My milk supply is almost up to his needs.

Keep up the good work! Even if you are never able to totally get off the supplement you have made great strides so don't beat yourself up. However, if you are determined, don't let others discourage you from continuing trying to increase your supply.

[@llli*maddieb]

Hi, I know the confidence is probably the hardest thing for moms who are contemplating weaning off supplements. I am going to answer your questions in detail, but first I would strongly suggest discuss your plans with the doctor or IBCLC and ask them to help you monitor the situation as you start weaning from supplements. I also suggest it might make sense to take a few days or a week or so (whatever feels right) of feeding baby the same amount of supplements overall, or very close to that, but in smaller amounts more frequently, before beginning to lessen the amount baby gets overall.

1) if i choose to breastfeed him 10 times a day, do I still need to pump after each session? That will mount to 20 sessions per day, i am already not getting any sleep, worried how long I can last if I have to do 20 sessions per day.

No. I do not think you need to pump every time baby nurses. Right now you are pumping 8 times a day, so certainly there is no reason to pump more than that! However, if pumping 8 times is still too much when increasing nursing sessions, I think it is ok to reduce pumping sessions more. But you do still need to pump as long as you are supplementing in order to keep increasing milk production, and the typical goal would be to pump once for every time baby is supplemented. HOWEVER, again, if that is too often, or baby is getting a little supplement at each feeding, then do what works for you. Also, to maximize sleep and to keep from going nuts, you can pump more often at times you are awake anyway, or pump for shorter sessions, pump right after nursing sometimes and at other times when baby is sleeping, etc. - fit pumping in where you can. Some moms keep two pumps set up in different parts of the house so they can do 'cruise by' pumping. Basically, you can get creative with fitting the pumping in.

2)I understand that the diaper count can be used to check if the baby is getting enough for a breast fed baby. But my son is only having one dirty diaper every three days, so I am afraid that would be a good enough measure. is there any other way to check if the baby is well fed? can i use the weight gain? when should i be alerted if the weight gain is used?

Yes, go by weight gain. I would suggest weight checks no more often than once a week, or once every two weeks if you can stand it, always on the same scale with baby naked or in a dry diaper. Weighing baby more frequently can be too alarming as weight gain rate normally fluctuates. In between, wet diapers (or lack there of) will alert you if baby is really not getting enough. Also, behavior. We want baby to wake up and 'act' much more hungry, and there is bound to be an adjustment period when baby might be wondering what is going on with the smaller (but more frequent) feedings. But in general, baby should seem reasonably satisfied and relaxed after most (although probably not all) feedings. A baby who is not getting enough may look worried, frantic. Normal comfort nursing, where baby may nurse in a relaxed way for a while, or nurse to sleep, is fine, I am talking about a baby who seems frantic or worried with his nursing even after nursing for a while. But again, weight gain is your most effective measure.

3)i have a very sleepy baby. he falls asleep as soon as he is not content with the milk flow of my breast. The SNS keeps him awake for at least 40 min. I am thinking to do the 5 daytime feedings with SNS (7am to 7pm), the same as the old schedule but with only 2 ounce of supplement. Then I add 5 breast only feeding sessions in between. I will also add two night sessions around 11 and 3 with SNS. This will give me 7 SNS sessions and 5 breast only sessions. Assuming he gets 1 ounce from me directly, that means i will give him 12 ounce of breastmilk, and 14 (2*7) ounce of formula. Is it this something reasonable to start? If he is still growing well with the plan, i can start to wean off the formula for each SNS sessions.

I think this is reasonable but since baby is getting 20 ounces of supplement right now, I would suggest not dropping down to 14 immediately, maybe take it a little slower. This is something yiou can discuss with your LC and doctor. Also, remember that a "normal' breastfed baby will not nurse on a schedule. They might nurse every hour part of the day and then take a longer stretch here and there. So you could consider scheduling the supplemental feedings, but letting baby nurse without the sns (or with very little in the sns) whenever baby wants, and fit your pumping in when you can.

4)let's say everything goes well, i can manage to get more milk produced. I will have to go back to work around 4 month meaning pumping would be pretty much the only way to keep breastfeeding the baby ( i work 12 hours from 7am to 7pm). Would it be possible for me to pump more milk by then? i am afraid i spend two months to establish breasfeeding, then have to give it up because i will have to pump again.

This is a really typical concern. I would suggest it is important to let go of the 'all or nothing' mentality. ANY breastmilk your baby gets and ANY time spent nursing is a proven health benefit to your child (and you.) You would not have to give up breastfeeding. Even if you are not able to pump enough at work, your baby's caregiver can give baby formula as needed and you can nurse all you want when home with baby.

Is that every day, 12 hours a day? Because another way working moms keep milk production as good as possible is to nurse lots on weekends and days off.

tclynx has some great ideas, for you, especially about the sns.

www.kellymom.com has a good article about weaning off formula supplements

[@llli*zaynethepain]

http://www.thankyourbody.com/drinking-too-much-water/
Meg as always has awesome advice. One thing is really jumping out at me though. I definitely feel 20 oz per hour is over hydration. Do you drink to thirst or aim for that amount? Here's a decent article on drinking too much water.