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Thread: Supply drop at 10 months... any other recommendations?

  1. #1
    Join Date
    Jun 2014
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    Default Supply drop at 10 months... any other recommendations?

    Hi, ladies. After lurking for some time, I'm throwing a veritable novel of a post at you. Hopefully someone can help!

    My 10 month old takes three 5 oz bottles of breast milk on weekdays in addition to nursing once in the morning, once before bed, and once overnight. We also exclusively nurse on the weekends. I LOVE our time together and for this reason (and, you know, the usual lasting benefits of breast milk) very much want to continue nursing at least past 12 months.

    But here's my challenge: a couple weeks ago, my pumping output started dropping significantly, and I'm now yielding only 10 of the 15 oz my baby boy needs for daycare each day. My freezer stash, never all that large, has dwindled down to just 8 oz, so I need to figure out next steps pretty quickly.

    I work from home and have a luxurious amount of privacy to implement extreme pumping schedules. In a last ditch effort to bump up supply, I currently pump every 1-1.5 hours for 20-30 minutes during the day, typically yielding 7-10 oz total. One or two extra pumping sessions in the evenings after LO has gone to bed will usually bump me up to 10 oz if I haven't gotten there during the day... which is still 5 oz short of where I need to be.

    I haven't had a period yet and don't feel any indication that there's one on the way. Work-related stress could certainly be inhibiting prolactin levels, though I hadn't thought periods of high stress could have a lasting impact on supply. I have PCOS, but I'm not overweight and haven't ever had notable issues with insulin resistance, which I know can impact prolactin levels as well. So I'm not sure what could be causing my supply to drop.

    I do think my supply is dropping rather than just seeing a decrease in pumping output: my little guy has started lingering on the breast longer and sleeping less soundly at night (though he still only fully wakes for one feeding around 1 am). He's not lacking for wet diapers yet, at least.

    I've tried all sorts of tricks to up my output. Oatmeal, water, brewer's yeast, flax seed; More Milk Plus, Mother's Milk tea, fenugreek and blessed thistle capsules; power pumping, more frequent pumping, pumping longer, pumping right after the baby nurses on the weekend, nursing on demand; Pavlovian letdown triggers (though the deep breathing exercises were relaxing, at least), watching home video clips or pics of my baby while pumping... None of it's having any effect anymore.

    So, ladies, any suggestions? Anyone gone through something similar? Is it time to admit partial defeat and supplement with toddler formula? (And how does one figure out the correct number of ounces to supplement, anyway?) Is there some secret means of increasing supply that I haven't yet tried?

    (P.S. Domperidone is conspicuously absent from this post. Ignoring the challenge of obtaining any from a trustworthy source here in the US, I'm not totally sure the risks -- not yet well studied -- are worth the benefits of 5 more ounces of breast milk per day, especially this late in the game. But your thoughts on the topic are welcome.)

  2. #2
    Join Date
    May 2006
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    21,142

    Default Re: Supply drop at 10 months... any other recommendations?

    Welcome to the forum!

    A lot of moms experience a "pump slump" around this time in their babies' lives. It's usually caused by some combination of the following:
    - Baby not nursing enough in general
    - Baby sleeping long stretches at night
    - Baby's solid food intake picking up, causing a decrease in milk intake and hence a decrease in supply
    - Mom having to rely too much on pumping (pumping is not as good at maintaining supply as nursing is)
    - Pump wearing down after months of hard use
    - Pumping with an underpowered pump- usually okay in the first months of breastfeeding, but often not offering enough stimulation in the later months
    - Mom needing a different shield size than what she started out with
    - New pregnancy
    - Mom using a form of hormonal contraception that inhibits supply

    So, in order to get supply to bounce back, you want to do the opposite of the above list. Nurse more often, particularly overnight. Pump more often- and not just for a couple of days! We're talking weeks of work, here. Rehab the pump you have or use a better pump. Make sure your shields are properly sized. Make sure you're not pregnant, and if you're using hormonal contraception, think about using some other method of birth control.

    Because you work from home, you have an option that is not available to most working moms, which is to simply nurse the baby. Have your caregiver bring you the baby when he's hungry, and take him away when he's done nursing. Sure, it will be time- consuming, but it's likely to be much less so than an extreme pumping program! And it's just for another couple of months- at 2 months you can start giving your LO bottles or sippy cups of whole cow's milk rather than breastmilk or formula.
    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
    Join Date
    Oct 2012
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    2,214

    Default Re: Supply drop at 10 months... any other recommendations?

    I was also thinking about whether baby could nurse at least some of the times during the day. Also 5 oz is a big bottle. Baby's usual meal at the breast would be 2-4 ounces. So you might want to try backing down on the bottle size, first to 4 oz, then to 3, with an additional oz if baby really needs it. This will make it easier for you to keep up and also may motivate baby to nurse more during non-work hours, which as mommal says is usually a better supply stimulus than pumping. I think one of your problems is that you are only nursing three times a day on weekdays. Average milk intake is 24 oz, with a range of around 19-30 oz. So if baby is taking in 15 oz of expressed milk that represents a significant portion of his daily intake.

    Some moms find that upgrading to a hospital-grade rental helps - just for the couple of months until baby turns one, for example. If not, definitely change out exchangeable parts like membranes, valves, flanges.

    Pump slump is really common at this age, but you are getting really close to that one year mark! If you try everything and need some formula during the day, so be it. But I still think there are some things to try first. The fact that you've exclusively breastfed for 10 months means that your body CAN make enough milk, it's likely the fact that you are relying a lot on pumping that is throwing the supply and demand equation off balance.

  4. #4
    Join Date
    Jun 2014
    Location
    Austin, TX
    Posts
    3

    Default Re: Supply drop at 10 months... any other recommendations?

    Thanks! It's reassuring to know that a 9 or 10 month pump slump is normal, though I feel for everyone else that has stressed about this too. You've made some solid suggestions.

    First, the big hormonal suspect: I'm definitely not preggo (I tested last week) and am not on birth control. I *might* have a period coming -- I mean, it has been since, oh, 2012 -- but haven't felt anything that would indicate that. Unfortunately, though I'd love to nurse more during the day, I actually work full time... just as a remote employee with a very different dress code than my office-based colleagues. My kiddo attends daycare a good 15-20 minutes away. I could may be get away with taking an hour to go nurse him once a day, but it'd be pretty difficult.

    Increased solid intake is a possible culprit, but I'm not sure it would have this much of an effect if I mostly pump. I mean, my little guy adores solids and happily polishes off about a half cup's worth for breakfast and lunch plus whatever snacks he can charm my hubby into sharing in the afternoon. But during the week, he's not drinking any less: he'll go through those solid meals AND still finish all 15 oz of expressed breast milk, then come home and act like he's not totally full when we nurse before bedtime. Maybe I should add in solids for dinner, too? He'd get his last bottle at 3 pm, eat solids at 5:30ish, then nurse for bedtime around 6.

    Jacob's also been nursing just once overnight since about 7 months, illness and growth spurts as the obvious exceptions. Would that be having an impact this many months down the road? I'm a marketer and love tracking data, so based on the stats, I'm also pretty positive that he's not nursing any less. On week days, he always gets three 5 oz bottles and three nursing sessions. On weekends, I always offer the breast at least every three hours during the day, and he rarely refuses. Either way, he nurses a steady average of 8 minutes per side per session, though that number's been creeping up recently. It's one reason I think this might be a supply issue rather than just a pumping issue. (Though pumping issues can absolutely amplify supply issues.)

    As you might have guessed from the weeks of extreme pumping I described, my trusty Medela PISA has been driven pretty hard. I've replaced the diaphragms and tubing within the past two weeks and never feel a need to turn up suction past the halfway point, but will try going a little harder there. I also use the smallest shield size: I'm a pretty small girl and never needed more than a medium shield. I did try breaking out the medium size again last week but didn't see a different in output. What else would you suggest doing to help my pump limp along for just a little longer? Is there a way to find out for sure if suction is decreasing? Could decreased pump performance be the reason so many weeks with LOTS of extra pumping hasn't increased my supply?

    Arg, sorry for yet another epic post. Just trying to be thorough. Your help really is appreciated! Honestly, it seems like I might have to just pump what I can and supplement the rest with toddler formula for just a couple more months. It's just frustrating to have made it *so close* to a year (and no supplementation!) without actually hitting that goal.

  5. #5
    Join Date
    Jun 2014
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    Austin, TX
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    Default Re: Supply drop at 10 months... any other recommendations?

    Quote Originally Posted by @llli*bfwmomof3 View Post
    Also 5 oz is a big bottle. Baby's usual meal at the breast would be 2-4 ounces. So you might want to try backing down on the bottle size, first to 4 oz, then to 3, with an additional oz if baby really needs it. This will make it easier for you to keep up and also may motivate baby to nurse more during non-work hours, which as mommal says is usually a better supply stimulus than pumping. I think one of your problems is that you are only nursing three times a day on weekdays. Average milk intake is 24 oz, with a range of around 19-30 oz. So if baby is taking in 15 oz of expressed milk that represents a significant portion of his daily intake.
    Really? Wow, I had no idea. My guy has been guzzling down 5 oz bottles since he was around 4 months. But that makes sense: if he fills up during the day, he'll just be snacking in the evenings. And when neither the pump nor the baby are doing what's needed to maintain supply, things are bound to start dropping. Ideally, if I dropped daytime bottle size to encourage more nursing, that additional nursing would happen morning and evening... not overnight. I rather like getting to sleep in full four hour bursts.

  6. #6
    Join Date
    Oct 2012
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    2,214

    Default Re: Supply drop at 10 months... any other recommendations?

    It's really easy for babies to drink big bottles. I had no idea, either, and my babies were pretty routinely drinking 6 oz bottles until I started hanging out on these forums and realized that wasn't ideal!

    I think the long stretch overnight with just one nursing session could be a problem too (from a milk supply standpoint, obviously from a sleeping standpoint it's pretty nice!). Baby nurses at 6 pm, and then when? Could you add in a dream feed when you go to bed (or even, let's say, at 8 or 9 pm) without further disrupting your sleep, but getting another nursing session in there? Rather than adding solids at 5:30, I'd focus on nursing as much as possible in the evening. I personally really minimized solids in the evenings and weekends and focused on nursing at those times. There is absolutely nothing wrong about nursing three times in an hour and a half (as an example) - there's no reason you need to stick to an every-three-hour schedule.

    If you call Medela they can walk you through a pump check to make sure everything is in working order.

  7. #7
    Join Date
    Sep 2011
    Posts
    56

    Default Re: Supply drop at 10 months... any other recommendations?

    If I understand, your baby is going to bed for the night around 6pm with one overnight feeding and is nursing okay when you are together. There are two different ideas I have. First, you could add in multiple pumping sessions in the evening/night to get your 15 oz. I am thinking 7pm, 9pm, and 11pm and make sure you pump a good amount of time (~10min) after the milk stops flowing for that extra stimulation. It might take a week before you see an increase in supply but it should help. Once your supply is up, you might be able to back off to just two extra pumping sessions. Second idea is to nurse your baby more in the evening/night. This might help increase your supply and also allow you to give smaller bottles as baby is getting milk more spread out over the course of 24 hours. However, I am not sure how picky your 10 month old is and he might not cooperate with smaller bottles at this stage.

    Those are just some ideas to add to everything else you have been trying. Keep doing those extra pumping sessions during the day too and hopefully your supply will respond.

  8. #8
    Join Date
    May 2006
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    Default Re: Supply drop at 10 months... any other recommendations?

    Unfortunately, though I'd love to nurse more during the day, I actually work full time... just as a remote employee with a very different dress code than my office-based colleagues. My kiddo attends daycare a good 15-20 minutes away. I could may be get away with taking an hour to go nurse him once a day, but it'd be pretty difficult
    Gotcha. When you said you worked from home, I assumed baby was home with you, under the care of a nanny or family member. Is there any chance you could switch to that arrangement, just for the next couple of months? IDK, that might be too crazy! I definitely wouldn't want to take an hour out of my day to drive to daycare, though. Awful for your work life, and probably not that productive for your milk supply as you're gaining just one nursing session. Better to spend your energy and time on more pumping, I

    But during the week, he's not drinking any less: he'll go through those solid meals AND still finish all 15 oz of expressed breast milk, then come home and act like he's not totally full when we nurse before bedtime. Maybe I should add in solids for dinner, too? He'd get his last bottle at 3 pm, eat solids at 5:30ish, then nurse for bedtime around 6.
    I would feed him some solids for dinner- it might eliminate the need to supplement with formula. But I would also add in some more nursing sessions. Nurse him immediately when he comes home from daycare- I'm guessing at around 5-5:30? Then solids, then nurse again before bedtime.

    Jacob's also been nursing just once overnight since about 7 months, illness and growth spurts as the obvious exceptions. Would that be having an impact this many months down the road?
    Yes. At the very least, sticking with a single overnight session isn't helping you increase supply.

    What else would you suggest doing to help my pump limp along for just a little longer? Is there a way to find out for sure if suction is decreasing? Could decreased pump performance be the reason so many weeks with LOTS of extra pumping hasn't increased my supply?
    You might want to look into renting a hospital grade pump for these last couple months of nursing. Your PISA has worked hard and there may be nothing you can do for it beyond what you have done already!

    Honestly, it seems like I might have to just pump what I can and supplement the rest with toddler formula for just a couple more months
    If this is what you end up doing, I think you want to use the regular infant formula. IIRC, toddler formula is for babies >12 months.
    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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