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Thread: Please Help - Milk Supply Dwindling

  1. #1

    Default Please Help - Milk Supply Dwindling

    Hi All! New to LLLI.

    LO was born 9.9oz on 7/22 and milk flow was excellent! BF on demand and pumped when she slept. Once or twice a week we'd give her formula followed by BF before bed. She has slept 7-11 hours every night since we brought her home. After she'd finish BFing, I'd pump and then again in the morning. Engorgement would wake me up - or waking in a puddle! Morning pumps were making 8-9oz (Left breast) and 4-5oz (right breast)

    Fast forward 2 months. I had appendicitis 9/20 and was released from the hospital on 9/21 - unable to pump while I was there so I hand expressed. Came home and pumped and dumped (anesthesia) until nighttime 9/22.

    Beginning the next day we started to BF again like clock work (and pump when she slept). Morning pump still making 8-9oz/ 5-6oz. Every midday bottle was making 4.-5oz (x2)

    I began working again on 10/20. Since 10/20 I have produced 4oz/4oz in the morning, I pump every 2 hours only getting 1.5oz/1oz. I leave at 7am and get home at 7pm. The first thing we do is BF from both breasts - baby SCREAMS!!!!! There's just not enough. I usually have to give her one of the 2-3oz bottles I made.
    We have to supplement with formula during the day because the tiny bottles I'm bringing home from work just aren't cutting it!

    Also - had first period 9/21, 2nd period 10/26. Why am I ovulating if I was EBF? Does this have something to do with the supply?

    Now - before I get the same info - here's what I've been trying to help (in no particular order):

    1. I drink over a gallon of water every day (always have even before preg)
    2. Very healthy diet - Think South Beach Diet - lots of protein, greens, whole grains
    3. 2 Fenugreek 3-4x day (since August)
    4. 5-6cups of Mother's Milk Tea (since August)
    6. 2 Milk Thistle 3-4x day (since October)
    7. I recently started taking Brewer's Yeast 2 per day (I'm afraid to increase - avoiding yeast infection)
    8. Tried Milkmaker's Lactation Cookies 2 per day (couldn't find serving size)
    9. Oatmeal EVERY morning for weeks now.
    10. Massage breasts
    11. Skin to Skin


    PLEASE HELP!!!!!

    It especially breaks my heart when I BF and she's crying because she's not satisfied!! I'll also note that she's almost 4 months old and she's 17lbs. I know she's satisfied because we've had to supplement and we started cereal but I'd like her back to strictly breast milk.

    Thank you!!!!
    Last edited by @llli*lexi113; November 18th, 2014 at 03:48 PM.

  2. #2
    Join Date
    Aug 2014
    Location
    Louisville, Kentucky
    Posts
    317

    Default Re: Please Help - Milk Supply Dwindling

    Lexi, let me check my reading comprehension (may help others, too, in providing thoughts):

    -You are separated from baby for 12 hours during the workday.

    -You are pumping how many ounces, typically, during the day when at work? (I think that you are using the "/" to show production from left and right breast? If so, you are getting 8 ounces at the first pumping session (9am?), 2.5oz (11am?), 2.5oz (1pm?), 2.5oz (3pm?), 2.5oz (5pm?), (--nursing baby, 7pm?)-- so 18 ounces total pumped during the day?

    A breastfed baby under six months of age requires, on average, 25 ounces of breastmilk per day, with a range being 19-30 ounces (http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/). The typical recommendation for what to leave for baby when separated is between 1-1.5 ounces per hour of separation. If you're gone from your little one for a twelve hour shift, 18 ounces would be the absolute maximum that baby would need... so if I've gotten everything right, you are right on target (or over!) for what baby needs when you're at work! But maybe I've gotten something wrong?

    -Are your care providers using a "paced bottle feeding" method? How many bottles, and of what size, are you leaving with the care provider, and do you know if they're feeding on cue?

    -How many times, typically, will baby nurse during the 12 hour period that you are together on a workday? What about on the weekends?
    Last edited by @llli*erin.in.middletown; November 18th, 2014 at 04:57 PM. Reason: formatting

  3. #3

    Default Re: Please Help - Milk Supply Dwindling

    Quote Originally Posted by @llli*erin.in.middletown View Post
    Lexi, let me check my reading comprehension (may help others, too, in providing thoughts):

    -You are separated from baby for 12 hours during the workday.

    -You are pumping how many ounces, typically, during the day when at work? (I think that you are using the "/" to show production from left and right breast? If so, you are getting 8 ounces at the first pumping session (9am?), 2.5oz (11am?), 2.5oz (1pm?), 2.5oz (3pm?), 2.5oz (5pm?), (--nursing baby, 7pm?)-- so 18 ounces total pumped during the day?

    A breastfed baby under six months of age requires, on average, 25 ounces of breastmilk per day, with a range being 19-30 ounces (http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/). The typical recommendation for what to leave for baby when separated is between 1-1.5 ounces per hour of separation. If you're gone from your little one for a twelve hour shift, 18 ounces would be the absolute maximum that baby would need... so if I've gotten everything right, you are right on target (or over!) for what baby needs when you're at work! But maybe I've gotten something wrong?

    -Are your care providers using a "paced bottle feeding" method? How many bottles, and of what size, are you leaving with the care provider, and do you know if they're feeding on cue?

    -How many times, typically, will baby nurse during the 12 hour period that you are together on a workday? What about on the weekends?
    Sorry - I may have confused something - I'm actually getting the 8oz at 5am when I pump (she's still sleeping but today I only made 5.5oz combined) 9am 3oz (combined), 11am sometimes a little over 1oz, 1, 3, 5pm pumps are pretty much the same as the 11am. I have to combine most pumps just to make a decent sized bottle.

    She's drinking 4-5oz bottles at every feeding. We've added cereal to 2 bottles a day just to fill the little meatball up!

    During the week I'm with her from 7pm till her bedtime between 9 and 10pm. She BFs once at 7 (both breasts) followed by a bottle usually 3oz - she screams through her latch, beats me up, talks to it - then we BF again after bath time before a bedtime bottle (6oz with cereal) which she inhales at record speed. Both Mommy & Daddy have excellent appetites and luckily we were blessed with a baby who does, too!

    She doesn't over eat - when she's done she will let you know she's done. When she wants more, she will turn towards me and suck at my top, sometimes pulling my shirt down, even an hour after a hefty bottle or feeding.

    During the weekend, I only pump when she's sleeping. I don't do the morning pump unless she's sleeping late. If I see she's starting to fuss in her sleep I BF while she's still sleeping. I BF all weekend long. I've tried to see if she doesn't want the breast but that's not the case. The kid's got an appetite. We've started sweet potato this week - 2.5oz of solid with a 3-4oz chaser.

    Usually, in my absence, there's 1-2 supplemented bottles.

    I hope this was a little more clear. I apologize for the confusion.

  4. #4
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    Aug 2014
    Location
    Louisville, Kentucky
    Posts
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    Default Re: Please Help - Milk Supply Dwindling

    Final round of clarification! (Sorry, this might seem tedious, but I really think it might be relevant for folk to weigh in on thoughts and ideas about things you may want to try to reach your own nursing goals)

    Workday:

    5a: (pump while baby is asleep) 5.5-8oz
    6isha: nurse baby?
    9a: (pump at work) 3 oz
    11a: (pump at work) 1 oz
    1p: (pump at work) 1 oz
    3p: (pump at work) 1 oz
    5p: (pump at work) 1 oz
    7p: nurse baby
    9/10p: nurse baby
    9/10p-6isha: Baby sleeps through? If so, what does the sleep set up look like? Is little one in her own room, in your room but in a separate crib, or in bed with you? Is she swaddled? Does she use a pacifier (and if she uses a pacifier at night, is she using it at other times? If she is sleeping through for this 8-9 hour stretch, how long has this been the case?

    Typical workday: 3 nursing sessions, 6 pumping sessions, 12.5-15oz yield. (?)

    There just seems to be a lot of different food items (breastmilk, formula, cereal, purees) and a few different delivery methods (breast, bottle, spoon), plus nursing at the breast/getting breastmilk via bottle... there's just a lot going on, so I want to make sure I (and others) understand exactly what your situation looks like now, to best be able to offer thoughts and ideas.

    ...So maybe it would help to just know:

    --In a typical work day, baby is nursing three times (correct?) and is getting how many ounces of other items not directly at the breast (expressed breastmilk = ?oz, formula = ?oz, cereal = ?oz, puree = ?oz)?

    --On a typical weekend day, baby is nursing on cue, but ~about how many times in the total 24 hour period? And then if other items are being given on the weekend, how much (expressed breastmilk = ?oz, formula = ?oz, cereal = ?oz, puree = ?oz)?

    And then, I think it also could help to know what your personal nursing goals are? In your first post, you mention wanting to get her back to exclusively breast milk. Would you like this to mean at-the-breast when you're together, and via bottle only when you're separated? Do you want to do exclusive breast milk until the 6month point? Do you want to do child-led weaning, or is there a specific end date that you have in mind for nursing altogether?
    Last edited by @llli*erin.in.middletown; November 19th, 2014 at 06:37 AM. Reason: Clarification; I'd been rambling and wanted to be clearer.

  5. #5

    Default Re: Please Help - Milk Supply Dwindling

    Quote Originally Posted by @llli*erin.in.middletown View Post
    Final round of clarification! (Sorry, this might seem tedious, but I really think it might be relevant for folk to weigh in on thoughts and ideas about things you may want to try to reach your own nursing goals)

    Workday:

    5a: (pump while baby is asleep) 5.5-8oz
    6isha: nurse baby? no - baby is still sleeping
    9a: (pump at work) 3 oz
    11a: (pump at work) 1 oz
    1p: (pump at work) 1 oz
    3p: (pump at work) 1 oz
    5p: (pump at work) 1 oz Don't pump - leave work
    7p: nurse baby
    9/10p: nurse baby -Sometimes she falls asleep after the bath without a feeding in which case I pump maybe 2oz
    9/10p-6isha: Baby sleeps through? If so, what does the sleep set up look like? Is little one in her own room, in your room but in a separate crib, or in bed with you? Is she swaddled? Does she use a pacifier (and if she uses a pacifier at night, is she using it at other times? If she is sleeping through for this 8-9 hour stretch, how long has this been the case?
    baby sleeps straight through from around 9:30-10 till after 7am
    she alternates from sleeping in her own room and sleeping in our bed (depending how tired we are!)
    no swaddling
    my MIL sort of pushed the pacifier on her during the day when I'm not home. I'm not a fan of it but it was becoming a household brawl! Now, she likes it mostly for the pressure since shes starting to teethe but she spits it out most of the time. When I'm home, I usually take the paci right out and put her on the breast. I'd rather her use me as a pacifier for an hour.


    Typical workday: 3 nursing sessions, 6 pumping sessions, 12.5-15oz yield. (?) Sounds about right

    There just seems to be a lot of different food items (breastmilk, formula, cereal, purees) and a few different delivery methods (breast, bottle, spoon), plus nursing at the breast/getting breastmilk via bottle... there's just a lot going on, so I want to make sure I (and others) understand exactly what your situation looks like now, to best be able to offer thoughts and ideas.
    She's never had any type of nipple confusion. We started her on the bottle very early on to monitor how much she was actually eating because she would do 20min each breast and then scream for more 45 min later so it was a Dr. suggestion. This is why I started pumping in the first place. We really haven't done too much spoon - just cereal in breastmilk / formula.



    ...So maybe it would help to just know:

    --In a typical work day, baby is nursing three times (correct?) and is getting how many ounces of other items not directly at the breast (expressed breastmilk = ?oz, formula = ?oz, cereal = ?oz, puree = ?oz)?

    --On a typical weekend day, baby is nursing on cue, but ~about how many times in the total 24 hour period? 6-7 times a day followed or preceding a bottle And then if other items are being given on the weekend, how much (expressed breastmilk = ?oz, formula = 8oz, cereal = 2oz, puree = ?oz)?

    And then, I think it also could help to know what your personal nursing goals are? In your first post, you mention wanting to get her back to exclusively breast milk. Would you like this to mean at-the-breast when you're together, and via bottle only when you're separated? Do you want to do exclusive breast milk until the 6month point? Do you want to do child-led weaning, or is there a specific end date that you have in mind for nursing altogether?
    I guess my concern isn't so much how much she's eating, it's more "I used to produce 12-16oz in the morning, and roughly 26oz throughout the rest of the day in pumps - which isn't the case anymore. How can I increase?" There used to be bottles stocked just in case and now whatever I bring home is barely making it through the day. Example - after pumping yesterday at work I brought home 5.5oz. Some days are just heartbreaking.
    Yes, at the breast and by bottle when separated or when situations don't allow. If I could have her on breast milk well past 6mo I would be ecstatic - a year? 2? 3? Whatever!! lol .

    Does the fact that I resumed menstruating have anything to do with this?
    Last edited by @llli*lexi113; November 19th, 2014 at 11:15 AM.

  6. #6
    Join Date
    Aug 2014
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    Default Re: Please Help - Milk Supply Dwindling

    Quote Originally Posted by @llli*lexi113 View Post
    I guess my concern isn't so much how much she's eating, it's more "I used to produce 12-16oz in the morning, and roughly 26oz throughout the rest of the day in pumps - which isn't the case anymore. How can I increase?" There used to be bottles stocked just in case and now whatever I bring home is barely making it through the day. Example - after pumping yesterday at work I brought home 5.5oz.
    I hear you. I think I meant to offer a "here's why I ask" to my insistent questioning, but my babe woke up. The reason I was asking is because I was trying to get a sense of how many frequently milk is being removed, and by whom (baby or pump), as well as how much of baby's nourishment is happening at the breast, and how much of her nourishment is happening through other means and substances. The reason this is important is (1) because frequent milk removal and stimulation, around the clock, is important for the continuation of a hearty supply and (2) because prior to about 6 months, research has shown that the introduction of solids (cereal included) often serves to replace breastmilk in the baby's diet, rather than being just additional calories (I'm looking for a succinct source to point you to... I feel like I've encountered this many places, perhaps most recently in a Academy of Breastfeeding Medicine podcast? but not sure, and I'll keep looking for a good link).

    So--while I think there may be some trouble-shooting tips that might help you increase pump output a little bit-- I think the most-likely-to-produce-long-term-success in terms of supply, to get baby back to exclusively breast milk, would be to nurse baby more, when you are together. I think there's no way to say that this would definitely increase your pump output, but it would certainly work toward shoring up your supply in its totality; and if it doesn't increase your pumping output, it would be additional opportunities for baby to receive nourishment, spreading baby's consumption out over the day, and so likely baby may need less in bottles during the day.

    Would nursing baby more frequently (offering more when baby is awake, offering a dream feed or two, waking baby up in the morning to nurse...) during the day be feasible to try?

    Does the fact that I resumed menstruating have anything to do with this?
    Now, I think that all bodies are different. If I were to guess, my guess would be that at this stage in the game, a return of menses is more likely to be the result of the same thing that is causing a decrease in pump output, rather than your period causing the reduced output.

    My babe just woke up so I have to leave it there, and haven't spell checked or etc. Maybe others can chime in too.

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