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Thread: Increasing supply/ weaning supplements at 2 weeks

  1. #1

    Default Increasing supply/ weaning supplements at 2 weeks

    Hi everyone- have read the great in-depth replies to other ladies' posts and would like to tell my story too, and ask for some advice.

    I delivered my daughter (uncomplicated vaginal) 18 days ago and had always planned to exclusively BF. I thought we started well with skin-to-skin and on-demand nursing. Also had LC help in the hospital. At the first pediatrician visit, she had lost ~10% which was ok, but needed to follow up. We kept nursing almost constantly during the day with a couple breaks at night and my milk seemed to "come in" around day 4. Two days later we had another weight check and she had gained 2oz, so thought we were doing well. Unfortunately when we rechecked a week later (still constantly nursing on demand) she weighed exactly the same (no weight gain over a whole week). I was devastated and felt very guilty and we started formula supplements - this was 5 days ago.

    With the supplements, she has started gaining weight well, but I still would love to exclusively BF... That's where I need advice. I'm waiting on a call back from the LC to set up a consultation. Currently I'm nursing baby on demand then following up each feed with supplement as needed (she usually takes about 2oz per feed and has ranged from 10-16oz of supplement in 24hrs). I'm trying to pump after feeds, but having trouble fitting in the pumping with very frequent feeding and baby care during the day.. have only been able to get in about 4 sessions/day. When I pump after feeds, usually only get 10-20mL per breast.

    I'm looking into herbal supplements as an adjunct, but I think the main thing is to figure out how to pump more often.. Any suggestions? By the way, I do have PCOS which is the only health issue I can think of which might be contributing to the low milk supply. Sorry for the long post and thanks in advance for the help!

  2. #2
    Join Date
    Jun 2009
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    Default Re: Increasing supply/ weaning supplements at 2 weeks

    Hi riamom, I am sorry you are having this difficulty! Glad baby is gaining well now.

    When weight gain issues occur, the first thing to rule out is some mistake. Birth weights done immediately post delivery are notoriously inaccurate, and all subsequent weight checks must be done with very careful accuracy. This means, on the same scale- every time, if possible- with baby naked or in a dry diaper, in a careful, measured (non rushed) way. Both human error and scale error can and do happen and may indicate an issue where there is none, or a worse issue than it really is.

    Aside from weight checks, which are the best measure that baby is getting what baby needs, another pretty reliable indication of intake is output- poops. By day 3, a newborn is typically pooping at least 3-5 times a day, and what counts is something with a little heft- enough to scoop with a small spoon, not just a streak. If a baby is pooping that much and apparently not gaining, that would be another reason to look at how the weights are being done.

    So, if it is ascertained baby is not gaining normally when exclusively nursing, it is important to try to figure out why. Is it low milk production? Does baby have a hard time extracting milk efficiently? Baby not nursing often enough? Some combination? Hopefully your IBCLC can help you with that when you see her. It is important that the right problem is being addressed. Increasing milk production is not going to help, if your milk production is normal but baby has issues transferring milk.

    Currently I'm nursing baby on demand then following up each feed with supplement as needed (she usually takes about 2oz per feed and has ranged from 10-16oz of supplement in 24hrs). I'm trying to pump after feeds, but having trouble fitting in the pumping with very frequent feeding and baby care during the day.. have only been able to get in about 4 sessions/day. When I pump after feeds, usually only get 10-20mL per breast.
    First I wonder if it is possible you are oversupplementing. A two week old only needs about 20-25 ounces of milk per day (some more, some less.) 2 ounce feedings would be the total typical feeding at this age, although of course a little less and a little more is also normal. In other words, I wonder if 2 ounces every time is needed? It would depend on exactly how fast baby is gaining at this point, and of course on how often exactly baby eats.

    Don't be discouraged by your pump output not matching what you are supplementing. This could be for may reasons - including, as I mentioned, over supplementing- and pump output is not in any case an accurate measure of milk production especially as we do not know how much of your milk is going directly into baby! (it may be more than you think.) That said, I do want to be sure you have the best pump you can get. For a situation like this, the typical recommendation is that mom rent a 'hospital grade' pump. The pump must work well and fit you properly.

    As far as finding time to pump-

    You are already pumping 4 times a day, as well as nursing on cue, which I assume it something like 8 to 12 times a day? In that case, 4 pump sessions is really good. But, let's say that based on the amount baby is supplemented, (which again we want to be sure is enough and not too much) the amount of daily pump sessions to aim for is more like 8. This does not mean you must do 8 every day or it's all over, it just means, you probably do want to up the pumping frequency if you can. Do you think you can add in 2 more sessions, to make it 6? What if you did 5 today, and 7 tomorrow? It does not have to be the same every day.

    How much help do you have at home with baby? 2 weeks is a difficult time even if all is going swimmingly, and it is really important moms have more or less constant help at this age-when at all possible. If you ever wondered what a crisis might look like, this (the newborn period) is it. It is time to call in all hands, as long as they can be supportive- doing things for you, including diaper changes, washing pump parts etc. - so you can concentrate on nursing your baby, pumping, and figuring this out.

    Some moms pump while they nurse. Never worked for me, but something to consider.
    Frequency is more important than duration. If you can only pump for 5 minutes, do it.
    Here is a pumping log that may help: http://www.llli.org/docs/00000000000...umpigchart.pdf

    Also are all bottles being given via paced bottle feeding? : http://www.llli.org/docs/00000000000...astfedbaby.pdf and https://www.youtube.com/watch?v=UH4T70OSzGs

    I suggest the book Making More Milk, which is a fantastic guide to navigating low milk production.

    I would also suggest discussing a lactation aid (at the breast supplementer) with your LC.
    Last edited by @llli*maddieb; April 29th, 2015 at 07:18 PM.

  3. #3

    Default Re: Increasing supply/ weaning supplements at 2 weeks

    maddieb, thank you so much for your reply! I am trying everything you suggested and my LC suggested most of the same things. At the appointment, baby transferred 1.2oz (total for both breasts) at the feeding, so we're trying to decrease the supplement to about 1.5oz. LC confirmed that she has a good latch and no tongue-tie issues. The other good news is that baby has gained 7oz more over 4 days this week and is now up 5oz from her birth weight, so I think we are catching up. I rented a hospital pump and am trying to average about 6 sessions per day after feeds. Also started Reglan 10mg QID as of yesterday. I'm interested in hearing if anyone has had good results with this medication.. Especially with PCOS?

    Lucky for me, I do have a quite a bit of help at home, my mom is here at least every other day. Realize that I may not make it to 100% adequate supply, but I'm trying to do everything I can, at least for a few more weeks. Thanks again for the help and encouragement!

  4. #4
    Join Date
    Jun 2009
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    Default Re: Increasing supply/ weaning supplements at 2 weeks

    Hi riamom. How great baby gained 7 ounces in 4 days, this is very rapid gain! Normal average gain is about one ounce a day. Is your baby's doctor suggesting baby needs to gain faster than that? I am not saying there is anything wrong with baby gaining faster than average-there isn't. But, if it is expected that a baby gain very very rapidly to 'catch up,' then sometimes that leads to over supplementing.

    At the appointment, baby transferred 1.2oz (total for both breasts) at the feeding, so we're trying to decrease the supplement to about 1.5oz.
    I am glad you are trying to reduce the amount of the supplement. Please remember that before and after nursing weight checks show only what baby took in at the one feeding that was measured. It is entirely possible your baby transfers (or is able to transfer) more than that at some feedings. When a healthy, gaining baby nurses, anything from 0 ounce transfer to several ounces is possible.

    This does not mean before and after nursing weight checks do not have their use. They do. You now know that the very least your baby is able to transfer is over an ounce. Since babies typically nurse at least 12 times a 24 hour day at this age, and need about 24 ounces total a day, a feeding of 2 ounces would usually be enough. Of course, since babies often take LESS than two ounces, as they prefer, they will also often take more.

    Reglan is a pretty reliable galactagogue but some moms find the side effects difficult. Did you and your LC discuss alternatives? What about metformin, for treating the PCOS?

    Also I hope you are over feeling the guilt you spoke about in your first post. You did nothing wrong- but rather, are doing everything 'right.' Many babies have some difficulty gaining in the early days, for any number of reasons. Your baby was not loosing weight or starving, and the problem (slow gain) was very quickly recognized and dealt with. This is why weight checks are done- to be sure all is well, because it is so hard to know otherwise.

    Also, I know you fear the issue is the PCOS. Sometimes it is never clear why baby did not gain well early on. Did you know that the PCOS/low milk production link is not consistent? Many mothers with PCOS have no milk production issues, and some have overproduction.. In other words, do not let yourself get psyched out by a PCOS diagnosis.

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