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Thread: 6 weeks, no milk; delayed onset

  1. #1

    Default 6 weeks, no milk; delayed onset

    I have never posted to any forum so I hope I'm doing this right. I am a mother of three beautiful healthy girls ages 7, 4, & almost 6 weeks. My first baby I didn't succeed in breastfeeding and quit after two weeks when I had no milk & a colicky baby as well as post partum depression. My 2nd I was determined to breastfeed. Note: I have great anatomy & my breasts get bigger and areolas darker during pregnancy. I also produce colostrum. So 2nd child I tried everything, herbs, pumping (got just drops), SNS, and three days of domperidone at 4 weeks post partum. Saw an endocrinologist who said I was fine and needed to just give up and bottle feed. So I started the bottle but would still put her to my "dry" boob before each feeding at 4 wks. At 6 wks out of insanity or desperation I tried acupuncture. Slowly started to see changes. By 9 weeks I had a full supply and could pump roughly 2 ounces out of each breast and feel strong letdowns while at work!! Crazy right? After taking 6-9 weeks to come in, I breast fed my middle DD for 16 months! I took Zoloft until DD#2 was 5 months and then weaned off. So when preg w DD#3 I started moringa at 38 weeks along with acupuncture. Totally expecting my milk to come in. Yet here I sit at almost 6 wks pp w DD#3 and only drops at the pump. Still doing sns using medela sns. I started Reglan almost 3 weeks ago (since I can't get domperidone now) and am weaning off as I see no changes. I take blessed thistle, fenugreek, dandelion tea (helps my allergies tremendously), and mothers milk tea. Started shatavari yesterday. Quit acupuncture over a week ago out of frustration that it's expensive and not helping! I haven't taken Zoloft this time as I haven't needed it. Normal tears of post partum but I can still laugh and enjoy life Also note: 4th degree tear w DD#1, 3rd degree w DD#2, & c section this time w DD#3. I am super frustrated and can't understand why I'm not seeing changes! My body has done this before! It's so weird to look at the pump and see just drops when I sprayed like a faucet to make 4 ounces when DD#2 was nursing. Any similar experiences or input is greatly appreciated. I just can't believe it won't come in this time, bc I know I can make milk, I am just starting to lose hope. Also, my kids have all had great latch.

  2. #2
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    May 2006
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    Default Re: 6 weeks, no milk; delayed onset

    Welcome to the forum and congratulations on the new baby!

    I have to admit that I find your situation rather puzzling. Your nursing experience with your second baby tells us that you have the potential to make plenty of milk. It sounds like you are doing everything right- if I understand you correctly, you are feeding the baby exclusively at the breast via SNS, the baby is latching well, and you are also pumping. So, some questions for you-
    - Can you tell us how often you are pumping?
    - What sort of pump you are using?
    - Are you using any form of hormonal contraception, including the minipill, Nexplanon, or Mirena?
    - Are you nursing and/or pumping overnight?
    - Did you have any sort of large volume blood loss during the birth of your children?
    - Are you taking any medications that you didn't mention above?
    - Do you have any medical problems not mentioned above? I would be particularly interested in any sort of endocrine disorder, e.g. thyroid dysfunction, PCOS, or problems with the pituitary.
    - Have you ever had any sort of breast surgery or breast injury?
    - How about nerve or brain damage? (I'm really reaching here but this could be relevant, since milk production is controlled by the brain.)
    - If you nurse the baby without using the SNS, does it seem like she gets any milk? Do you hear her gulp or swallow?
    - Did you ever feel like your milk "came in" this time around- that is, did you experience any engorgement or increased feelings of fullness?
    - Do you ever feel like your breasts are more full than usual?

  3. #3

    Default Re: 6 weeks, no milk; delayed onset

    I left a few things out to save space, was such a long post. I am an RN and work a flexible schedule only 1-2 times a month. Usually 7p-7a on Friday nights when I want to. So I only needed to pump at work at 10pm and 2am. I would usually get 4-5oz at 10 and then maybe only 2-3oz at 2am. A larger percentage of that came from my right breast. Also feel stronger letdown on right side. I pump maybe twice a day after or between feedings w a medela double pump in style. I actually have two bc insurance paid for a new one this time. Pumping when you are only getting drops is mentally and physically exhausting. I didn't pump until my milk came in w #2. I only put her to breast before giving her a bottle (did sns prior to 4wks). Yes this time I'm exclusively doing sns, right now actually I will sometimes do hand expression on the side she's not nursing on. Too hard to catch it so I just wipe on burp rag. No hormonal birth control now or when nursing #2. I have wondered about blood loss. I do have thyroid problems and an interesting fertility story. Went off birth control TTC #1 and two cycles later got pregnant. Tore 4th degree and hemoglobin got to low 9. TTC #2 took a year and some clomid, but actually got pregnant after stopping clomid as it made my ovaries painful. Doc pulled on my placenta/cord (after being asked not to) during delivery w #2 and pulled cord off and had to do manual placenta extraction. Discharged two days later but returned back for hemorrhage and clot passage that happened end of day 4. It was not retained placenta. Just a huge clot and lots of bleeding. But the bleeding stopped before we got to the ER and my hmg was fine (around 10). So re: thyroid. I started taking a low dose of synthroid (25mcg) when TTC #2. My OB didn't keep it tightly controlled. After the experience w #2 I got a new OB. She keeps my thyroid tightly controlled and I'm currently taking 100mcg and my last TSH was under 2. Last TSH was around 36 weeks gestation. She will recheck at my follow up next week. TTC #2 took two years and two cycles of IUI w Femara. No brain damage No engorgement yet this time but she does swallow maybe twice on the left side and a handful of times on the right. But not vigorously like with a letdown. I don't feel my breasts are fuller than usual however I get sharp pains occasionally in my breasts like they are trying to fill up. I also can barely feel a letdown on my right side. After posting my initial post I pumped between a feeding and got the most I've gotten yet this time around which was about 1.5 ml total. And at this last nighttime feeding I over fed her. Makes me wonder if changes are slowly happening. When my milk came in w #2 it was a gradual thing from about 6-9 weeks. I didn't feel engorgement until it was all the way in and she would go long periods at night. Oh! And I also didn't tell you that even after my milk was in w #2, I would "top her off" with 2 ounces of formula at bedtime bc I couldn't bear to go from a formula fed baby that slept to a breastfed that didn't sleep! I'm sure she didn't need it, but I couldn't let go of it. And when I started food at 6 mo I quit the night time supplement. Thank you for reading all of this and caring to investigate w me! I hope my story can help other moms. And I hope my milk comes in this time, but it's hard to keep hoping. Just seems like it should be here.

  4. #4

    Default Re: 6 weeks, no milk; delayed onset

    I hope that is all clear, I've been up nursing and I'm tired! Haha.

  5. #5
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    Default Re: 6 weeks, no milk; delayed onset

    Thanks for adding that additional detail! You're painting a complicated picture, so hopefully I am understanding everything right. Based on my understanding of what you have posted, here is what I am thinking:

    - Possibility 1: the thyroid issues could be standing in the way of a normal start to milk production. As you probably know, thyroid issues are tricky. They can mess with just about every system in your body. They can affect you in ways that they aren't supposed to- hypothyroidism is supposed to make people hirsute but for some it causes hair loss. One person might feel totally normal with a given TSH, whereas another person might feel awful with the same TSH. So I would definitely want to keep a close eye on TSH, and make sure you get the expanded thyroid panel instead of just the TSH. T3, T4, that sort of thing. I would also want to see an endocrinologist and see if there might not be something else hormonal going on. Your history of fertility issues, ovarian pain, and issues with milk production suggest to me that testing for PCOS might be a good idea, particularly if you have other PCOS-like symptoms which you haven't mentioned.

    - Possibility 2: the large volume blood loss associated with the tears was the cause of delayed/reduced milk production with your first 2 babies. IIRC, the hypothesized method of action is that when a mom loses a lot of blood at birth, that blood is not available to carry the "hey, the placenta is out, time to start making milk" message to the brain. But I would also be suspicious at this point that you have a fragment of retained placenta. This might be a good time to talk to your OB and ask her if the placenta came away in 1 piece, or if it broke up. I would also want to have some testing done to see if there are hormones present which suggest the presence of a piece of placenta; IIRC you'd be looking for hcg, human chorionic gonadotropin.

    - Possibility 3: the delay in milk production is caused by issues with breastfeeding management. This is by far the most common cause of issues with low milk production. I'm not saying you made any of the following breastfeeding management errors, but common ones are things like:
    - Introducing a bottle or pacifier before mom's milk comes in, which generally happens at 2-5 days postpartum. Before that point, a baby is designed to get enough to eat from colostrum alone. Feeding a baby via bottle or using a pacifier in the colostrum stage can delay/reduce supply by reducing the number of nursing sessions, by decreasing the amount the baby eats when he is at the breast and by interfering with the baby's latch.
    - Not nursing enough. A newborn baby should be nursing a minimum of 10-12 times a day. After milk supply is well-established, the number of feedings may decline, with the usual minimum being 8 nursing sessions per day.
    - Skipping night nursing. Night nursing can be very hard on mom, but the it's also very good for supply. Skipping night nursing sessions will result in lower supply.
    If any of the above seem familiar, the solution to these problems will be more nursing and more pumping.

    - Possibility 4: issues with the pump are standing in your way. When a baby is unable to bring in a good supply via nursing, the way to remedy that is by using the pump to mimic a newborn baby's feeding pattern. That means pumping as often as possible, usually a minimum of 8x per day, more if possible, with some pump sessions occurring overnight. (Yes, I know that means a lot of VERY hard work!!! I'm not trying to be a sadist- it's just that frequent pumping is what works.) Using a very good pump with properly fitted shields is also important. The PIS is a good pump, but in your situation an upgrade to a hospital-grade rental might be a good idea.

    - Possibility 5: anxiety? Your most successful nursing experience was the one where you took Zoloft, right? So my thinking is that anxiety can impact a mom's ability to let down her milk- farmers know this because cows who are anxious about cold teat cups or rough hand milking will actually "hold up" their milk. So maybe the Zoloft helped you out with baby #2 in more ways than you think?

    - Possibility 6: your issues are caused by some combination of the above.

    What do you think, mama? Do you feel like you have some avenues to investigate?

  6. #6

    Default Re: 6 weeks, no milk; delayed onset

    Thank you for the ideas. Will take to my OB on Monday. I pumped a lot and nursed constantly also did skin to skin and baby wearing the first two weeks. I don't think it's a management issue. However, I'm no longer doing skin to skin and only pump one to two times a day now. I am feeding her 8 times a day now. You've inspired me to pump. Doing that now. I think it has to be thyroid or possible retained placenta or some weird combo. I'll let you know how Monday goes. I definitely bled longer than I was expecting for a c section. Bled for 5 weeks. I have reddish hair was a red head as a child (it's faded now, I'm 32). Anyway, we nurses (I work OB) say red heads bleed more and it's true! That is my observation that we do bleed more. Thank you again for your input!! Also, yesterday I noticed 7-8 swallows from my right breast without the sns. I'm almost 6 weeks, so maybe my body just does it at 6 weeks.

  7. #7
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    Default Re: 6 weeks, no milk; delayed onset

    Let us know how things go! I am really curious to see how your experience goes- it's an unusual one!

  8. #8

    Default Re: 6 weeks, no milk; delayed onset

    I have pumped 5 times today so far! I'm getting milk every time which is unusual for me. I'm getting 1-2ml which is way more than drops. Was exiting to see actual squirts a couple times today! I'm taking fenugreek blessed thistle, shatavari, and mothers milk tea. Wondering about adding goats rue? Is that too many herbs? Would it be better to drop the blessed thistle and add goats rue? I've only been on shatavari for a few days.

  9. #9
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    Default Re: 6 weeks, no milk; delayed onset

    IMO, the best thing you can do is just keep on pumping! The herbs are nice, don't get me wrong. But they generally produce a modest boost, at best. We tend to want them to work because they are so easy- all you have to do is swallow some pills or some tea. But it's the grueling work with the pump that really pays off.

    You're doing an awesome job, mama!

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