Inconsistent pumping output

[@llli*ln22]

Hi! I am a first time mom to a four week old. I have vasospasms so at night I pump and bottle feed to give myself a break. I feed her every 2 hours during the day. At night, I nurse at 8 pm then pump at 11 pm and 3 am. When I started about two weeks ago, I was getting 2 ounces total, but for the past week I've only been getting an ounce. My lactation consultant recommended larger shields, so I have been using those. Last night, I tried smaller shields and got back to 2 ounces. Tonight, I used the smaller ones again and only got 1 ounce. I pump for 20 minutes with expressions using a double electric pump. I'm also taking fenugreek. Any suggestions or thoughts would be so helpful! Thank you!

[@llli*maddieb]

Hi, sorry you are having this trouble!

First, always, trouble shoot your pump. Pumps sometimes just are not working right and it is hard to tell. Get it checked out if necessary.

Are you getting help with reducing the vasospasm pain? What have you tried? Some moms just do not respond well to pumping and in those cases, pumping instead of nursing, even for a few hours a day, can (over time) harm milk production.

Also, is baby requesting to nurse every 2 hours all day? She might, of course. Or even more often. But I am wondering if you might be able to reduce overall nursing frequency during the day, but nurse around the clock, and get more of a break from the vasospasms that way?

It sounds like you are having trouble getting a correct flange fit. Why did you change to larger ones in the first place- was pumping hurting too?

Some moms need to use two different sizes, also many moms find that size changes. Some moms are in-between sizes and need to get special flanges in a different size than their pump manufacturer carries. Some moms find they have to use a smaller flange than is really comfortable, but they can make it work by being very careful where they position their nipple when pumping and/or lubing up the flange with a little olive oil.

Some moms find hand expression works better than pumping. And a few moms say that they find hand powered pumps work better than the double electrics.

Some moms seem to do better pumping one sided. I am one of those, pumping both sides at once never worked for me.

What happens if you pump 30 minutes rather than 20?

Are you taking fenugreek due to low milk production? I mean, is the problem overall low production or that you are not able to produce much for the pump? If it is overall low production and the fenugreek is not working, maybe try a different galactagogue or a blend. Has your LC mentioned prescription galactagogues? Also I have heard fennel is helpful for let down issues and that is a common problem with pumping.

There is a lot of psychology with pumping, so I would suggest figure out how to maximize your comfort and relaxation when pumping.

I have pumped in the middle of the night, I have to say that given the choice I would consider pumping a couple times during the day and nurse at night instead. Pumping at night while in a stupor is harder than pumping during the day in my experience.

Your schedule (both nursing and pumping) sounds kind of rigid. Rigid schedules can mess with pump output because it is just not the norm, biologically speaking. Is the two hours during the day when baby cues or are you and baby "on" that schedule for some reason?

Are you setting an alarm to pump? An alarm waking you in the middle of the night can make you tense. Have you tried the "drink a big glass of water before you lie down so you wake naturally to pee" trick?

When you are pumping, where is baby? Is baby getting fed at about the same time? Some moms find the presence of baby when pumping helps and others find the opposite.

Maintaining good hydration is vital for normal milk production.

[@llli*mommal]

with the PP. I just want to point out that "inconsistent" pump output is the norm. We're biological beings, not machines. So don't expect a perfectly regular output. Some pump sessions will yield more than average, some less. It's not 100% under your control.

[@llli*ln22]

Thanks for the replies! Since I posted, we had my daughter's one month appointment. She had a weight check at three weeks and was gaining really well, but she didn't gain anything between the three and four week check up. I didn't change anything in my routine, but I'm worried that the change in pumping output might be a sign of a bigger issue (low supply). My daughter's pediatrician said that if my production is this low now, it is unlikely that I will ever catch up to where she needs to be. It was really disappointing to hear. I'm still trying to nurse and pump in hopes that it's not a lost cause. I'd love to be able to supplement with pumped milk as much as possible.

To answer your questions:

I did troubleshoot the pump and since this message, I received a hospital grade pump and I've been using it for a day.

For the vasospasms, I've just been trying to keep warm using hand warmers. It helps with the cold, but not with pain associated with feeding.

I was feeding her every two hours on her doctor's recommendation. She hadn't gained weight in the first two weeks, so the do wanted me to increase feedings.

The lactation consultant recommended the larger phalanges. I'm trying to switch off and get a good idea if one works better than the other.

I tried pumping for 30 and I got a bit more, but still not the full two ounces I had been getting before.

I was taking the fenugreek to increase supply. It does not seem to be working. My lactation consultant also recommend Go Lacta, so I will switch to that. I've also been drinking nursing teas.

I pump at night because my daughter is a good sleeper (thank goodness) and has trouble waking up to nurse. She falls asleep a lot so it takes forever. I set an alarm to pump then wake her up to eat. After I pump, I wake her up and give her the bottle.

Thanks again for the replies! any other advice would be great!

[@llli*mommal]

First of all, it is absolutely untrue that low production means you'll never catch up with your baby's needs. Milk production can be increased at ANY TIME in your nursing journey. The only issue- in the vast majority of cases- is that it can require significant work, and some people aren't into that.

Has the baby been checked carefully for tongue and/or lip ties?

And would you say your baby is generally sleepy? Does she fall asleep often while nursing? How long does she typically sleep at night, if you don't wake her?

[@llli*ln22]

Thank you! That is so encouraging to hear. I am definitely willing to put in work.

Since we went to the doctor (three days ago), I've been nursing, supplementing and pumping. I've also tried power pumping a few times. I try to give her as much expressed milk as possible, but I have to give formula at some feedings.

She does not have tongue tie but she is very sleepy. In the early weeks, feedings took over an hour because she was constantly falling asleep. She still falls asleep, but not as much. I haven't tried not waking her yet, but last night she slept five hours at one stretch before I woke her.

[@llli*mommal]

Okay, sleepy babies can definitely be slow to gain because they spend too much time lazing about and not enough time eating! For sleepy babies, these tricks can help:
- Keep the baby cool when she's nursing, because cool babies are generally a little more alert. When it's time to nurse, strip baby down to a single light layer, and keep a fan blowing in the room where you nurse- just not directly on the baby.
- Annoy her if she seems to be drifting off at the breast. Rub against the grain of her hair or tickle the soles of her feet using your hand or a cool damp washcloth.
- Dim the lights. New babies often close their eyes in response to bright light.
- Do breast compressions when baby seems to be drifting off during nursing.
- Try switch nursing. When baby seems to be falling asleep, take her off the breast, burp her or change her diaper to wake her up, and switch her to the other breast. Repeat as many times as necessary, until the baby can no longer be woken.


All that being said, in your shoes I would want a LC- preferably an IBCLC- to take another look at the baby's mouth and help you with positioning. You're having vasospasms, and those can be triggered by compression of the nipple related to tongue tie or lip tie or just a generally not quite right latch.

[@llli*maddieb]

All that being said, in your shoes I would want a LC- preferably an IBCLC- to take another look at the baby's mouth and help you with positioning. You're having vasospasms, and those can be triggered by compression of the nipple related to tongue tie or lip tie or just a generally not quite right latch.

Yes! Also anytime there is a question of whether baby is getting enough milk, baby should be checked for nursing issues.

Also, please do not be discouraged by what your doctor said. It is absolute hogwash that milk production cannot be increased after a month. In fact, assuming there is not some physiologcical issue with mom that prevents her from producing any more, (and that is pretty rare) it is possible to increase milk production at any time, including long after a baby has weaned. Secondly, even when all is well and milk production is 100% normal milk production is often STILL INCREASING at the one month mark as the biological norm.

Does your doctor even know how much more your baby needs to eat to gain normally? My guess is no. So how can he/she say that you cannot increase your milk production that much? Ugh this kind of thing drives me crazy. Your doctor is wrong wrong wrong. Just wrong.

Also there are other reasons a baby might appear to have not gained weight for a week when in fact all is entirely well. 1) scale error 2) human error and 3) babies gain in fits and starts, not steadily such and such each day.

I should have asked in my first post- how much are you are expecting to pump? In fact 1-2 ounces is normal output when mom is also nursing with normal frequency. And it is true it is going to vary. The "problem" I was writing about was not really how "little" you pump when you pump at night, but that if that is a routine you are going to stick with and, in fact the pump is not working well for you, it might start to harm your milk production over time.

[@llli*ln22]

Thanks! When I breastfeed during the day and pump after, I get probably 10-20 mL total. At night, I just pump and then feed her with the expressed milk. So at night, it usually has been about three hours since I last nursed or pumped. When I started doing this, I was getting 2 ounces total both times. The past week, it's gone down to about 1.5 ounces. I know things change from week to week. But this, coupled with the fact that she went from gaining a half a pound to only an ounce in a week, made me think perhaps there is a supply issue.

[@llli*mommal]

If there is a supply issue, then the way you solve it is to remove more milk more often. The way you do this is:
1. Nurse the baby more frequently, aiming to use the tricks for waking a sleepy baby as consistently as possible.
2. Pump in addition to nursing, using a high-quality pump with properly sized shields.
3. See a lactation consultant, preferably an IBCLC, for in-person help.