When Can I Start Pumping Less Often?

[@llli*dta115]

My baby is 11 weeks old and I have been exclusively pumping for 8 weeks, due to a forced formula trial and her refusal to latch now because of hypotonia.

I have been pumping 8-10 times a day for approximately 20 mins each time and currently pump between 1100-1200 ML per day. My baby is only eating about 750 ML per day and only takes a bottle 7 times a day.

I am beyond exhausted at this point and ready to get more sleep. I am only getting a few hours a night total between feeding her for 30-45 min (it takes that long for her to drink a bottle), getting her back to sleep, pumping, putting everything away, etc.

The past couple of days I have been so tired that I have went up to 5 hours without pumping at night. I am terrified of losing my supply, especially, because My baby has to have breast milk because she cannot tolerate any formula. She cannot have even hypoallergenic kinds. I have still been able to produce the same amount having pumped only 7 times a day in the past few days, but is that sustainable or will it drop? I am also hoping to go back to breastfeeding at some point when she gains better muscle control. So, I want to be able to constantly produce and not have my body too scheduled, if that makes sense. I have read that some women can go down to only 4 pumping sessions per day, but is that realistic? This is my 3rd child, but my first time having to pump and bottle feed. So, this is all new to me.

[@llli*maddieb]

Hi and welcome. The Womanly Art of Breastfeeding (8th edition) suggests that once baby is over 6 weeks old AND a normal level of milk production is established (mom no longer needs to increase what she makes daily) then pumping sessions for the EPing mom can often be reduced to 6 times a day.

This won't work for all moms, it depends on the mom's personal anatomy and how her body would respond to the less milk extraction. But since you are currently making more milk than your baby needs in a day, I think you can safely reduce how often you pump to see how it goes. Just some things to consider:

It is not relevant how often your baby eats, because your baby is bottle fed, and bottle fed babies often eat much less often than a breastfed baby typically would. This is because they are given bottles that are larger than what a baby would typically take at the breast. (Actually, you might even find baby eats faster if baby is given smaller bottles more often.)

But how much your baby needs to eat on average per day to gain normally is relevant. I assume baby is gaining normally at this point(?) Baby is currently eating 25 ounces per day, which is considered within typical average intake. Assuming baby is gaining normally, your baby is not going to need more than this daily as baby ages! She might want more some days than others, she may go through growth spurts so be hungrier overall for a time, but you can also expect days of less intake in there as well. (Assuming baby is not being overfed, a common issue with bottles.)

But my point is, your baby apparently needs about 25 ounces a day and you pump close to 40. If you were nursing, right now you would probably be experiencing some of the symptoms of overproduction (in fact you may be experiencing those anyway.) We are not meant to make so much more than our babies need over long periods of time. So when a mom is overproducing, nature reduces the milk production based on baby's signals, and even if a baby nurses very often, they do not take out more milk than they need each day. On the other hand, your pump takes milk out of the breasts for as long as you pump, so your body gets the signal you and the pump give it. So, if you reduce pumping, you are changing the signal you are giving your body, and so you may see a reduction in milk production. it is likely, actually. But, this might be entirely normal and expected and not signal a problem! It just depends how much of a reduction you see. If it is getting lower than you are comfortable with, you can begin to pump more often again. Also, always be sure your pump is in perfect working condition, pump malfunction of one kind or another is common and will of course hurt milk production if it results in less milk output per session.

It also probably makes sense to reduce pumping sessions gradually, both for your own comfort and to avoid sudden drops in production. So rather than jumping right from 8 to 6, you may want to spend some time with 7 first.

A very good resource in this area is the book Making More Milk.

I have read that some women can go down to only 4 pumping sessions per day, but is that realistic?

I think that anything is possible, but 4 times a day is simply not going to be anywhere near enough for most women to pump while maintaining normal milk produciton, at least not until baby is eating lots of solids and needs less milk. These are moms who must pump a very large amount at a time- in other words, have very large breast storage capacity. You may find this graphic and info about breast storage capacity interesting. This in part explains why a mom's individual anatomy to some degree dictates how often milk needs to be removed from the breasts for a mom to have normal milk production: http://www.nancymohrbacher.com/breas...orage-capacity Basically, the smaller the breast storage capacity, the more often a mom will need to pump (or nurse) in order to avoid feeling full. The full feeling is what tells the body to make less milk.

Are you thinking of trying to get baby nursing, or are you planning to continue to EP? Many moms assume getting baby to the breast later is not possible, but while it can be difficult, it is often possible, so I just like to mention that as a possibility should you be interested.

[@llli*dta115]

Thanks for responding!

I do plan on trying to go back to breastfeeding as soon as I can. I have been trying (very unsuccessfully) for a month. I am working with a lactation consultant, but even she doesn't seem hopeful that she will be able to get back to the breast. I should also mention I am currently living in Eastern Europe (I'm an American) and language barrier is a huge hindrance. We are in the process of moving back to the States within the next month. We have tried alternative feeding methods, but none seem to work. The LC said she is more concerned with her being fed than getting her back to the breast, but that is my goal.

To give you a little background, my baby has pretty severe hypotonia of the face, neck, and trunk. She was born at 37 weeks, but stopped growing at 33 weeks. This was all due to her having twin to twin transfusion syndrome (my other daughter was stillborn, we lost her at the end of the 2nd trimester). I was attempting to breastfeed initially, but she would not latch at all. The Dr's all insisted it was me (I successfully breastfed my other children, so I know it wasn't) and made me use a nipple shield. She was able to latch, but still had transfer issues due to weak sucking ability. She was growing very slowly, but I fed her very often to try to remedy the situation. Then, she developed a malabsorption issue due to multiple food allergies and was hospitalized. She was put on NeoCate while I waited for the allergens to leave my system. She was unable to keep the formula down, so they added thickener to it. So, of course, they had to use bottles with large cuts in order for it to flow. Now that I am able to breastfeed, she refuses to latch unless she is already asleep. When she does latch, she still hardly transfers anything (10 ML or less). The LC believes it is due to the hypotonia. She was severely underweight as well, dropping to 4 1/2 lbs at one point, so we are trying to get her to eat as much as possible to gain weight. She did gain almost 3 lbs over the past month, which is great. It hasn't regulated out yet, so I'm not sure how many oz she will need in the future.

I don't even know where to go from here, other than waiting to get back to the US to see another LC. I'm worried that she will be even more reluctant to breastfeed because she will be almost 4 months old at that point.

I have tried using an SNS, which she hates, nipple shields, skin to skin, laid back feeding, nothing works. I'm not sure what else to try and the LC seems out of ideas too. She definitely has some nipple confusion, but all other feeding methods aren't working. So, I kind of have to use a bottle. The hypotonia is the reason bottle feeding takes so long also. Sometimes, she will eat less, but still won't eat more often. I don't know if it's because she is so tired from working so hard to eat or what.

As far as supply, I'm not sure if I have oversupply from consistent pumping or from the fact that I was pregnant with twins. I never feel full or engorged though. I can even pump 9 oz at a time on occasion and never feel full. So, I really don't mind cutting down on the pumping sessions and producing less, as long as I still produce enough.

[@llli*maddieb]

Have you looked into resources regarding nursing a baby with Down's Syndrome? The most common barrier there is also hypotonia if I understand correctly, so such resources might be helpful in your situation.
Since your baby is gaining excellently now, there is no harm in continuing to try to get baby to nurse while baby is also is supplemented as much as needed. (As much as you can, obviously, you are obviously dealing with a lot!) But the more you can have baby nurse at the breast, even very briefly, even if the transfer is lousy, even if it is "just for comfort" - basically, baby equating the breast with food to some degree, but especially with comfort, should help prevent out and out breast refusal. Babies have been brought to the breast at many months, even toddlers have, so you can certainly keep hoping even if current LC is out of ideas. In many cases it is not so much new ideas that are needed, but time. In other words ideas that do not work now may work in the future.

Wow you have been through a rough time and are doing an amazing thing for your baby. Again given your situation and current output, I think reducing your pumping frequency just a bit may be fine, and you certainly deserve the break!

Here are some resources, you may have seen all these.

ABM protocol nursing the hypotonic infant (it is written to doctors, that is why there is a whole section on why supporting the breastfeeding mother is important even when there are issues like hypotonia- you can skip that part if you want.) http://www.bfmed.org/Media/Files/Pro...rotocol_16.pdf

Kellymom hypotonia facebook discussion https://www.facebook.com/kellymomdot...75100119275619

Australian breastfeeding association nursing baby with Down's Syndrome. https://www.breastfeeding.asn.au/bf-...q=bf-info/down

LLL same: https://lllmom.wordpress.com/helpful...down-syndrome/