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Thread: supply problems

  1. #1
    Join Date
    Apr 2008
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    2

    Exclamation supply problems

    OK
    My son is 6 wks and was born a little shy of the 36 wk mark. He weighed 6 lbs 15 oz at birth. I had preeclampsia.
    He was in the NICU for a week. When they let him start eating I made sure I breast fed him before anything else was given. But, even with pumping my milk had not come in and I only had colostrum to give. They told me they needed to see if he could suck and feed and gain weight before he could go home... so teary eyed... I let them supplement with a bottle. I continued to offer him the breast before each day time feeding and in a few days my milk came in and while he was still in the hospital the last few days he was exclusively breast fed during the day. Night feedings were still with the bottle. When we got home the docs and nurses said to just offer him the breast on demand. So I went about feeding him exclusively on the breast...
    At his check up just a few days from release he had lost an oz but doc and I were both not too worried... I thought we almost had it... but a week later... he had lost another oz. Doc told me I needed to offer formula.

    He took about 2 oz each feeding. I saw a LC who told me to pump to get up supply. Which I did for 1 and a half weeks. I ended up pumping exactly one oz every pumping session for the entire time. Never went up. And it made my nipples so sore. And it made me super tired.
    I decided to stop the pumping and give myself a week to let him gain weight and just offer him the breast as much as possible.
    How long is it supposed to take to increase your milk with pumping?

    At this point he is eating 3 oz formula and I am guessing 1 oz on the breast most feedings and wanting to eat every 3 hrs. about. Sometimes 1 or 2 but usually 3. He gained weight easily with the supplementation. The last doc visit was over 7 lbs. He had gotten down to 6 lb 6 oz. I bet he is well over 8 lbs now.

    SO... my questions.
    There was some nipple confusion / frustration in the hospital so I was given a nipple shield. He really latches well most of the time with it and now is starting to latch sometimes without it. When he latches and eats without it I feel a difference and I am wondering if the dulled sensation of the nipple shield / breast pump is part of the problem as far as milk production. I wonder if I should work harder on transitioning him off of it. Up until now I have not been very worried about it (last of my worries). I figured eventually he will just not need it. Has anyone heard of the shield decreasing sensitivity and therefore milk supply?

    He has been a sleepy baby... but he is starting to be more alert now that he is older. I am wondering if I start to slowly decrease the bottle feedings if he will now be able to work hard enough to get my supply up. Just a little at a time. I would rather do this than pump. Even if it takes nursing him constantly.
    I feel confident enough to try this now that he has gained. Does that sound like a good idea?

    Our routine is let him eat off both breasts until he is finished (goes off by himself) or until I see he is not swallowing / just pacifying. This is usually at least 15 min each side (but not always active really good eating the whole time, just depends). Then I give him the bottle. A lot of times, esp lately he is not hungry any more but still wants to suck so I give him the breast... trying to get my supply up and the whole thing perfected. This all takes forever! So you can see how adding pumping is very difficult.

    My breasts have gone from feeling engorged between feedings, leaking, etc. To just a little tightness and leaking sometimes. Which maybe could be normal. I also have to admit that it still takes a lot of work to get him fed on the breast. I usually have to hold my breasts the whole time, latch him on several times... wake him... strip him... strip me... all kinds of work. And honestly, esp at night when I am tired I do not get it done as well. So all in all mom & son laziness creeps in and the bottle is too easy. I am worried now that not only is my supply not going up... it is going down. And this is exactly what happened with my daughter and my supply dried up at 3 mo!!!!

    I am starting to think maybe I just have some kind of supply problem... like my body can not make enough milk. esp since this happened with my daughter.

    HELP! I feel like I am fighting a losing battle. I really want to Breastfeed!
    Tell me it is possible to get from here to exclusive breastfeeding. Tell me it is possible!

    The hospital LC were good.. the LC I saw recently was OK... but I am just frustrated... I want some really good advice that is not just PUMP... it feels unnatural to me. Am I wrong in this? Do I just need to suck it up and PUMP?
    Reading some here helps a bit because I was told to pump 15 minutes.. and I always stopped expressing milk way before 15 minutes. So reading to just pump until 3 sec after drops have stopped would help the soreness I was experiencing pumping. I have also thought about not being all or nothing. Meaning if I pump half the time that is better than nothing.

    I guess I need to find a different LC... I just want a really good one.
    I will look at those resources.

    The good news is he likes the breast. If I could just get my supply up I am sure we would be bottle free in no time. ANY SUGGESTIONS ARE WELCOME!

  2. #2
    Join Date
    Oct 2007
    Posts
    50

    Default Re: supply problems

    Have you thought about supplementing & pumping only every other session ? I read it as a transitional method at one of Kellymom's links (A Guide for Breastfeeding your Premature Baby at Home by Karin Gracey, RNC, MSN, CNNP and Jane A. Morton, MD (http://www.kellymom.com/bf/preemie/preemie-links.html)), which I found out today, was a dead link.

    In this method, you offer your breast without supplementing first. Then at next session, which probably come earlier than 3 hours (since your baby did not get the supplementation), you breastfeed/supplement/pump, in that order. You alternate these two sessions. It is important to make sure that your baby gain weight.

    Also can you have somebody help you with the baby when you pump, too?

    I hope you will find a good LC who can work with you to come up with the transitional plan. Weight check and test weight (weighing my baby before and after breastfeeding) helped us tremendously.

    You can do it, you can do it, you can do it! So hang in there.
    - - - Penga (@ 32 weeks gestational) and my DH

    Mother of two girls:
    Sydney (born 10/31/01- nursed until 3 yrs & 10 mos)
    Penga (born 08/15/07 - former 25 weeker who loves to nurse)

    & no more!

  3. #3
    Join Date
    Apr 2008
    Posts
    32

    Default Re: supply problems

    Just a few ideas (you may have heard this before, but just in case):
    1) Are you making sure your nipple is in the center of the suction cup when you pump? If it's off center then your nipple can get sore from rubbing against the plastic.
    2) I was told to stop pumping when my milk stopped flowing, rather than waiting for 15 minutes to be up, to prevent getting sore from the pump. Try doing that - as soon as you see your milk stop spraying, or dripping out, turn off the pump.

    I hate to say it, but I think you need to keep pumping in order to increase your supply (I'm no expert, just going from my own experience). I was pumping every 3 hours (day and night) when my little girl was in the NICU (but I don't have other kids so I was able to do it that often), and that really helped get a good supply. BUT, it your baby is draining each of your breasts at each feeding I would have thought that that would help increase your supply on it's own.
    I know that whenever I get really tired, or stressed I see a noticable difference in the amount of milk I pump - so try to get some rest if you can. During the night, I have been BF my baby, then handing her to my husband to give her supplemental bottle while I pump - that way, I get back to bed a little sooner than if I was doing it all myself.
    This might sound silly, but I also made myself a 'hands-free' pumping bra - I took an old bra and cut little holes where my nipples are (just big enough to push the small part of the pump flange through), that way I can pump while burping the baby - or I can at least read a magazine and relax a little while doing it.

    I have been pumping for 5 weeks now, and wasn't sore at all until I started to breastfeed AND pump - now I'm really sore too.

    Finally, what type of pump are you using? You need a double electric pump, maybe even a hospital grade one to get your supply going, and that might also help with soreness.

    Good luck - I have all sympathy for you - I know what it is like to be exhausted in the middle of the night and to give in to the "easy" option of the bottle. You have to do what you have to do - your baby will be way better off having a bottle, and having a Mommy who is slightly more rested, than and exhausted and exasperated Mommy trying to BF!
    Last edited by Jazzle; April 13th, 2008 at 06:59 PM.

  4. #4
    Join Date
    Sep 2007
    Posts
    1,090

    Default Re: supply problems

    Hello and welcome... I am so glad so are trying to find help and support at this early age and not as late as I did!!!!... I have a 10 month old premmie who was born at 32 wks due to pre-eclamsia by c-section....

    Breastfeeding wasnt easy for me iether so I can relate to you in everysingle way

    The way your body will produce milk is in demand.... if you remove milk frequenly your body will make milk acording to the demand (do I make sence???)
    How many times are you pumping/nursing in a cicle of 24 hours????
    its said that a min of 6 to 8 times its nessesary to maintain your supply... But if you wish to increase it you need to pump/nurse at least 10-11 times in 24 hours...

    **** it doesnt need to be evenly spaced... example - not every 2 hrs, but the closed possible to each seastion....

    **** nursing or pumping at night it will help you tremendouly!!!!
    Prolactin is the name of the hormono that produces breast milk and its found in bigest levels between 1-5 AM... with this said, thats the best time to nurse pump.....

    SLEEP WHEN YOUR BABY SLEEP!!!!!!..... if like that you will have more energy during the night

    HAVE OTHERS HELP YOU WILL THE HOUSE!!!!.... this is a moment when you need to dedicated to you lo... I am not saying forget about the house, but if you have your husbands supports as far as breastfeeding exclusively he can help you with the chores while you take care your supply..... (I was not lucky I had to take care EVERYTHING by my self)

    YOU ARE ON TIME TO BUST YOUR SUPPLY!!!! ITS NOT LATE!!!!

    Like other poster said get an Hospital Grade Pump or a double electric one... (not trying to sell brans but could be Ameda or Medela.... I use Ameda)....


  5. #5
    Join Date
    Feb 2006
    Posts
    422

    Default Re: supply problems

    Congratulations on the birth of your baby!

    Milk production depends on milk removal -- kind of a "move it or lose it" principle. Milk removal depends on an effectively sucking baby or an effective breast pump. (A good explanation of milk production is at: http://www.kellymom.com/bf/supply/milkproduction.html). There is no way around this one -- it's just the way our bodies work, dance in tune, with our babies...

    Many milk production problems are not really a problem with mother herself. A mother may have great physical potential for producing milk, but if a baby who can suckle well does not have "on cue" access to mom's breast, mom's body cannot make enough. Or if a baby is not yet completely able in his or her ability to remove milk effectively/thoroughly, which is common for preterm/late preterm babies -- milk production can be compromised short or long term. When a baby isn't yet able to effectively or thoroughly remove milk, compensating via effective pumping is crucial for building or maintaining good milk production.

    Because you described “my breasts have gone from feeling engorged between feedings, leaking, etc.” it sounds as if your body works fine and any decrease in milk production is more likely being affected by a baby who is not yet breastfeeding/removing milk as thoroughly as needed, although it sounds as if your baby is making great strides in BF!

    When it takes a baby a very long time to latch or it takes a very long time to BF (more than 35-40 minutes or so before self-detaching at the first breast) or an extremely short time (baby drifts to sleep in less than 5 min and mom is constantly having to wake baby up to keep BF), it's often related to a baby that is still somewhat disorganized in the ability to coordinate sucking with swallowing and breathing -- and then keeping that coordination going long enough to remove adequate milk. Breast compressions, which are shown on film at Dr. Jack Newman's site (http://www.drjacknewman.com; click on Breastfeeding Help at left; then click on Video Clips – several may help), can help encourage a baby to remove more... But it also sometimes helps to recognize when a baby is still having difficulty and limit time at breast to 10-20 minutes and getting more into baby another way -- letting others help when available -- so there is also time for milk removal via pumping.

    However, if he breastfeeds about 15 minutes per breast per feeding and lets go of the breast on his own, it may be that he is effectively removing milk and it’s just a matter of 2-3 days of round-the-clock breastfeeding to get away from bottles and rebuild milk production. If/when you and your baby are ready to do this, monitor diaper counts closely and watch behavior at breast.

    If you or baby is not ready for this, extra pumping/milk removal may really help as long as you’re using an effective pump. I can respect the issue of it not being “natural” -- on of the moms in my LLL group called the pump her “ugly baby’ -- but bottom line it’s about effective milk removal. If baby can do that often and really well, terrific…. But if baby has an issue with frequency or thoroughness, it’s a matter of other options until baby gets there. (If you’re experiencing soreness, I’m wondering if there’s an issue with the type of pump or the “fit” of the collection kit pieces.) There are lots of ways to use a pump in ways that both fit one’s life and also boost production. If pumping routine is the issue, perhaps we could share ideas about that…

    I'm not sure if the above is helpful. Hang in -- you're doing a super job and it sounds as if your body has been responding to what it's being asked to do re: milk production...

  6. #6
    Join Date
    Feb 2008
    Posts
    175

    Default Re: supply problems



    You've gotten some great advice already. I just wanted to encourage you, and say that it can be done! My DD was also in the NICU for a week and we had to supplement with formula to get her weight up and get her out of there. For me, it just took time to get my supply up to meet what she needed. We did the nurse, pump, bottle routine for about 2.5 months until most of what I was giving her was my milk pumped from the previous session. We probably could have quit sooner, but I was nervous about my supply. Anyway, after all of that, she'll be a year next week and is still nursing.

    Just a couple comments on pumping - I think it's a good idea to stick with it if you can. Have you tried using the lowest setting to minimize soreness. I know I couldn't handle much more than that in the beginning. Also, I like the idea of alternating pumping sessions if it gets to be too much. I never tried that, but it could definitely make it more bearable.
    Julie
    Wife to Jeff
    Mom to Alexa, born 4/22/07

  7. #7
    Join Date
    Apr 2008
    Posts
    2

    Smile Re: supply problems

    Wow I came to the right place.
    After talking with friends, a LLL leader via phone, and reading all of your advice... I am at least feeling more encouraged.

    Lexa's Mom, I esp feel encouraged by your experience. Your time frame seems realistic and gives me the idea it can be done with time.

    As far as pumping I am using a Symphony pump that I rented. I am using a very low setting, but it helps to hear the lowest setting is ok. I also have large breasts and was given a larger breast (what is it called) cup. But, sometimes I think maybe it is still just not big enough.

    Karen, your advice is esp helpful. Esp understanding my baby... I think you are point on as far as describing his ability to suck, breathe, and swallow. I see him letting milk fall out of his mouth, choking sometimes if it is too fast (esp the bottle, but sometimes the breast) and this just really resonates with me as what is going on. That helps me not worry to know he will get older and it will get easier. So thanks for that. I have been using the compressions and you are right they are helpful esp for when he is sleepy.

    Sambarou, so helpful... the night nursing stuff.. because that is generally when I do not pump. I do bf at night just as much as during the day... but I tend to want to stop the pumping or take a break. Knowing this helps me know when I am more likely to have success and it makes it worth it.
    I do sleep during the day. My husband is on a night route so he comes home at 6am and helps me get our older daughter off to school and then we all go back to sleep with baby. I tend to sleep like this sometimes even as late as noon. This has been a new development... just creating a schedule that puts the bf and baby first.

    Jazzle, your points are good. Since my breasts are so big it is hard to get it in the center. I find what ends up rubbing is an area that was not centered. I am not sure how to make sure that happens... because I think like I said there are just areas that are rubbing. I absolutely am now using the stop when the spray stops technique! So happy to know and not to have to watch the clock. The bra idea is a great one... I have been using my body pillow to hold them in place which works pretty well.

    And finally
    wakawaka, you have been the most helpful. Although at first it seemed a bit extreme and I worried about my baby not getting enough... the method you suggested started making sense to me as I looked at ways to switch up the kind of schedule the baby and I had already created to get in a bit more sucking time.

    So...
    here is what I have done the last 2 days...

    before I was
    bf as long as he wanted.. then feeding the bottle of formula he would take 3 oz usually. Then I was not pumplng, but if I was this was when. He was wanting to eat every 3 hrs because of all the formula. I figured he was taking in about 24 oz of formula.

    So... here is how I switched it up.
    I nurse, bottle feed, then pump (like you suggested)
    Then the next session I bf exclusively. This has meant pretty much non stop bf for a couple hrs at a time. In the middle of the two hrs or when he really needs it to not be fussy I give him the expressed milk.

    The first day I kept track of what he was taking in via bottle (including expressed milk) and he was taking in 24 oz... the same amount from the bottle.. just more sucking time and more breast milk because I had time and energy to pump.

    I decided that this method got him more breast milk and that should be my guide. Instead of getting frustrated that I was still bottle feeding... I just am thinking of it as getting more breast than before.

    When I pump I am only getting a half an oz most times. And when I feel like he is not eating well sure enough I will get like almost 2 oz. So I think he is taking more in than before.

    So, Thanks so much for all the advice. I will check back in and let you all know how it is going.

  8. #8
    Join Date
    Feb 2006
    Posts
    422

    Default Re: supply problems

    Re: <<I also have large breasts and was given a larger breast (what is it called) cup. But, sometimes I think maybe it is still just not big enough. >>


    The size of flanges/breast cups that comes with a Medela pump collection kit are 24 mm, and the larger sizes usually are 27 or 30 mm. However, 36 mm are also available and I think they still have a glass version at 40 mm (but the glass is expensive). If you are using 30 mm (size should be imprinted near rim of flange), you might call the rental station or your LC and see about the 36...

  9. #9
    Join Date
    Jan 2006
    Posts
    2,866

    Default Re: supply problems

    This page describes proper breastshield fit:
    http://www.medela.com/ISBD/breastfee...eldfitting.php

    Hang in there. You can do it!

  10. #10
    Join Date
    Oct 2007
    Posts
    50

    Default Re: supply problems

    Great to hear that you have more energy to pump and that you now have a very good idea that your baby is taking more than before! Reading how hard you are working brought to me tears... You are doing an amazing job!

    We will be looking forward to more update
    - - - Penga (@ 32 weeks gestational) and my DH

    Mother of two girls:
    Sydney (born 10/31/01- nursed until 3 yrs & 10 mos)
    Penga (born 08/15/07 - former 25 weeker who loves to nurse)

    & no more!

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