Tales From the Crib: From the Tales Inbox: Dwindling Milk Supply

Thursday, February 01, 2007

From the Tales Inbox: Dwindling Milk Supply

I'm a first-time mom with a five month old son. I planned to breastfeed him exclusively. However, at his two-month checkup, he hadn't gained much weight. That made me suspicious about his fussy evenings. He would typically try and nurse for an hour and half to two hours in the evenings, and then fuss when I ended the feeding. He'd suck for a bit, then spit out my nipple and wail, then latch back on for a bit, then spit it out and wail again. After that check-up, I gave him formula in the evening *after* he'd nursed for more than an hour. He sucked it down like he hadn't eaten all day. Suddenly we had a happy baby in the evenings instead of a fussy baby.

So that was fine - I could give him a bottle in the evenings and nurse him the rest of the day. I typically nursed him before he got the bottle. I also nursed him just before he went to sleep. I didn't hear much swallowing during the evening feedings, but I nursed him for comfort and because I didn't want my milk supply to decrease due to lack of stimulation.

Lately he's been nursing for more than an hour and crying shortly after his feedings for his afternoon and sometimes even his morning feedings. My breasts don't feel as full in the mornings as they used to. They used to be so full they were rock solid and hurt - now they're a bit soft although I can still tell there's milk in there.

I've always spent longer in the mother's room at church than the other moms who had babies at the same time I did. I'd be in there for 45 minutes to an hour, and they'd be in and out in less than half an hour. I just thought I had a slow eater, but maybe it takes him that long to find enough milk.

Why would my milk be drying up at five months? I drink plenty of water, I'm not dieting, I don't exercise excessively, I'm not stressed out, I haven't been sick, and I'm not pregnant again.

Has anyone else had a problem with their milk supply? How can I increase my milk supply? I do plan to start him on solids in the next week or so, but I've heard the baby is supposed to still get as much liquid as before he started solids so I either have to produce more milk or give him more formula in addition to the solids.

I haven't called a lactation consultant because I figure they'd tell me it's my fault because I've been giving him formula in the evenings for a couple months now.

Thank you for any advice you can give me!

Melinda

23 Comments:

Oh STOP!
Honey, it is NOT your fault that your milk supply is leaving. It is NOT your fault if you don't have much milk to begin with. I promise!

Some people dry up. Some people never even HAVE milk to give.

And you are right --it should NEVER (I've nursed three kids) take more than 25 minutes to nurse your baby. If you are trying to feed him for an hour and he's not getting anything, then chances are you don't HAVE anything.

Do NOT feel guilty. Do NOT feel like you are a failure. Your child needs to eat and he needs to survive.

Here's my advice: Nurse him a couple of times a day, but then feed the kid. Give him formula. If you have to end up weaning him, then do it. You are NOT a bad mom for having to do this. It sounds like you are trying everything that a lactation consultant would tell you to do to keep your milk. And even after that? Well, it sounds like your milk is just done. And that's really okay.

OH--and I PROMISE you that babies can still nurse and take bottles of formula intermittently. That's how you wean to the bottle anyway. All of my children took a bottle of formula every once in a while from one month on just so I could go on a date with my husband every now and then.

Some will tell you not to give up --and that's not bad advice. But I promise you that if you want your child to thrive and you want to stop feeling so frustrated all the time --make the switch. I'm sure you both will be much happier...
posted by Cheryl at 2/01/2007 12:02:00 PM
My first stopped nursing at four months, just by her own choice. And she's turned out just fine.

But before I gave up, I ended up turned nursing into a power stuggle between the two of us. I wanted her to nurse, she didn't. We FAUGHT over it, tooth and nail, and we both ended up crying. I decided in the end it would be better for both of our emotional healths to switch her to formula.

Yes, your own breastmilk is the best for your baby, but a lot of the time formula really is the better choice.

Now with my second she is a much better nurser, but I have only been able to produce on one side. My doctor recommended Fenugreek Seed (an herbal supplement) to help my one side produce more. I take two in the morning, and two at night (as recommended by my doctor), and my supply is doing fine. So whether it's my body or the herbs I can't really be sure, but it's something to try if you really want too.

Don't worry too much about it. As long as your baby is healthy and thriving, you're doing just fine. And that's the most important thing.
posted by Trivial Mom at 2/01/2007 12:22:00 PM
I can help!

I fought with supply issues from day one, but we made it back and continued to nurse to our target goals. I have been there and understand the worry and anxiety you are feeling. If I can come back from the brink, so can you! You can DO IT!

Ok, here are some things to keep in mind.

1. First, sorry to disagree with Cheryl, some babies are just slower nursers! My son would often take 45 minutes. It was a little frustrating when my friend's kid would take 10 minutes MAX, but that was the way our cookie crumbled. It did get shorter the longer we nursed--to 15-20 minutes. I've also heard anecdotally that boys sometimes just take longer to nurse. It's always tricky comparing your kid with other kids, in nursing or milestones, we're all different!

2. Your child is probably going through a growth spurt. They cry, demand more, try to nurse more, etc, as they try to naturally stimulate your supply. All you really need is to spend the time with him, nursing as long as he wants. It will take two days or so, but you will start making enough to meet demand. I know it feels like "You just nursed! How is it possible you're hungry again?" but it's his only way increasing your milk.

3. Your breasts are not supposed to feel like rocks continally at this point--that would be bad. Some women continue to feel let down; some get to a point and don't feel the let down anymore. This has NOTHING to do with how much milk you have. However, if you are concerned, sometimes it can indicate that...

4. You might have lazy latch issues that would prevent him from getting all of your milk out, especially the fatty latter milk. That leads us to...

5. Don't be afraid of the lactation consultants. If you hate the one you're talking to and she makes you feel badly, demand to see someone else. Be sure that any LC you see is board certified--you don't want some chick who doesn't know what in the H she's talking about giving you advice.

6. Yes, the reality is that the formula is decreasing your supply. It's totally up to you whether you want to continue it. I would of course say that it's better that your child gets some breastmilk instead of none. If you decide to keep supplementing with formula, that's fine, but don't expect your supply to remain the same. Again, you're the mom; your decision.

7. Some natural ways of increasing your supply: it's as easy as eating more oatmeal. Oatmeal naturally stimulates production. Try whole rolled oats for breakfast and making some oatmeal cookies for snacking. I make a low-fat oatmeal cookie with craisins, raisins, nuts, and white chocolate chips that is awesome for energy as well as supply. You can also try Fenugreek tablets, a herbal supplement avail at your local natural foods store. You take an obscene amount of tablets--like 6-8 a day. They don't taste like anything and the worst side effect is that your sweat might smell like maple syrup (fenugreek is often used in fake maple syrups to simulate maple flavoring!)

8. You said he hadn't "gained much weight" at his two month. Are they using the old charts or the new growth charts? The old charts were based on formula fed babies and are hardly compatible with nursed babies--who tend to be (but are not always) smaller. As long as your child is growing appropriately along his own growth curve you shouldn't be worried.
Doctors, especially if they are older or less knowledgable about nursing may not be supportive. It really is a good idea to see a lactation consultant at that point.
If he went from 50% percentile in everything to 5%, that's worrisome. In some cases a drop like that (that happened to my son) is causal to physical events--in his case he had started not just walking but running, so he slimmed down just before that appointment, but then regained his former place on the charts for the next visit.

9. Stressing WILL affect your production. I know it's a vicious cycle, but you have to trust that your body knows what it is doing.

Check out the book Nursing Mother's Companion Guide--it is the BIBLE and will totally help you.

After seeing lactation consultants, spending nights crying, stressing, all I ever really needed to do was listen to my mom:
Sit on the couch and nurse him as long as he wants and your supply will right itself.

GOOD LUCK!
posted by Carina at 2/01/2007 12:24:00 PM
Sorry, but I agree with Cheryl on this one. My first baby nursed for over a year, with no problems whatsoever. My second baby was a totally different story. I was always anti-formula - I don't like not knowing what they put in that stuff, but you DO have to worry about feeding your baby. You are the mom, and you know whether or not your baby is getting milk. I ended up giving my 2nd baby formula in the evenings when she was about 4-5 months old, and judging by the way she guzzled it, it was obvious she needed it. I still nursed her for almost a year. I wouldn't worry too much about the weight gain thing, just focus on making sure your baby gets enough food and is content. You will know, trust yourself!!
For a suggetion on increasing your supply, I noticed that "Mother's Milk" tea from Traditional Medicines helped me out. I also like talking to the people at my local health food store, they sometimes have good suggestions.
Just don't feel guilty about it, it really isn't your fault.
posted by m e l at 2/01/2007 12:46:00 PM
Definitely don't beat yourself up and feel guilty over this (even though it might be hard to fight those feelings). If you have a genuine desire to continue breastfeeding I would call a Lactation Consultant. The one that I worked with at the hospital with my baby was really great. And if she makes you feel bad for giving your baby formula, try someone else. She shouldn't make you feel that way, and try not to assume that she will.

Also, I have breastfed for awhile and my breast definitely did not stay "hard as rocks". Mine are pretty soft and not that big (sorry if that's too much info.) but they are still producing milk. I think you're right though at looking at your baby's weight gain. I would be a little more worried as a mom if my DS wasn't gaining any weight.

Pray about it and talk to someone who can help you one on one. As great as it is to get advice from tons of mommies, we will probably all say different things (based on our own experiences) and none of us know you or your baby as well as you do (obviously). Maybe the switch to formula will be right for you two, or maybe you need to hang in there with the breastfeeding. Trust your insticts.
posted by Anonymous at 2/01/2007 01:21:00 PM
Just one thing to try that I haven't seen mentioned here - if you want to get an idea of how much milk you're producing, try pumping at one feeding (and then you can give that to him in a bottle that time or replace with formula) -- it will at least give you some idea of how much is in there, which can be difficult to gauge otherwise. If you don't have a pump, try renting one for a couple of days (many hospitals and baby supply stores do this) or borrow from a friend.

This was suggested to me by my pediatrician - he asked me how many ounces my son was eating per feeding, and I looked at him like he was nuts and asked him how the heck I was supposed to know that!
posted by marian at 2/01/2007 01:56:00 PM
Oh - another thing that increases milk supply is the herb Fenugreek. I never tried it, but I heard it works. And I think that the pumping advice is good, but supposedly (depending on your pump) a baby's suck is stronger than what you can pump out. Maybe rent a hospital grade pump since they're super strong. I know that my manual pump doesn't pump out as much as Baby T gets in a feeding. Good luck.
posted by Anonymous at 2/01/2007 02:03:00 PM
My doctor suggested feeding my baby and then pumping immediately AFTER I nursed to get my supply up. Also, adding one or two feedings during the day was helpful.
I think very key is NO GUILT (I know - easier said than done) but seems like you are doing everything in your power so you can feel at peace.
posted by Melissa at 2/01/2007 02:12:00 PM
I had problems with nursing from the beginning so I can relate to what you're going through. My milk supply never came in very well (don't know if it was from the fat free diet my last trimester, 30 hour labor or surgery 2 days after delivery) and I had terrible guilt issues about it. It didn't really help when I went to a lactation store and the owner told me the problem was because I wasn't pumping every 2 hours 24/7 in addition to nursing. The LC I went to was wonderful though, not a nursing nazi at all(her term)! But it finally got to the point that it wasn't making any sense for the well being of my child or me to continue and I had to stop. Although it was difficult at first, we both did better afterwards and I still had as close a bond with my daughter. Now I'm expecting my second and although I'm planning on nursing her, I will not put myself through what I went through the first time.
I hope you find the answers that you're looking for and don't feel guilty. Although I think nursing is wonderful and the best option when possible, the ultimate goal is a happy, healthy baby and a happy, healthy mommy.
posted by Anonymous at 2/01/2007 02:31:00 PM
Another way to measure how many oz of milk they get is to weigh them before and after a feeding then taking the difference. The trick is getting access to a good scale. If the doctor is asking for that information then you could probably use theirs.

Also breasts getting softer and not being rock hard in the morning is not a bad sign- it's a good sign.
posted by Starfoxy at 2/01/2007 03:27:00 PM
Oops, I mispoke, I agree with most of what Cheryl said, just not the nusing session time. I just realized it sounded wrong when reading some followups.

A second on the pump thing, The Nursing Mother's Companion Guide (I'm such a shill) has more detail on how to perform a pump production test. Beth is right that the pump will never be as efficient as the little people, but it will help you get your supply up and give you some peace of mind.
posted by Carina at 2/01/2007 03:36:00 PM
I have always had a problem with low milk supply. My first was small and we made it through 8 months (with some formula supplements). She was never a chubby baby, but she was healthy and happy. The second was born larger and had an unsatiable appetite as well as a bad stomach. Combine that with my low milk supply and it was a rough first couple of months. I tried the herbs. I tried pumping with a cheap pump and a nice pump. The most I ever got was 2 ounces over 45 minutes. I continued to pump after every feeding for a week hoping to get my supply up but nothing changed. I finally gave up but felt so guilty about it that I couldn't tell anyone for a while -- not even my dh (who is always super supportive). So believe me, I know all about the turmoil. I actually wrote about it here almost a year ago. I hope you can work it out because breastfeeding is obviously something you feel strongly about, but if you don't, I hope you can find peace instead of guilt.
posted by This is Carrie at 2/01/2007 03:42:00 PM
I have to chime in here- I pumped everything my first two babies ate- EVERYTHING- for 8 months, and I can't beleive no one has mentioned this:

Feed him MORE OFTEN, for shorter durations. This will up your supply. Yes, he needs to get the fatty hindmilk, but right now he's not getting much of anything.

When pumping exclisively, one of the few bennefits it that you can see exactly how much you get, and how often. WHen my supply would start to slow, it was ALWAYS because I was going too long between pumpings and then pumping too long.

Lactation consultant #4 finally told me the key... pump 10 minutes, then stop. Period. In two hours, do it again, and again, and again... within a day or two, my supply was way up.

The reason is, if you nurse more frequently but for less time, you body accomodated that, and makes more milk- if you then go three hours, you have than much more milk, and can gradually stretch the time out again.

Nursing a baby for 1 1/2 hours is CRAZY- you likely have nothing left after 20-30 minutes, and you need to stop the stimulation in order for your body to know to make more.

All that said, you ARE the ultimate expert on your baby and your body... and if you choose to move to formula, you and your baby will both be fine. I just had to chime in with my own hard-learned information... Good luck to you and your baby!
posted by tracy m at 2/01/2007 04:32:00 PM
It's not your fault! I have breastfed all three of my girls for just over 4 months. (Don't flame me for the following statement). I'm not a fan of nursing. I just don't enjoy it a whole lot. I don't know why. When I had my first daughter I went back to work full-time when she was 3 months old. I wasn't very good about pumping as often as I should have and my supply dwindled away. I cried about it for awhile, feeling guilt mostly because so many other people I knew were making it work. That's silly, really.

When I had the twins I was a pumping maniac. They were in the NICU for 2 weeks, I had enough milk and then some to sustain them. It was amazing. When they came home, it was easier to continue pumping while they had a bottle of expressed milk. I brought them to the breast a couple times a day, but I had another child at home to keep happy and I didn't have the option of staying in bed all day to feed the babies. (It really almost would have required that). Again, I felt guilty mostly because I knew many moms of twins that had made it work. My supply went away slowly, I started supplementing with formula and it got to where I was lucky to get an ounce per pumping session. One day I was telling a friend this and verbalizing it made me realize how ridiculous it was. I decided to stop.

It got to the point where breastfeeding was causing more stress than it was worth. I applaud moms who are able to nurse for a very long period of time.

You have gotten some excellent advice! Good luck with what you decide to do.
posted by Tandy at 2/01/2007 04:54:00 PM
Ooh. Just had a thought (oh, and azucar, no problem, I know some people might disagree with that part, too. :) )...

I always had a good milk supply. Not overflowing, but not lacking. One time I DID lose my supply because I was in the hospital and they had to give me meds for something and so I had to stop nursing for 2 days. Took me a week to get my milk back, but I did! Yay!

But anyways, even though I had a fabulous milk supply, I can NEVER pump. I've tried and tried. Can't do it. My breasts won't give up milk unless it's to a living and breathing baby. Don't ask me why! The lactation specialists thought I was making it up until I showed one that I could only pump 1/2 an ounce in an hour, but my baby could drink to her heart's content in 20 minutes.

So, don't freak out if pumping, for some reason, doesn't work. It might not mean anything (or it could be that I'm just a freak of nature, which really wouldn't surprise me that much...) :)
posted by Cheryl at 2/01/2007 07:29:00 PM
if you want to increase supply it is feeding frequency, not length that counts. In the first minutes, hormones tell your brain that the baby wants more milk. it takes 2-3 days to catch up, but that is how more production is triggered.

I can't get anything by pump either, though my supply has been ample for 3 babies. A better test is wheighing the baby before and after. and don't be so scared of LCs!

When my girl was 7 months, nursing fell to pieces. I never imagined weaning a baby so young, and I scrambled not to, but it happened, and we were alright. It's not the end of the world, really!
posted by cchrissyy at 2/01/2007 08:21:00 PM
My son finally dropped below the 5th percentile and we admitted there was obviously a problem. I had plenty of milk and he was a healthy nurser, but that just wasn't enough. His weight would soon have become a serious health issue.
I absolutely opted to supplement and I've never regretted it. While he had a bottle of formula, I pumped. That way my production never suffered and neither did he. He had a bottle of breastmilk whenever he needed it and we replaced some feedings with formula. He's turned out great.
Your child has food, that's the most important part.
posted by Mo at 2/01/2007 09:10:00 PM
I'm so sorry for this struggle. I would third the Nursing Mother's companion. Another great resource is www.kellymom.com. The information is evidence-based and often provides links to the original studies.

Best of luck!
posted by Anonymous at 2/02/2007 06:56:00 AM
My son, after two weeks of nursing, would at the end of the day cry and cry and then suck down four ounces of formula once I gave it to him. My problem was letting him sit at the breast too long. I thought it took him 45 minutes to an hour to feed. It didn't. Once I figured out how to listen to whether or not he was swallowing, I'd stop the feeding when he was done. Shorter, more frequent feedings made all the difference and then by six weeks he didn't need formula at all.

Best of luck to you!
posted by Madame Coin at 2/02/2007 07:41:00 AM
With my first, my milk supply dwindled after 2 weeks. I was devastated (she was a preemie and I wanted desparately to breastfeed). I pumped for 4 more weeks but supplemented with formula - I was so worried about her gaining weight and such.

When I got prego with #2, I was determined to not let what happened in the past happen again. So when #2 came 8 weeks early, I talked to a lactation consultant immediately. She was very non-judgmental and even chastized me for thinking that I failed with #1. Throughout my son's stay in the NICU, I saw 4 different LCs in the hospital.

Here is the advice that they gave me:

1) For some women, taking the mini-pill makes their milk supply dwindle. I believe this is what happened to me so this time no mini-pill and so far no problems with supply.

2) Offer the breast for 10 minutes and every time he is upset or wanting food. If you are stressed about the baby gaining weight, offer a bottle after you've offered the breast. Also when possible, your husband should feed the baby the bottle so the baby identfies you with breastfeeding.

3) If you have latch issues, use a nipple shield.

4) After you offered the baby the breast, pump to get all the milk out and also to increase your supply.

5) Rent a hospital grade pump - more efficient and can pump both sides at the same time. I use the Medela Lactina. Also make sure the flanges are the right size for you so you don't get sore.

6) If you do pump, don't pump for more than 15 minutes each time. Also don't think that you have to pump on the highest strength. I use a medium to low strength - any higher and my output goes down and my nipples are extremely sore.

7) If you pump exclusively, pump at least 8 times a day. I have pumped exclusively for 8 weeks (son is still in hospital) and I pump every 3 hours. When I want my production to increase I pump 9 times a day for a while and then go back down to 8 times a day. Currently, I am pumping 30 ounces a day.

8) Try Mother's Milk Tea. I drink 2-3 cups a day.

9) Try fenugreek but according to La Leche League, you should also take Blessed Thistle. I take a Herbal Tonic for Lactating Moms 3 times a day.

10) Talk to either LC or your OB-GYN about this. Some doctors will give you Reglan, I believe, to help you increase your milk.

11) Definitely talk to and see a LC. They can help you identify the issue and also help you solve it.

If all that is not for you or if you just decide to give your baby formula exclusively, you are not a bad mom and your baby will be fine. My daughter is 2.5 years old now and is perfectly healthy. I was very upset when breastfeeding didn't work for her and felt like such a failure. But when the LC told me I wasn't, it was a lightbulb moment for me. I did what I had to do to help my daughter thrive. And you will too. That's what mothers do. Good luck.
posted by Elise at 2/02/2007 05:47:00 PM
Thanks for posting Elise - very helpful.
posted by Anonymous at 2/03/2007 12:29:00 AM
Melinda,

If you do have to pump, check to see if the flanges on your pump are the right size - a LC can tell you. Makes a huge difference in the pain factor of pumping.
posted by Elise at 2/06/2007 11:08:00 PM
My baby refused to nurse from the very beginning, so my milk supply never came in properly. In the beginning, I couldn't get more than an ounce of milk per day. On fenugreek and with pumping every 2 hours, it increased to 3 oz. It wasn't until my pediatrician (who is very pro-lactation) prescribed domperidone that my milk increased gradually to 9-10 oz. per day. It's not enough for my baby to drink milk exclusively, but it's the best I can do, and better than nothing. Domperidone is expensive ($80 for a month's supply) and isn't FDA-approved for lactation (I think it's for stomach problems), but it's used to increase milk supply in Canada and Europe. It also is free of the scary side-effects of Reglan.

I have been pumping for seven months, now, and never have successfully nursed her. It is harder than it really ought to be, but I understand the feeling of failure. It is hard to feel that my baby's rejection of the breast is not a rejection of me as a mother.
posted by SilverRain at 2/07/2007 06:50:00 AM

Thursday, February 01, 2007

From the Tales Inbox: Dwindling Milk Supply

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