Is my milk supply drying up?

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Is my milk supply drying up?

Postby bluemagicstar » Wed Nov 20, 2013 10:14 pm

I'm worried that my milk supply is rapidly drying up.

Bub is 7.5wks old and in the last week he only put on 40g. He was born via EMCS at 36.5wks and weighed 3.2kg. I lost a massive amount of blood (3L in total) which I was worried would affect my breastmilk supply but it didn't seem to. Bub took a little while to come back to birth weight and then seemed to be putting weight on each week (albeit not massive amounts - 110-120g). At 37wks he weighed 4.16kg.

My early childhood nurse suggested I contact my paediatrician and GP about the low weight gain and my supply. My paed suggested that I supplement bubs feed with EBM each time and to starting on medication 1 tablet 3 times a day for 10 days. He said if there is going to be an improvement it will happen in 10 days and if it doesn't then the medication probably won't work. I started taking the tablets two days ago.

I've pumped now and again over the past few weeks more to get bub used to taking a bottle than increasing my supply. At those times I was only ever able to pump 50ml. After taking the 3rd tablet I pumped 90ml and thought that things might be on the mend however since then I've only been able to pump 40-45ml at a time. It seems to be getting harder to pump each day.

On the first day I had to give a formula bottle as a top up as I didn't have enough pumped. I'm now faced with that again because my supply just doesn't seem to want to increase and bub is obviously hungry.

When I feed he fusses at the breast and is obviously annoyed by the lack of milk. Prior to the last week he guzzled away merrily and I could easily hear gulping sounds. He has good attachment. I should mention though that since topping up I'm now seeing that milk drunk look again which I hadn't realised that I hadn't seen in a few weeks. An obvious sign that I somehow missed.

Anyway, I'm really worried that my milk supply is drying up completely and I'm desperate to do anything I can to increase it. Can anyone advise if the dose of medication I'm on is right or if it needs to be more as I've seen others mention higher doses and for longer periods. I'm also interested if anyone has any suggestions to increase my supply other than the medication.

I was so scared of breastfeed at first and now I love it and don't want to lose the opportunity to continue with my baby.

TIA!

Kylie x
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Postby AbbeyCat » Wed Nov 20, 2013 10:26 pm

Hi Kylie!

Welcome to the forum and congrats on the birth of your little one. :D

Are you able to give the Breastfeeding Helpline a call? 1800 686 268 It's open 24 hours a day, and all of the trained Counsellors are really friendly, and can have a chat with you about what might be going on at the moment, and some things you could try. Or, if you are an ABA member, eCounselling is also available (access it via the main ABA website).

Just with regards to pumping, stress can affect the amount you yield, as it can inhibit the let-down reflex. It's not easy to do, but if you can try to relax as much as possible while pumping (I find watching TV or surfing the net is great distraction), and maybe try some hand expressing too. And, remember the amount you can pump is not an indication of the amount that bub would get, as babies are much more efficient at removing milk from a breast than any pump.

Wishing you all the best. xx
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Postby Rachwa » Wed Nov 20, 2013 10:28 pm

Hi Kylie,

I can't write as much as I would like ATM but I can highly recommend calling the helpline and talking through your situation with a trained breastfeeding counsellor. I would also recommend seeing someone in person (an international board certified lactation consultant would probably be the best bet) to see what is going on for you.

Is your baby looking alert? Having some content periods during the day? How many wet and dirty nappies?

I'm not a counsellor but from my own experience 50ml is a great amount to be pumping. Many mums find they need a few pumping sessions to make up one feed as a pump is generally not as efficient as your baby (I say generally - because I was able to pump more than my baby was taking due to a severe upper lip and tongue tie).
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Postby Nedsmum » Thu Nov 21, 2013 3:20 am

I had an absolutely abundant oversupply of milk, but rarely expressed more than 50mL. Expressing is definitely a skill and certainly expressing a few times rather than one big session, is probably easier.

Also, I'm not sure what goal you have with giving top-ups, but I would imagine that 50mL for a top up is a plentiful amount for such a tiny baby. There is a calculation for milk based on the weight of the baby as well as the number of feeds in 24 hours - how often is bubs going on the breast ? For my babies, they would definitely be on the breast every 2-3 hours, including overnight, and I would not be comfortable if they went more than 5 hours without a feed overnight or in the day.

I'm also not sure what sort of weight gain 'targets' you have in mind, but to me 50g, 100g, 150g or even 200g are all 'gains'.

Has bubs had any immunizations, or been unwell ? Jaundice? Medication? How long were you in hospital ! Did they offer a transfusion?

Sleep is also a milk booster. Trying to get some short naps in the day will help the milk supply. Relaxation is important for getting the milk to flow...

What sort of pump are you using?


Do you know what bubs lowest weight was ? If you look at the growth charts you will see that the chart has a dip around the end of the first week...that's because pretty much all babies lose a little weight in the first week, some kore than others.

You have to put bubs on the chart based on due date. So your 7.5 week baby is quite likely behaving like a 3 week old.... Fairly sleepy, still just getting the hang of things, and probably wAnts to be really close to you and feed little and often...

Around 6-8 weeks adjusted age, based on due date, they tend to wake up from the newborn stage and become more demanding. If you had quite a sleepy baby at the beginning, you might think the increased demanding behavior means there isn' enough milk. This is not usually the case, it's just that the baby now has the energy and awareness to demand more.... They know what they want..so just keep offering the breast and try to get as much rest as possible !

I found i hit a really low point about 6 weeks, after the birth...the initial excitement end gone, the visitors stopped bringing food, the exhaustion peaked and the baby became even more demanding !

I think many parents assume it will really hard for the first few weeks and get slowly better....that was not my experience...it was much more like a roller coaster!

Hang in there, and please do feel free to phone the breastfeeding helpline, as many times as you need, to get some strategies and reassurance!
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Postby Yankee » Thu Nov 21, 2013 3:47 am

Big hugs and keep your chin up. I'm going through a similar issue, and unfortunately stressing about it is very counter productive!

Just on the medication, it can take a week or two to fully kick in. You're on the minimum dose so if you don't get enough improvement within say a week then I would ask your medical professional about increasing the dose. But do give it a little bit of time.

Is that 50ml in one session, or across multiple sessions? Pumping to increase supply works best if you spread it out across a few quick sessions across the day.
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Postby fellare » Thu Nov 21, 2013 4:10 am

Congrats on the birth of your bub.

What are the nappies like? What goes in must come out and if plenty is coming out, then there must be plenty going in!

Don't worry about expressing, just do what you can and relax. 50 gm is actually close to a full feed!

Have you looked into wonder week? That might explain the fussing.
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Postby mooki » Thu Nov 21, 2013 6:14 am

Welcome Kylie,

I actually wrote this last night but for some reason it wouldnt go through :/

Sounds like youve had an up and down few weeks! I would also suggest calling the helpline as they can go through your situation and ask you relevant questions which can help build a picture of whats going on.

Generally to get an idea if bub is taking in sufficient milk we ask mums to look at nappy outout (5-6 wet nappies a day) pale and odourless, poos soft and loose, some growth in weight length and head circumference, some settled and content time while bub is awake and looking at bubs skin, eyes etc, hydrated? alert? Those signs are generally good indicators of milk intake.

As already mentioned, a pump isnt as efficient as a baby. Expressing can be a bit of a learned skill for many mums too.

Breastmilk is made on supply and demand so the more milk removed, the more your body will make. Young babies will often need an average of 8-12 feeds in a 24 hour period.

There are lots of articles on the website about supply, offering top ups, expressing etc so you might like to have a browse.
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Postby bluemagicstar » Thu Nov 21, 2013 9:08 am

Hi All

Thanks so much for the replies. I'll try and answer the areas mentioned above.

I've put a call into my hospital Breasfeeding Support group and am waiting to hear back. I'm hoping they can put me in contact with a LC.

LO is alert and is content throughout the day except feed times when he's annoyed and fussy. He has plenty of wet and dirty nappies throughout the day so I know that he is getting a decent amount of BM just not adequate amounts of calories to have proper weight gain for his age. I'm usually feeding him 7 times a day (roughly 7am, 11am, 3pm, 6/7pm, 10pm, 1am, 4am). I try to make sure that he has 2 sleeps and 1 nap during the day and bedtime around 7.30pm. Based on his charts his length is consistently average but his head circumference has just dipped below average this past week and his weight has consistently been dropping percentiles weekly (he started at 30th and is now about 5th).

The goal of the top ups was to ensure LO was receiving enough BM and increase his calorie intake and therefore weight gain. This was recommended to me by his paediatrician. He did have his immunisations last week and I wasn't sure if that would affect his weight gain. The child health nurse didn't seem to think that it should. He was on antibiotics for 24hrs after birth as a precaution. I was given a blood transfusion in the ambulance on the way to hospital but none after the birth. I only needed to stay in hospital for the standard 5 days for a c section.

I haven't felt the need to nap during the day and perhaps this is one of my problems. I'm making a conscious effort to get at least one day nap and to go to bed earlier and hope that this has some effect on my supply. Fx it's that easy!

I read last night that the normal dosage for medication is one tablet 3 times a day for two days then up it to two tablets 3 times a day. I started this last night and will see what happens. My GP called this morning to see how I was going and I mentioned this to her and she was happy about the increase in dose.

This morning (after my dose increase) I did feel like my breasts were fuller. Normally I don't feel engorged at all in the morning but perhaps this is because night feeds are so regular?? Anyway, this morning I definitely did feel fuller. I feed bub from both sides and he gulped away and had that content milk drunk look afterwards. I didn't have anything expressed so I didn't top him up but he seemed content. About an hour afterwards I tried to express and only got 30ml. Albeit it wasn't the calmest expressing session I've had but 30ml isn't much at all! I'm using a medela swing pump.

Fx that things start to improve over the next few days. I'm going to weigh him again tomorrow so will see if there has been much of an improvement.

Thanks again for all of your advice and replies.
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Postby MamaMagoO? » Thu Nov 21, 2013 9:52 am

So those times you mentioned. Is that feeding to demand or on a schedule? What is LO doing between feeds? Just asking because 4 hours between feeds is quite a long time for a new baby to go. With newborns its usually better not to let them go more than 3 hours between feeds especially if you are trying to build up your supply. Could you just try feeding more frequently?
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Postby Yankee » Thu Nov 21, 2013 2:10 pm

I was just thinking that too. Even with medication, smaller more frequent feeds will stimulate your milk more than big, spaced out feeds. Have you tried offering the breast after only 2 or 3 hours at least during the day? Your bub might be less frantic and impatient if the last feed was not quite as long before.
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Postby bluemagicstar » Thu Nov 21, 2013 7:20 pm

Those times are just rough. I'm demand feeding but he seems to have a bit of a routine. He has his biggest sleep in the morning which is why there is usually about a 4hr gap between feeds then, the others are usually about 3-3.5hrs between feeds.

Between daytime feeds he is usually awake for 1-1.5hrs during which time we play (songs, tummy time, play mat etc). I'm not sure of the reasoning but at his 6wk check my paediatrician told me not to feed him less than 3hrs (this was before supply issues). Does anyone know why this would be?

I've been feeding any time he fusses today (when I might have normally soothed in other ways) instead of trying to stimulate with pumping in-between feeds. He's still fussy even if his last feed was only an hour before but I guess it might take some time for my supply to increase.
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Postby fellare » Thu Nov 21, 2013 7:32 pm

if his output is good, then his input is good and you might want to look into other reasons his weight gain is worrying you.

Was his birth weight over estimated due to IV fluids in you? Why was he given Abx?

no idea why the pead told you that tbh. Maybe her/his training isn't up to date with breastfeeding? they have so much to learn and stay up to date with! sometimes they give advise that is not current any more.
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Postby ClOuD_NiNe » Thu Nov 21, 2013 9:33 pm

fellare wrote:if his output is good, then his input is good and you might want to look into other reasons his weight gain is worrying you.

Was his birth weight over estimated due to IV fluids in you?


Just on this, I went through a similar situation with my DS. I thought he was getting enough milk as he was having the required amount of wet nappies. However he dropped from the 50th to the 3rd percentile on the weight charts in the first 4 months, and from then on he followed the 3rd percentile line. I had a considerable amount of IV fluids during labour so I think its possible that his birth weight was elevated.

We had been doing a feed-play-sleep "routine" but he was a great sleeper and long naps meant he would often go for 3-4 hours between feeds. My MCHN suggested doing a top up feed on the breast before nap time, so essentially we were doing feed-play-feed-sleep. He never refused those extra feeds and it did make a little bit of difference to his weight gains. He was happy and content and meeting his milestones, so we came to the conclusion that he was just meant to be little!

One other thing is that its better to weigh bubs less often as weight gains can vary considerably from day to day and week to week. In the early days a baby might put on 40g one week and 400g the next, but over a month it may average out to be 150g/week which is in the range of normal.

I'm also not sure why your paed would say not to feed less than 3 hourly. If you're trying to build up your supply, feeding more often is better. The more stimulation your breasts get and the more milk is removed, the more your body will make - supply and demand. As long as bubs is sucking well and removing milk efficiently (a lactation consultant watching you feed would be able to tell you this) there's no reason why you couldn't just put him to the breast more often and do away with the expressing altogether. I personally found expressing quite stressful, I was never very good at it and found it quite demoralising when I didn't get much. I also found that whenever I gave DS a bottle of EBM, he would often fuss at the breast at the next feed. He liked the bottles because he didn't have to work for the milk. I certainly don't have a forceful letdown, and my babies have had to work quite hard to get milk from me! I found that once I got rid of the bottles the fussiness stopped.

A few things to think about anyway. Let us know how you go!
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Postby Bailey's Mum » Fri Nov 22, 2013 3:06 am

How would you feel about feeding instead of expressing? Or are you expressing when your LO is sleeping? Babies are more efficient at removing milk than a pump, so if you were to feed him twice in a wake cycle, instead of expressing, you may also be able to get some rest while he is sleeping, and give your breasts extra stimulation at the same time.

Just one other thought - Has his suck been checked? If his suck pattern is disorganised for some reason (eg. low muscle tone, tongue tie, etc), he may not be able to effectively drain the breast. A paed or LC or even a speech therapist could do this for you if you have concerns.

Research tells us that babies have very small tummies - about the size of their clenched fist. Also, because breastmilk is a complete food, it is easily digested. While an adult may only have something to eat or drink every 2-3 hours, most babies need smaller feeds more often - your paed's advice to feed no less than 3hrly may be based on older research, or perhaps on his/her experience of formula fed babies (cows milk protein takes longer to digest, and there is a risk of over-feeding a baby via bottle, so formula feeding patterns are different from a normal, healthy breastfeeding pattern).

OR, did the paed mean the opposite - "no less than 3 hrly" can be understood to be either "no less than 3 hrs between a feed," or (and I wonder if this is what was meant) "not to let more than 3 hrs PASS between a feed." Which is actually the opposite of the first one - leaving a gap of three hours vs having a gap of less than 3 hours each time. A number of women are given this "no less than 3 hrly" advice, and I wonder if they are receiving it as point A when the paed may mean point B? Is it worth having a chat with your paed to figure out which was meant?
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Postby MamaMagoO? » Fri Nov 22, 2013 1:38 pm

Bailey's Mum wrote:OR, did the paed mean the opposite - "no less than 3 hrly" can be understood to be either "no less than 3 hrs between a feed," or (and I wonder if this is what was meant) "not to let more than 3 hrs PASS between a feed." Which is actually the opposite of the first one - leaving a gap of three hours vs having a gap of less than 3 hours each time. A number of women are given this "no less than 3 hrly" advice, and I wonder if they are receiving it as point A when the paed may mean point B? Is it worth having a chat with your paed to figure out which was meant?


I had this thought too BM.

How are you going today Bluemagicstar?
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