My breasts or is it the baby?

[Crankerton]

I am in the midst of trying to get our breastfeeding issues resolved here ...

I have two month old baby girl and we have had issue from the start with getting her to get enough milk from me. To make a long story short, I have been having to weigh her, breastfeed her, weigh her again to see what she got, give her a bottle of EBM and then pump after each feeding. We had been having supply issues, but the Domperidone has helped significantly.

Here's my question/problem: My daughter is still not getting enough milk from me after two months. The only time she does is first thing in the morning, when she will drink 4-5 ounces (depending on how hungry she is) and then I will pump 5-6 ounces afterwards. All other feedings, I will feed her for 30-40 minutes or so and she is getting a maximum of 3 ounces in a feeding. On average, I would say that it is closer to 2 ounces. Afterwards, I pump and get anywhere from around 2 - 3 1/2 ounces. It's in there, but she's not able to get it out! Very frustrating.

I am working very closely with an EXCELLENT LC, but I thought I would bounce this off someone else. Why is she not getting enough milk from me? My nipples are larger and have a crease through them and we thought this might have been the issue at first -- That she just needed to "grow" into them. We also thought she had a little bit of a weak suck, so I have been using a Haberman bottle to make her work harder and it has improved a lot, but she is still not getting a lot more milk from me.

Here's what's making me wonder if its my breast structure, etc -- When I pump or feed her, I have to do LOTS of compression to get the milk out. I wouldn't say that I compress them hard or anything, but I have to do it the entire time I'm pumping and probably harder than recommended. In fact I would almost call what I have to do squeezing. If I don't, I would say that I would probably get half of what I usually pump or maybe even less. I have Polycystic Ovary Syndrome and many women with this often have Hypoplasia. I asked my LC if she thinks I have that and she said she doesn't think so, although one breast is a little more narrow than the other. I have to compress both breasts the same, though.

Anyway, is this odd that I have to compress this much to wrestle the milk out of me!? Also, do you have any other ideas on what in the world could be going on that at two months we are still not transferring enough milk to be off the pump? Any ideas are so welcomed and appreciated. I would like to get off this pump at some point!

To give you another piece of background, I have a three year old son and we had similar breastfeeding problems out of the gate -- He couldn't get around my nipples, I got terrible bleeding sores and had to exclusive pump and bottlefeed. At two months, we got him back on the breast. I also was not making enough milk and had to supplement with formula the entire 13 months that we breastfed. (In hindsite, more Domperidone than I was taking might have helped. I'm on 90ml per day now and I've had enough to not have to use formula and can even freeze some.)

I'm willing to do what I have to do get my little girl breastmilk, but its hard to imagine that I am going to be able to keep up this pumping routine long term. I'm hoping there's something I'm missing here. HELP!

[thepeach80]

I wish I knew, it's hard to not know. As a happy thing though, YOU HAVE MILK! Yay! What flanges are you using on your pump? I found when I went up a size in flanges I got more milk w/out having to compress. I still compress when Liv eats b/c it speeds things up, lol. What happens if you don't supplement and just let her nurse? Does she gain still? I know Liv only takes 3.5 ozs on a really good feed and then spits up right after that, yum. She's 50% across the board though so is doing well. Have you looked into Saw Palemetto Berry? It's cheaper than Dom and you don't have to take as much and it's supposed to work well for PCOS/IGT moms, it helped me and I was able to actually quit taking it. You are making a lot of milk now though, Liv probably takes 24 ozs in a 24 hr period, up to 30ozs I'm guessing. Good luck.

[sgmom]

I wish I had some advice for you, but I had very similar problems.

One thing I did want to mention though (if for no other reason than for humor sake), was I had the same problem with having to always use compression when feeding. I quickly learned that she was WAITING for me to GIVE her the milk. There was nothing wrong with her latch, but BOY did she ever become lazy. At only a few weeks old, she would literally nurse (with poor effort), then when she saw my hand move, she would release her latch and wait for the compression, with mouth wide open.

It took a long time for her to get over that and take the milk herself. lol!

I hope you get it all figured out sooner than later.

[Megan73]

No advice about the source of the problem – I was in the same is-it-me-or-the-baby quandary. I still don't know and my LO is now almost 10 months!
I do have a suggestion that will save time and eliminate bottles, which IMO are pretty much always counterproductive. Has your LC talked to you about using an at-the-breast supplementer like a Medela SNS or (better yet) a Lact-Aid?
I used to do the weigh/nurse/weigh/bottlefeed/pump routine.
What I started to do instead is figure out from the test weights how much I was supplementing – on average – and supplement that amount at the breast with a Lact-Aid. Then I only weighed my babe every few days to keep an eye on weight gain. You can then tweak the amount of supplement to keep weight gain at the average for a breastfed newborn – 6-8 oz a week according to Kellymom.com. You would start the flow of supplement after the baby stops active swallowing, even with breast compressions.
I still pumped until my son was five months but just eliminating the weighing and bottlefeeding was a relief.

[snowgirl]

How many wet diapers does she have per day? Are you wearing her? Skin to Skin? Maybe have a day or 2 of laying in bed doing skin to skin.(I know this is hard with an older LO) Or taking a bath with her. Where is she on the growth chart? Even if she is off of it, is she following the curve and still gaining? Has her frenulum been checked?
The hard thing here is the bottles. Nipple flow is fast even on the slowest flow nipples. Bf'ing is a lot of work to get the milk out. So, the bottles can cause some nipple confusion.
You make more milk when you are well rested, hence the larger supply in the morning. Is there anyway for someone to help care for your older LO for a couple days so you can focus on your babe?

[stoof21]

Have you been put on Metformin for your PCOS? A lot of PCOS ladies say that it really helps their supply once their insulin issues even out.

[Crankerton]

Let's see where to start ...

Yes! I am still celebrating this time around that I have milk and have not needed to supplement with formula! We have had moments when we have come really close to running out, but somehow we have made it through and have not had to. Then, got going on the Domperidone and my supply went way up. Whew!

Thepeach80 -- To give you a little more background, the reason that we started this whole pumping and bottling routine after nursing is because she lost over 10% after birth. After having my LC evaluate and try a couple of things, she still continued to not gain, so we had to do this. On a couple of occassions, I have tried to not feed her afterwards and she lasts about 15 minutes before she is crying and wants to eat again. We haven't tried it in a while because of the quantites that she is getting after feedings. On average, she is still only getting around 2 ounces per feeding from me. About the Saw Palmento Berry, I have never heard of that for women with PCOS. I have also been taking Malunggay, drinking nursing teas, taking goat's rue and nursing mama's vitamins. I will look into definitely adding it! With the Dom, I will probably still with it because I bought 1800 tabs over the internet and I know it works. The more milk the better!

Sgmom -- I read you story about the compression to my LC tonight over the phone and she laughed! She thought it was very interesting and definitely thought there could be something to that with me. Maybe my LO is expecting me to do it, so she thought I should try to stop compressing and see how things go. Thanks for sharing that!!!

Megan73 -- My LC and I have tossed around the idea of an SNS and I think we are going to do it now after talking to her tonight. She said that some moms like te Lact-aid better and to read up on both of them tonight. You sound like you like the Lact-Aid better. Any reason why?

Snowgirl -- Wet diapers are too many to count! She is always wet! As far as wearing and the skin to skin contact, we have tons of that. She hates being put down and I would guess is held almost the whole day and I will at times put her in my homemade wrap (like a a Moby) and she sleeps like a log in there. She will not take a pacifier, so she uses me for comfort and often times this is the only way that we can get her to fall asleep. When she's fussy, I ask her if she wants to "snuggle with mama" and she definitely knows what that means! As far as on the growth chart, she is right at about 50% and has been gaining fine. I also doubled checked with my LC about her frenulum and she said she checked that out at our first appointment and that's a non-issue. The bottles are definitely a stinker -- Our best option seemed to be the Haberman bottle. It doesn't have the wide latch, but it is probably the bottle that is going to make her work the hardest, I would guess. Also, our focus has been so much on the baby, that I almost feel like my son as gotten the short end of the stick. I think when we are ready to do a nursing vacation, my husband is going to take a Friday or Monday off (and then have the weekend) so I can just focus on snuggling with her, feeding on demand and getting some rest. I think the next thing we are going to do is the supplemental feeder, though.

Stoof21 -- As much as I hated taking the Metformin (because it made me sick at the beginning of it and I hate taking drugs), it turned out to be a blessing. We use NFP and it was very obvious a few months after starting it that I was ovulating, which I never did without it. (When I got pregnant with my son, I ovulated on Clomid.) With the Metformin, we just sort of threw caution to the wind and I got pregnant without even trying and that's how we got our little girl. For now, the Domperidone has worked wonders for my supply, but my LC said a few weeks ago when I got going on it, that if this doesn't work, that the Met would be a good next step to take.

Thanks for all your help ... If you have anything else to add, I really appreciate all your help. My LC said that you guys all had some really insightful things to add.

[Megan73]

Originally Posted by Crankerton

Megan73 -- My LC and I have tossed around the idea of an SNS and I think we are going to do it now after talking to her tonight. She said that some moms like the Lact-aid better and to read up on both of them tonight. You sound like you like the Lact-Aid better. Any reason why?

It's night and day for me. I could never get the SNS to work for me but I've been using the Lact-Aid (www.lact-aid.com) for about eight months. It's fed by suction, not gravity-fed like the SNS, so you don't have to worry about getting it at the exact right level to regulate the flow and you can nurse lying down. It's a soft plastic bag so you can nurse in public with it under your clothes without anyone noticing, unlike the hard plastic SNS bottle.
They also have amazing customer service – it was started by a woman who used it to induce lactation for her adopted babies.