Not pumping enough to keep up with 5mo DD - help, please!

[e(Lisa)beth]

I have a 5 month old DD who is exclusively breastfed, and I WOH full-time. DD spends the day with my MIL. I pump three times at work, and usually produce about 8oz total in those three sessions. Since DD drinks 15 oz a day at MIL's (plus a lunchtime feeding from me), I am not replacing what she drinks on a daily basis. I make up the difference pumping at home in both the morning and evening, and as much as possible on the weekends. My at-work pumping is on a Symphony, and my at-home pumping is on a Lactina. I take fenugreek daily.

Pumping has been very stressful for me - not the act itself, but my output. I am constantly on edge because I never know if I will have enough pumped milk to feed DD while I am away. I keep hearing that most women only pump about 2oz per session. In three sessions a day, that would be 6oz, so how the heck are they producing enough to feed their kids if they WOH full-time? Is my DD just eating more than the standard breastfed 5 month old? Can you think of a way that I could pump more?

And to make it worse, I am not quite sure that she is getting enough. I drop her off at 8:30 and feed her then, come back to feed her at 12:30, and return for the day at 6:30 and feed her then as well. She gets 5oz bottles at approximately 10:30, 2:30 and 4:30. So she's eating every two hours, but my MIL says she is usually fussing to eat after about 90 minutes, and when I arrive at 6:30 she is often screaming. My MIL really wants to give her more food - she constantly asks about solids (which I'm not starting until six months, and then I'm planning to do BLW), a fourth bottle or moving up from the 5oz bottle to a 8oz or 9oz bottle. I have talked with MIL about other reasons she could be fussy, but it always seems to come back to hunger. DD does have a lot of wet diapers, a BM once or twice a week and she weighs 16lbs, but sometimes I can see her rib cage sticking out and then I worry. Does it sound like she needs more food?

And the icing on the cake is that I am starting grad school in January, and the end result is that I am going to have to cut out my lunchtime feedings. It looks I am going to have to supplement with formula, which breaks my heart. I would really like to avoid it, but I just can't see how. I can't see any possible way to pump even just another 5oz a day. As far as I can tell, my supply is fine - it's just pumping output that is a problem, but I'm afraid that when I start her on formula, even just one bottle a day, my supply will start to drop.

Any ideas? Am I doing something wrong or does this all sound normal?

[Shelsi]

Actually I'd say she's getting over fed. The general "rule" is 1-1.25 oz per hour. So if she's taking in 15 oz plus an afternoon nursing that would prob be enough for 18-20 hours of time! On average bf babies get 25-30 oz a day.

They are also VERY easy to over feed because the nature of the bottle is so different. Is your caregiver doing paced bottle feeding? That can really make all the difference.

[lizzylou]

Are you waiting for a second letdown when you pump? Sometimes it might take several minutes to happen. I would try waiting an additional 5 or 6 minutes to see if it happens. After the second letdown, try breast compression to get out all the milk that you can.

I've always had an adequate supply when nursing, but found it difficult to keep up with my son when I had to pump. When he was that age I would usually pump 2 oz per breast. He took 4 oz bottles every few hours, and it worked out that he needed 4 full bottles and one half bottle at the end of the day. Was he overfed? I don't really know, but all indications were that he needed that milk. He is a big guy.

I know it's tough, but try not to stress! You might get some relief once she starts solids (if she likes them right away). If you want her to remain exclusively breastfed, look at the schedule and see where you can fit it. Maybe right before you go to bed? When she naps on weekends? Personally I could only pump if he hadn't nursed in the previous 2-3 hours, which definitely made it difficult to find spare time to pump.

[Bokonon]

Originally Posted by Shelsi

Actually I'd say she's getting over fed. The general "rule" is 1-1.25 oz per hour. So if she's taking in 15 oz plus an afternoon nursing that would prob be enough for 18-20 hours of time! On average bf babies get 25-30 oz a day.

They are also VERY easy to over feed because the nature of the bottle is so different. Is your caregiver doing paced bottle feeding? That can really make all the difference.

I agree with this. A breastfed baby should NEVER be given 8-9 oz. at a feeding. It sounds to me like your MIL needs to be better about bottle pacing. Your baby may be screaming because she's getting too much food too fast, or because she just has a need to suck, and will take the bottle because it's given to her.

http://www.kellymom.com/bf/pumping/milkcalc.html

[Megan73]

Originally Posted by Bokonon

I agree with this. A breastfed baby should NEVER be given 8-9 oz. at a feeding. It sounds to me like your MIL needs to be better about bottle pacing. Your baby may be screaming because she's getting too much food too fast, or because she just has a need to suck, and will take the bottle because it's given to her.

http://www.kellymom.com/bf/pumping/milkcalc.html

Yup. I think so, too.
I would get MIL to read the info on Kellymom.com on bottle feeding the breastfed baby. I'd also feed her 2 oz bottles less often and use the lowest flow nipples you can find.
Don't stress, mama. It sounds like you're doing great.

[Llyra]

Is she offering a pacifier, if your LO will take one? A baby being bottlefed often needs one, to satisfy the urge to suck for comfort. Giving a bottle when baby really just wants comfort sucking may result in overfeeding. I would encourage MIL to try other methods of comfort like a pacifier. A low flow nipple can help a lot, too, so that baby gets to suck a LOT without getting too much milk.

I don't think 15 oz sounds excessive, though. Does baby wake to feed at night? Night nursing can do a lot to increase your supply in general, and to fill baby up so that baby is less hungry during the day.

Have you changed your soft pump parts? Many pumping mamas see a drop in output after a few months, because of the soft silicone parts not getting as good a seal anymore. Replacing them can sometimes help.

[PatioGardener]

Here is the Kellymom handout on bottlefeeding the breastfed baby. It may help your MIL feed her slower/less volume: http://www.kellymom.com/store/freeha...le_feeding.pdf

and the non-pdf version: http://www.kellymom.com/bf/pumping/bottle-feeding.html

[RPS67]

I agree with the others -- your MIL probably doesn't have much experience with feeding a breastfed baby, so she expects your LO to eat like a formula fed baby.

When my 3 year old was a baby, I sent 3 3-4 oz. bottles to day care. One of those bottles was for back up in case I couldn't get to day care at the end of the day for whatever reason. I also went each day and nursed him at lunch time.

I had to educate the ladies in the infant room because my son was the only one getting these tiny bottles of breastmilk while the other babies the same age were getting 6, 7, 8 oz. of formula in each bottle. Breastfed babies just do not eat the same way and they generally don't need much more breastmilk as they get older because your milk will change to meet your LO's needs.

[sillysmile]

I agree with PP's that you could try smaller bottles more frequently. I also don't think that it would be the end of the world if you needed to supplement with formula. I exclusively pumped for 5 months before starting to supplement, and can relate to the stress of always trying to stay one feeding ahead and worrying if my baby was hungry. As long as you are still pumping as often as you would otherwise, I don't see any harm in supplementing a little if you really feel that your baby is hungry and you just can't keep up. I think a 90% BF baby has a better situation than the hungry 100% BF one with a super stressed out mama!

[sunshynbaby]

Wow, five ounce bottles are way too much! Please check out Kellymom for the wealth of information on pumping and the milk calculator. You're doing great mama!

[sahmmie]

I wouldn't just assume she's getting enough. Each baby has his or her own caloric needs. My first ate 25 - 27 ounces a day on average. My second about 20 - 22 ounces and my last baby thrived somehow on a meager 15 ounces of expressed breast milk a day. I was a nanny for a little guy who ate 40 plus ounces per day and was still starving. The kid was eating adult sized bowls of oatmeal, a jar of baby food and an 8 ounce bottle of formula for one meal at six months of age and he was SKINNY. I was a nanny for another baby who never ate more than 2 ounces at a time. I took care of another baby whose mom pumped and left milk for him. This baby took 8 ounces of breast milk and was starving 2-3 hours later. She nursed him at 6am, left him three 8 ounce bottles for the 7-8 hours he was with me, and nursed him twice more in the evening. All babies are different.

Is your little girl happier when you are home to nurse her on demand? If so I'd guess that she truly is hungry when she's with her grandma.

I pumped exclusively for all three of my babies for a variety of reasons (reflux, poor latch, high palate among other things). I can give you a few tips on how to increase your supply.

1. Pump at least once in the middle of the night. It sucks to be up pumping when baby is sleeping soundly but it does wonders for supply.

2. Do some cluster pumping. This means that you schedule some intense pumping time into a small period of time. It's works wonders if you pump or feed, wait an hour, pump or feed again, and then wait no more than two hours and pump or feed again. This tells your body that the baby is not getting enough and your body will respond by producing more milk. I'd do this cluster pumping each morning for about two weeks whenever my supply began to diminish. It always worked (in combination with the other tips I am giving you). Cluster pumping is especially helpful if you begin in the wee hours of the morning when supply tends to be highest.

3. Continue to pump for about 5 minutes after the flow stops. Often times you will get a second let down which not only gives you more milk but tells your body that the baby needs more food and bumps up your supply.

4. Make sure you are drinking lots of fluids to stay hydrated and avoid high sodium foods which dehydrate you. I noticed a pattern in which whenever I'd give in to my craving for saltines, my supply would dip the next day.

5. I read this somewhere but I was a stay at home mom so I didn't need this trick but supposedly if you look at your baby's picture or hold something that reminds you of her it will help with let down and output. It's worth a try!

All of this pumping sounds exhausting and it is, but once your supply is up you can gradually start decreasing your pumping and hopefully keep your supply up. Just to encourage you - I increased my supply from 20 ounces per day to a whopping 50 ounces per day using these techniques!! No drugs/no supplements. Just pumping and lots of it. I froze half of what I pumped and was able to quit pumping at six months and have enough milk frozen for another six months.

Good luck. You are an awesome mommy!!

[smpayne]

I had the same problem. When I was home, no bottles were needed, but the sitter always went through all my pumped milk plus some formula. I never could understand how that worked. It didn't matter how much I sent, she was always 1-2 bottles shy. If he was being over fed, this may explain some of his late night tummy issues.

I did get to a point where I was pumping 8-12 oz a session, but that was around 8 months.

[LilaQ]

in the same boat

I don't have much advice but I did want to sympathize because I'm in a similar situation. I WOH 4 days/wk--my inlaws watch my son 3 days a week and my husband does one day. I've been back at work for 3 weeks and am only able to pump 10-ish oz at work. (DS needs about 13-14 oz.) This stresses me to no end which of course only hurts the output. Another stressing factor is being told by my inlaws that I need to bring "just a couple more ounces". Like I can just turn the boob spigot on to get whatever amount I want!! They mean well but are clueless about so much.

Okay, my personal ranting aside I would def advise asking your MIL about how she is bottlefeeding. My husband can make 13 oz stretch thru the day but my inlaws cannot. I gave them an "instruction manual" that included the info from kellymom about how to bottlefeed a BF child but I finally realized they were not using the info about pacing. When I asked, they were pretty sheepish and admitted they "forgot". grrrr... Anyway, once I'm back to work after the holidays, I expect them to go thru less milk.

Another thing--my baby sleeps so much better for me and DH than for my in-laws so we can space the feedings out more. I figure if DS is awake and crying, of course he wants to eat. Maybe that's something to consider...

As far as pumping advice I don't have any except that I wouldn't sweat the formula thing so much. I try to pump extra at home so I'm not so pressured to pump more at work but if I come up a little short, he gets a few ounces of formula. My free time at home is so precious, I don't want to stress pumping there too. I really want my babe to be 100% BF but I'm trying to accept the fact that, as PP said, your baby will be fine if they are 95% BF and you are both relaxed and happier. Also, now that I've let myself relax a little about the amount I need to pump, the output is slightly better and I'm hoping it will continue to increase. hang in there!