supply question

[Rose-Roget]

What does a true low supply look like? I was reading on Kellymom about things that could be indicators but with reasons they are not always indicators. Baby is 4 mo and gains about 3-4 ounces per week, maybe a little more since I started back to work and she's taking bottles of expressed milk. I feel like I have to work really hard to keep my supply up. I take Fenugreek and try to drink Mother's Milk tea regularly. I avoid mint. I nurse frequently, do skin to skin when we can. What else can I do?

[PatioGardener]

4 months is a really really common time for moms to question their supply - which is most often fine.

True low supply results in slow or no weight gain (3-4 oz/week in a 4 month old is great!), not enough wet diapers (fewer than 5 HEAVY wets in 24 hours at that age) and often but not always a fussy, hungry baby.

If baby at 4 months is newly fussy, wakes more at night, etc BUT is gaining well and peeing well then supply is adequate. Those are normal 4 month old behaviours - as moms we just often internalize and blame it on a low supply.

[Rose-Roget]

Hi, PatioGardner! You've actually been really helpful throughout our ordeal over the past couple of months - I've had a few threads like "baby not gaining." She's been averaging 3-4 ounces since very early on. We've struggled a lot with this for the past 2 months, since her well-baby check when we realized how little she was gaining.

She's not gaining, but she has a good amount of wet diapers. She isn't usually too fussy, but frequently when nursing. She is on reflux meds which help somewhat sometimes. We're also trying chiropractic. She doesn't seem to like to work for her food - so once the flow from the initial letdown slows, she stops eating. I'm guessing this, in turn, tells my body not to produce as much. She eats about 1-1/2 to 3 ounces per breastfeeding, depending on whether she takes on side or both (I do weighed feedings pretty frequently). When I pump at work, I get about 2-3 ounces per session (but she drinks 4 ounces from a bottle, so then I don't end up with enough at the end of the day for her to have the next day and have to pull form my stash - grrr).

I also try to pump after 1-2 feedings when I am home. And I pump at night when she goes to bed.

[filewizard25]

I am experiencing the exact same thing. She's fine on the weekends when she has me all day, but at daycare she wants more than the (3) 3 oz. bottles I send with her to daycare... or so our daycare provider tells me. I think she's just more fussy because of her age (4 months) and my daycare provider takes that as she's still hungry, when really she's not. I got my period back at 6 weeks postpartum for some reason this time so my supply goes up and down with my cycle. I pump around 7-9 oz. per work day when I'm low, and 8-10 oz. when I'm back up. I've been taking fenugreek, but then on day 6 of taking it I started breaking out with a itchy rash that I don't know the cause of yet, so today I haven't taken any fenugreek thinking maybe I'm allergic to that. ?? Inevitably the night that I decide to pump after she goes to bed are the nights that she will wake up early and want to nurse and I've got nothing left.

[Rose-Roget]

Filewizard - Sorry you're in the same boat as far as pumping goes. It's frustrating! It sounds like you could very well be allergic to Fenugreek. Whole Foods has a More Milk tincture that doesn't have fenugreek in it. That might work for you.

Btw - I'm in Omaha. We're neighbors!

[PatioGardener]

Hi Rose-Roget, I remember! I'm sorry that you are still dealing with the weight gain issues. I'm going to think about you guys today and write more this evening - perhaps I'll be able to think of some tricks you haven't tried that may help.

[PatioGardener]

OK, so I bet you've already tried most/all of these, but just in case...

1) breast compressions while nursing. 5 seconds on, 5 off

2) switch nursing - giving baby '4' or even '6' breasts per nursing session to encourage let downs and active milk transfer

3) a good pumping routine, including pre-pumping massage and 'jiggle' with a massage and jiggle again 1/2 way through to encourage more letdown.

4) thoughts about domperidone?

5) SNS/lact-aid introduced when baby's feeding slows to spur more milk transfer

I'll keep thinking about more tricks that may help.

Hang in there! You're working really hard!

[Rose-Roget]

Thanks for those ideas!

1) I've been doing breast compressions. But I heard to keep compressing until baby stopped drinking. I can try the 5 on 5 off routine.

2) I try switch nursing when she accepts. If the milk isn't there and ready to be sucked back, she gets impatient and won't nurse anymore. Sometimes, I can get her back to the 1st side, but she doesn't usually drink - just comfort sucks.

3) I try to pump after I've fed her at least once per day, and always in the evenings. I pump every 3 hours at work. I will add massage (and jiggle) to the routine.

4) I've been strongly thinking about domperidone. I don't quite understand why it's not FDA approved in the US, though. Does that make it difficult to buy offline?

5) I've heard of SNS/lact-aid, but I don't know what it is or where to get one.

I am so grateful for the support. I really want dd's and my nursing relationship to become more positive and relaxing for both of us. But mostly I want her to grow and be healthy, so I need to try what I can before saying enough is enough and considering supplementing .

[PatioGardener]

Supplementing at the breast may be an option that allows you both to be more relaxed too.

The SNS/lact aid can be made for cheap as a temp solution before buying the brand name one. It is a 5 French feeding tube that allows baby to take extra milk at the breast while breastfeeding. Here is a video from Dr. Newman: http://www.nbci.ca/index.php?option=...lips&Itemid=13 Your milk or donor milk or formula, feeding the baby is the most important thing!

The breast compressions work better if you squeeze, hold and then release and then repeat. A 5 sec on 5 off pattern seems to give baby that extra burst of milk to inspire more sucking/transfer. If you just hold the compression it can actually block the milk from coming down the breast from the tissue above the hold and result in less transfer (and even blocked ducts).

Here is Jack Newman's take on the FDA and domperidone. http://www.nbci.ca/index.php?option=...tion&Itemid=17 There is a tread about it too if you search (just called 'domperidone' I think) that will have lots of useful info. Here in Canada it is often used. I think the only contraindications are a family or personal history of long QT syndrome (a specific heart issue), or unexplained fainting. The doc I know who prescribes it sends moms with heart arrythmias to a cardiologist for a work up and the OK before prescribing it, but moms without any history of heart conditions are no problem. Oh - and it is one of those medications where they tell you not to eat grapefruits or drink grapefruit juice while taking it.

Just remember that you can (and will) be breastfeeding if you need to supplement!

[starling&diesel]

Sounds like you're already off to a great start, compared to me!
Also from the sounds of it, you'd be a good candidate for domperidone. It seems to work really well for mamas who already have a decent foundation, rather than mamas who are starting from near to zilch.
It's legal in Canada, if that makes you feel any better!

[Rose-Roget]

Thanks for the added input. I'll look into domperidone. I'd seen that it was legal in other companies. Funny what gets pushed through the FDA and what doesn't. It doesn't seem to have any affect on Baby, though, right?

I think I may give the lactation aide a try. I think if dd continues to get milk easily, she will continue to suck longer. I'll read more about how to do it, but any suggestions on how much to supplement with (I'd be using expressed milk for now)?

The good news is that our ped wasn't concerned at her 4 mo appt today. She thought formula would just upset dd's tummy, as would solids. I am glad she was so supportive of continued ebf'ing.

Starling&Diesel, I'm sorry to hear you're off to a rough start. It sounds like you're pretty knowledgeable, though. I hope you find some solutions that work for you!

[starling&diesel]

Originally Posted by Rose-Roget

Starling&Diesel, I'm sorry to hear you're off to a rough start. It sounds like you're pretty knowledgeable, though. I hope you find some solutions that work for you!

Our rough start was over a year ago ... but thanks for your kind thoughts! We ended up using herbs, high dose domperidone and the LactAid system (LOVE IT!!!!!) for nearly a year, and are now breastfeeding without supplements at long last now that DD is a toddler and getting a portion of her nutrients from solids.
My caution with the LA is that the learning curve is fairly steep, but once you get the hang of it, you will love it! It is an incredibly simple, but very, very important invention.
The woman, Jerry, who runs LA is very helpful and will answer any questions you have. Her husband invented it for her back in the 70's so she could breastfeed their adopted children. The LA is far superior (in my opinion) than the Medela SNS. I didn't like using that one bit.
We found all of our LAs on Craiglist, which can make it cheaper. It's good to get as many as you use in a day, say 5-8 or so, and maybe more if you're going to supplement at night.
Glad to hear your ped appointment went so well!