Milk Supply Issue

[mum06]

I have a two week old baby that is not gaining weight. The doctor is having us count diapers and come back in on Monday for a re-weigh. He has plenty of wet/poopy diapers. I've started pumping my milk to help boost my milk supply. My question for you moms with experience is...

How many ounces of milk should I be producing when baby is two weeks old? I'm currently pumping about two ounces total every two hours.

And I know what to do to build my supply (rest, water, increase demand, skin to skin contact, teas), but am I missing something? Is there anyone out there that knows about special circumstances where milk supply could be effected? I just can't keep up with baby's demand! He is sucking down the two ounces and wanting more!

[kavamamakava]

What was your baby's birthweight and what is it now? Did baby lose any weight at all after birth and then gain it back? It doesn't sound like you have a supply problem nor does it sound like baby isn't getting enough. Babies will often suck down the contents of a bottle because it's pretty easy to get the milk out compared to a breast. Skin to skin is definitely the most important thing you can do here. Your bodies will communicate so that you can produce what baby needs.
Also, if baby wants more and more, I think you're about to head into the 3 week growth spurt. Babies nurse a lot right before it and then sleep a lot for a few days and suddenly they are much heavier and you're getting the next size of baby clothes out of the closet.

[mamaw/two]

The baby is much more effective on getting milk out then the pump. If he is doing fine on the wet and poopy dipes, then your supply is just fine, I would suggest just nursing him on demand (no pumping)...even if it's 20 hrs a day. Don't let anyone talk you into supplementing, that will mess with your supply that is just trying to get established. Try to remember that lactation is a supply and demand thing, if baby demands more (by nursing alot), the supply will increase. I really wouldn't worry about a baby that is just at his birth weight at 2 weeks, he will pick up his growth soon

[mum06]

Originally Posted by kavamamakava

What was your baby's birthweight and what is it now? Did baby lose any weight at all after birth and then gain it back? It doesn't sound like you have a supply problem nor does it sound like baby isn't getting enough. Babies will often suck down the contents of a bottle because it's pretty easy to get the milk out compared to a breast. Skin to skin is definitely the most important thing you can do here. Your bodies will communicate so that you can produce what baby needs.
Also, if baby wants more and more, I think you're about to head into the 3 week growth spurt. Babies nurse a lot right before it and then sleep a lot for a few days and suddenly they are much heavier and you're getting the next size of baby clothes out of the closet.

He was 9lbs 4oz at birth, was 8lbs 8oz last Monday, and was 8lbs 6oz on Friday. The doctor is telling me he is going to screen for metabolic disorders if he hasn't gained weight by tomorrow. I'm wondering if he just isn't very good at extracting the milk. He may be tongue tied (I am and so was my first) and I have very large nipples.

[mum06]

Originally Posted by mamaw/two

The baby is much more effective on getting milk out then the pump. If he is doing fine on the wet and poopy dipes, then your supply is just fine, I would suggest just nursing him on demand (no pumping)...even if it's 20 hrs a day. Don't let anyone talk you into supplementing, that will mess with your supply that is just trying to get established. Try to remember that lactation is a supply and demand thing, if baby demands more (by nursing alot), the supply will increase. I really wouldn't worry about a baby that is just at his birth weight at 2 weeks, he will pick up his growth soon

I have been nursing on demand since birth and he was still losing weight as of Friday. He has passed the dreaded 10% marker. Sigh... The doctor said that if I continued to nurse on demand, I would give myself mastitis and really mess things up. He is telling me to stretch the feedings out to at least 1 1/2 hours apart.

[Bokonon]

Originally Posted by mum06

I have been nursing on demand since birth and he was still losing weight as of Friday. He has passed the dreaded 10% marker. Sigh... The doctor said that if I continued to nurse on demand, I would give myself mastitis and really mess things up. He is telling me to stretch the feedings out to at least 1 1/2 hours apart.

Wait - your doctor is concerned about weight gain but is telling you to space feedings????

Nursing on demand won't give you mastitis. Your doc is setting you up for trouble by advising you to space out feedings for a baby whose weight gain is already in question.

[kavamamakava]

Not to go against your doc, but mastitis often develops when you have clogged ducts - which won't happen if you're nursing all the time. I don't follow that mastitis logic at all. I mean, maybe he means that if your baby's latch is poor and your nipples are getting damaged that 24/7 nursing might cause so much damage that you could get cracked nipples and the cracks can get infected and lead to mastitis? But you're not having that problem now, are you?
I put my little one in a sling and let her nurse in the sling whenever she needed to. Skin to skin contact was so important. Have you found a comfortable nursing position that you can relax into while he nurses as long as he needs to? How about lying on your back and laying him on top of you? http://www.breastfeeding.com/reading_room/lying.html "When mothers were lying flat or semi-reclined, babies could find the breast easier and in many cases attach themselves and feed whilst asleep."

Is his tongue really short? When he latches on, is he able to get the whole nipple in his mouth? Does he stick his tongue out ever? And if he does, does it dimple in the center? Brian Palmer recommends having it clipped if it interferes with breastfeeding http://www.brianpalmerdds.com/bfeed_frenulums.htm

[Megan73]

Your doctor is clearly clueless about breastfeeding but I understand your concern that he's not on the way back up at two weeks. I really strongly urge your to see a lactation consultant.
It is unfortunately true that babies can have the right number of wets and dirties and still not get enough milk to gain weight - that was the case with my son.
It could be low supply, it could be that your babe isn't transferring milk well enough (perhaps from the TT), which will affect your supply.
A LC will be able to do test feed weights and help you figure it out.
There are lots of things you can do, from getting that tongue-tie clipped to taking galactagogues (particularly the drug domperidone, which you can buy online or by prescription in you live in Canada, not sure about other countries) and pumping after feeding on demand (preferably with a hospital-grade pump) to maintain supply while you figure out what's going on.
If you nurse then pump, you may be able to supplement with your own breast milk instead of using formula. I'd urge you to avoid bottles and use a syringe, cup or at-the-breast supplementer such as a Medela SNS or Lact-Aid to prevent the baby from developing flow preference.
It's SO hard to struggle with breastfeeding but you WILL figure it out with the right support. Hang in there mama.
And congrats on your new baby

[cristeen]

Are you pumping in addition to nursing? In that case, 2 oz every 2 hours is phenomenal. If it's instead of nursing, then 2 oz every 2 hours is still mighty good. Pumping will never be as efficient as baby though.

What I would suggest, before doing anything drastic is to get yourself a supplementer (I like the Lact-Aid, but you would have to order it... the Medela SNS may be available locally). Put your pumped milk in the supplementer, and feed the baby at the breast. Ditch the bottles completely.

Then I'd contact an IBCLC and quit taking BFing advice from your ped. While your ped may know a thing or two about babies, most don't know jack about BF. Have your LO checked for ties (tongue and lip), and have his latch assessed to see if he's actually moving milk.

I know this can be very difficult to deal with at this time that should be all about snuggling your LO, but I just have to advise everyone with a similar problem to not make the same mistakes I did - keep the baby at the breast, get his latch assessed ASAP, and don't give up.

Oh, and you said he's not *gaining* weight... at 2 weeks, is he back to his birth weight? If he is, then I wouldn't be too worried. If he's not, then that's a bit of a concern. If he's dropping then you have a problem. I know my guy was 18 oz below birth weight at 2 weeks - that was a cause for concern. But a baby who is at birth weight at 2 weeks really isn't.

[mum06]

Update!

I took baby in for a weight check and he gained 7oz over the weekend! Hooray! At least we know that the problem lies with my milk supply and not any other medical issues.

The doctor doesn't seem to be a big bfing supporter; he told me 1/3 of my feedings should be formula. I really don't see how that will increase my milk supply. The jerk. I can't wait for open enrollment so I can change our insurance so we can see a different doctor!

So instead of listening to him, I'm going to nurse him, pump when he is done, and then bottle feed pumped milk (or the darn formula) until he is no longer ravenously hungry and is all caught up.

[Mirrormonkey]

He gained so much I would forget about supplementing and focus on continuing to increase your supply by nursing constantly. Don't use formula that will just decrease your supply, plus it is full of fructose and other bad stuff for baby.

Sounds like you are doing a great job!!

[mamaw/two]

Originally Posted by mum06

I took baby in for a weight check and he gained 7oz over the weekend! Hooray! At least we know that the problem lies with my milk supply and not any other medical issues.

The doctor doesn't seem to be a big bfing supporter; he told me 1/3 of my feedings should be formula. I really don't see how that will increase my milk supply. The jerk. I can't wait for open enrollment so I can change our insurance so we can see a different doctor!

So instead of listening to him, I'm going to nurse him, pump when he is done, and then bottle feed pumped milk (or the darn formula) until he is no longer ravenously hungry and is all caught up.

So glad he is gaining!! Since he is gaining so well, it doesn't sound like you have any problem at all with your supply. I would highly suggest that you ditch the bottles and pump, then nurse, nurse, and then nurse some more. Your dr. doesn't seem to be educated at all on bfing, so glad you are looking to find a new one.

[blessedwithboys]

your dr is dead wrong about mastitis and nursing on demand. scheduled bf'ing may cause mastitis, nursing on demand prevents it.

7oz over a weekend? that is the growth spurt. expect another one around 6wks.

there probably is nothing wrong with your milk supply. pump if you wish, but stop using bottles at this young age. as baby learns it is easier to get milk from a bottle, he may not want to nurse anymore. if you wish to give expressed milk, give it through a lactaid or SNS.

and formula is not necessary at all based on what you described. if your lo is tongue tied, i highly recommend getting it cut. that will help with milk transfer. bf is a perfect process, the less we mess with it, the better it works.

[kavamamakava]

Hooray! Wonderful news

[Heba]

Great that there is weight gain! In your earlier thread you described nipple pain, which does suggest poor attachment and can lead to inadequate milk transfer. Did you manage to get a face-to-face assessment of positioning and attachment (LC can also check for tongue-tie which would explain both your pain and the milk transfer/weight gain problems), or try the "laid-back" nursing positions? Do let us know how you get on!