Supply challenges after relactation

[MaxineIsCute]

Hi everyone, I'm new here. Well, I've had my username forever but haven't been here in a long time! :-) I have an issue I'm not sure what to do about.

My baby (6.5mo old) has MSPI + corn/bean/tomato/artichoke/chocolate intolerance. We weaned completely at 5mo because no matter what dietary changes I made, she was still having bloody (and mucousy diarrhea) poops. She was on formula 50% before weaning, but after a week EFF she started having horrible reactions. I tried two specialty formulas full-time with bad results, then decided to relactate.

She's been back on the breast about 3 weeks, and was only off the breast for 2 weeks or so. I am on domperidone 30mg 3x/day, Mother's Milk Tincture (GROSS) 3x/day, Mother's Milk Tea a few times a day at double strength, and I have oatmeal for breakfast every morning. My baby is 50ish% FF and gets a formula bottle 2-3x a day. She is not getting enough at the breast for the 3 feedings a day she is nursing, so I have been giving her solids after nursing to help fill her up. She does very well on solids and loves to eat. She STTN if she has 3 formula bottles a day, but wakes up to eat during the night if she has only 2 and an extra nursing instead.

I cannot put her to the breast more times a day because she refuses to nurse if there is not milk flowing (prefers the bottle, I suppose. I also had OALD before weaning so she was used to a fast flow.). I try very hard to keep her on the breast as long as possible and do compressions, but she's over it as soon as the milk stops flowing very readily. I had rented a hospital grade pump and was pumping multiple times a day in addition to the nursing, but I can't keep that up (it was very challenging to fit that into my schedule), so I returned the pump. I still have a single pump that I use as often as I can, but I haven't noticed any difference when I do that, even when I try to 'power pump'.

I need her to nurse at least 40% of her fluids b/c of her tummy, but not more than about 60%. About 50/50 BF/FF is where she is healthiest and happiest.

I haven't taken Fenugreek/Blessed Thistle directly in pill form because I have a sensitive tummy myself. I am also not eating a ton of food so my tummy is a bit more sensitive than normal. My caloric intake is adequate to maintain my weight and nurse, and I drink water all throughout the day, as much as I can!

Am I missing something here or is this just the way it's going to be now? I can try the Fenugreek as well and hope it doesn't upset my tummy but am hesitant. I tried Reglan but had horrible side effects so dom is my best option. I have been considering going to 30mg 4x/day to see if that helps a bit. I also try to make things like apple crisp w/oatmeal struesel for dessert frequently.

I feel like I've tried everything, and I'm committed to nursing but I have to make this work in our life every day so extreme things (like pumping multiple times a day) are just not realistic for me. But I would love to get my supply to the point where I can provide full feedings 2-3x a day instead of partial feedings. Then the solids would be just extra on top of getting her basic nutrition from bottle and breast.

Sorry so long, but thanks in advance for any help! She is growing and developing well - small but on her curve - so weight gain is not an issue. Thanks for any advice!!

[Megan73]

Kudos to you for relactating!

You can get her to nurse more by supplementing at the breast with a SNS or Lact-Aid instead of using bottles. I think it will make a BIG difference for you, both by emptying your breasts more often if you won't pump and by improving her nursing.

I'd also experiment with upping the dom - I've heard of women taking 120 mg and even 160 mg a day.

[MaxineIsCute]

Thank you! I talked about an SNS with my LC, but she and I bought thought with how grabby my baby is, she'd rip the tubes right off me. She said I could try it but she didn't expect it to work that well for us - with an 'older' baby. I can definitely give it a shot though if it'll make that big a difference!

I added a 4th 30mg pill today to see if that will help. My supply is definitely dwindling and it SUCKS. My baby is starting to get really crabby and refluxy b/c she's getting too much formula and it's sad! I had to give her 4-5oz bottles after every nursing yesterday (so 5x), just supplementing with some solids wasn't enough.

Ok rambling, I will try upping the dom first and maybe taking more of the herbs, then maybe experiment with the SNS. I remember it was kind of expensive at my local birth center so that's another reason we didn't try it, since we weren't sure it was a good fit for baby.

Thanks again for the advice!

[Megan73]

It's true - a SNS may be a real problem with an older baby who grabs the tubes but I would try it because it will stimulate your supply and may well be easier on her tummy. 

Are you using the lowest-flow nipples when bottle-feeding and pacing feedings? That my help, too. Kellymom.com has a great fact sheet for bottle feeding the breastfed baby.

I know pumping is a PIA but I would worry that if only nursing three times a day is going to mean that your supply keeps dwindling. Can you fit in at least a couple of daily pumps with a consumer-grade double electric? If you work outside the home, I found it helpful to pump around naptime (just for 15 minutes in a bathroom stall) during the week so I could nurse then on weekends and have the milk as supplement. Any evening TV or computer time is good for pumping, too. You can make a cheap "hands free" pumping bra by cutting holes in an old sports bra which helped me fit in more pumping sessions.

Good luck, mama.

[MaxineIsCute]

Thanks again Megan! I really appreciate it. I rented a Symphony again yesterday so I am back to pumping. I do have the bra so I can multi-task. ;-) So I'm aiming for 4 pumps a day if possible - which would be during 3 naps + after she goes to bed. I can't really pump when she's awake b/c she won't sit still quite that long, though I suppose I could do 5 minutes here and there while she plays in her exersaucer or with her food. I also rented a baby scale and this morning, after nursing a 7am + 3oz bottle (when I didn't weigh her), she got a little less than 2oz from me at 9:45am. Better than I expected, though earlier in the day I imagine she gets a little more than in the evenings.

Some of my friends also think maybe AF is to blame. She's probably due in about a weekish, and apparently supply can dip the week before? This will be only my second cycle pp, so I am not sure when to expect it.

I also got fenugreek tincture and loose-leaf mothers milk tea that I steeped overnight last night. So between the oatmeal, MMP tincture, Fenugreek, tea, dom, and extra pumping, I hope my supply will increase. If it is AF apparently it'll come back naturally? If that's the case I can prepare next month a little better if it should happen again. My supply was never affected by AF (that I could notice) with ODD, and she nursed for 10 months after AF came back!

I am using the next-size up from newborn nipples. I had to use them b/c I had OALD (my supply was very abundant pre-weaning...oh the irony) and when I tried to give her newborn nipples she flipped out and wouldn't eat. Even now she wants a faster flow sometimes but I am not going to go up a size, obviously!

[Megan73]

Big hugs for pumping. I know full well what a sacrifice it is when you're so busy and you'd rather just nurse, YK? The good news is that if the pumping works to stimulate supply you may have enough milk to replace pumps with direct nursing.

Have you had a period since you started the dom? I ask because I didn't have a PP period until I stopped the dom entirely at 18 months or so and most women here seem to find it stops their cycle from returning because of all the extra prolactin in their systems. If you keep having periods, I've read a magnesium supplement can help with AF supply dips.

Good luck!

[MaxineIsCute]

Pumping is definitely a total PIA. My hats go off to all the EPers out there! I have to force myself to do it, I hate it so much.

I have not had a period since the dom, no. I only started it about 3.5 weeks ago. I was pumping like mad a week before that, but my relactation only started a month ago, so this is all pretty new. My supply had come back decently before it disappeared and got me in this predicament. I have heard that said before about dom, so maybe AF won't come after all! It would be nice to have something to blame this on, though.

In other news, a friend of mine said she has an SNS kit she tried with her ODD, but he wouldn't latch so it was never really used. She is sending it to me to try! I am thinking I could wear strategic shirts that may cover up the tubes a bit while she nurses. So I will give that a shot too!

Today I only weighed one feed, but it was 2.2oz on her second feed of the day, so that's pretty good. You know, it's all relative.

[Megan73]

That's all good news. Well done! I'll be rooting for you.