Baby born 3 days ago, very little if any milk... do we have a clogged duct?

[chrisLA]

Hi everyone,

My wife and I had our first child exactly 3 days ago and we started with BFing.  At first colostrum used to come out and baby got fed fairly quickly when she was hungry.  But now after 3 days just not enough milk comes out.  So to test the volume we tried the pump. After 15 minutes of pumping a few table spoons came out in total. Yet mothers breasts are very enlarged, and feel very firm, all while almost no milk comes out.

Does anyone have any recommendations on what to do? Is it simply too early?  We've tried hot towels on the breasts, not much success so far and my wife is worried sick borderline tears over this.

Thanks for any advice,

Chris

[cristeen]

The pump is not an accurate test for milk.  How are you judging that not enough milk is coming out? Engorgement is middling normal at 3 days pp when the milk comes in. Since her breasts are full, try hand expression.  And find someone to evaluate the baby for tongue/lip tie immediately.  If the baby is truly not getting enough milk, do not put it off.  You'll need someone with experience diagnosing them, but the longer you put it off, the worse the problem becomes.

[Heba]

Congratulations on the birth of your baby!

PP is spot on when she says that a pump is not an accurate measure of milk supply.  That said, a few tablespoons is pretty high output at this point!  Baby's stomachs are still small (22-27ml capacity on day 3 - about the size of a ping-pong ball) so cannot take much at one go; they do however need feeding often!

One sign of sufficient intake is nappy output.  By day 3, you should be seeing *at least* 3 soaking wet nappies (4 by day 4, and then 5-6 from day 5 onwards), and *at least* 3 poos from day 3 onwards.  Poos should be changing colour at this point from the black meconium to sort of greenish - in the next day or two they should be mustard-yellow.  A weight drop of more than 7-10% is also a red flag.

Several things can affect milk transfer in the first few days.  I wonder if any of the following apply?

- tongue/lip tie (as per the pp)

- medicated delivery can make a baby sleepy and unable to nurse much - or to sleep instead of waking to feed.  In this case, stimulate baby to nurse, don't let baby sleep for more than 2-3 hours without a feed  (no more than 4 hours at night), skin-to-skin for stimulation

- Baby needs to be allowed to "finish" the first side before being offered the other breast and come off of their own accord (which they may or may not take).

- Feeds need to be "on cue" rather than scheduled; watch for baby's cues.  These include lips opening and closing, baby's head moving from side to side as if looking for milk, baby bringing fists to mouth, even stirring from sleep.  Crying is a late cue, and indicates that baby has been hungry for some time.  *The only exception is if baby is too sleepy to cue hunger.  If more than 2-3 hours have gone without a feed, wake baby and offer the breast.*

- Engorgement can make it difficult for baby to latch on and effectively milk the breast.  Try Reverse Pressure Softening just (http://www.llli.org/faq/engorgement.html )    afjOPFjopprior to a feed.  This softens the area around the nipple.

Keeping baby really close to mum (lots of cuddles and skin-to-skin where possible can help stimulate supply) often helps.  (cont below)

[GoBecGo]

If you know the baby is hungry because she wants to nurse continuously then you need help NOW with latch and feeding to make sure you are on track to establish a good feeding relationship.

If you know the baby is not getting enough because she is feeding every 2 hours (from start of feed to start of feed, so maybe every 30mins if she feeds a long time each time) then she could be just a normal newborn.  Breastmilk passes through pretty fast.  Is baby pooping and peeing?  How many wet/dirty nappies in 24 hours?

If mama is in pain and the breasts are hard i would assume a transfer issue (the milk isn't getting out of the breast and into the baby).  Please ignore the pump, i have 3, one i can get literally only 1-2 teaspoons out with, the other up to 9oz immediately after.  The BABY is the most efficient milk extractor IF the latch is good.  Try to get an appointment with an LC asap.

Best of luck!

[Heba]

(Sorry, something happened with my keyboard.)

Also, breast compressions are very effective in helping baby get more milk in the early days:

http://www.drjacknewman.com/help/Breast-compression.asp 

As the PP says, getting a face-to-face consult would be invaluable, if this is an option for you.  Until then, you could perhaps call a breastfeeding helpline if there is one where you live (I know the UK, Australia and the UAE have them, for example; I don't know about other countries); they are staffed by well-trained breastfeeding counsellors but are free.  Also, if you pop back here with more details we may be able to offer further suggestions.

Hang in there - it is brilliant that you are looking for help for your wife and baby.  You have a really important role to play in encouraging your wife and helping her access information and skilled support if necessary.  Please do let us know how you get on.

Best wishes

Heba

[womenswisdom]

 Day 3 is a typical time for the milk to come in and many moms feel engorged.  Getting a few tablespoons is actually plenty at this point!  Each tablespoon is 15 ml and like a pp said, am 3-day old baby's stomach capacity is very small (22-27ml).  Sounds like everything is really normal from your post unless there is something you didn't mention, like lack of wet diapers or signs of dehydration.  You didn't really mention why you think there is not enough milk at this point.  How often is baby feeding? Keep doing lots of skin-to-skin time with mama, let baby nurse as often as she wants to and try to relax a bit :)  You might pick up a copy of The Womanly Art of Breastfeeding (you can probably find a copy at a bookstore like Border or B&N), which will give you tons of great information about what to expect and what is normal.

One more thing:  if you are in the US, call 1-800-LALECHE to speak to someone directly about the particulars of your situation and get good information.

[chrisLA]

Thanks for the advice everyone,

Situation might be getting bit better now.  Last night my wifes breasts were extremely engorged so we basically hand expressed the milk out, it was a very very painful process, since we tried to squeeze it all out using basically brute force, but it seemed to get things moving.  Today we were able to pump out several oz's.

We also saw a lactation consultant today. She said if we keep up the hot compresses and pumping the milk flow should become all right.

[Heba]

I'm glad things are getting a bit better.  The most important thing is to get that milk flowing!  Do do do try reverse pressure softening (link as above http://www.llli.org/faq/engorgement.html ).  Not only will it help baby to latch on, but it can also trigger let-down and get the milk moving :).  Then encourage your baby to feed feed feed!

Your wife might like to consider temporary medicinal pain relief (paracetamol/acetaminophen is considered compatible with breastfeeding so she could ask her HCP about this) if it's still painful. 

[womenswisdom]

Glad to hear things are improving!

However, I would caution you not to pump a huge amount.  The baby should be nursing as often as she wants, and mama can pump a bit if she's very uncomfortable, but pumping a lot will cause her to develop an oversupply, which is then another problem you will have to deal with.  The breasts are a supply and demand system, so if she is nursing the baby AND pumping several ounces, her body will think that it needs to make enough milk for two babies.  Your baby is not eating several ounces at a feed at this point, and a few tablespoons is a normal amount.  I would not pump at all unless she needs to for comfort and then just pump enough to relieve her.  If baby is having an appropriate number of wet/dirty diapers and is gaining well, mama does not need to pump at all unless it's a minimal amount to relieve discomfort and the aim should be to stop pumping altogether until her milk supply is well-regulated (several weeks).

[chrisLA]

Thanks, we'll try to make sure to keep it under control.  Milk supply is getting better now since our little girl is sucking at it and pump is helping occasionally.  Still not enough to get off the formula completely, but almost there.  Hand expressing got the milk flowing.

Just to share, kind of ticked off at the local doctors.  Met 3, and every single doctor recommended giving up on the engorgement/milk and just killing it off with ice pack and antibiotics. Glad we found this forum, advice helped save my wife's breasts and our baby's milk, unlike local MD's whose only advice is to give up and use a commercial product even though better natural alternatives exist.

Thank you very much again.

[Viola]

Something to keep in mind with engorgement is that it is not just milk making the breasts feel full and hard, but other bodily fluids, like lymphatic fluid and increased blood flow to the area.  Reverse pressure softening has already been mentioned, and sometimes just trying to treat the inflammation can help, which is why cold packs might have been mentioned.  If your wife takes over the counter NSAIDs like ibuprofen, then that might be useful in this situation, although it sounds like things are getting better now.

Although pumping regularly can build supply, sometimes it might be warranted in the case of extreme engorgement, where there is ineffective milk removal.  Getting enough milk expressed to soften the breast can allow the fluid in the tissues to be released, from what I've read.  However, my experience was that I couldn't get anything with the pump when engorged, but the baby could--my issue was my newborn decided to sleep for 5 hours at night at the time I was engorged and no amount of coaxing would get her to latch on.  So I tried two different pumps that I had used successfully before, and got nothing.  I finally got up and did warm compresses and tried to manually express in the shower.  

The pressure from the engorgement is what sends the signals to stop making milk, so if there has been ineffective milk transfer, and it sounds like there has been if she is still needing supplementation, just make sure to watch that and pump and hand express when necessary to relieve some of that pressure, if it keeps happening.  You can supplement your baby with this milk first before using the formula.