What does Low-Supply Living look like in the long-term?

[gemasita]

DH and I had a talk last night because we feel like we are going crazy.  My DS is now 2 months old and I am still trying to pump every 3 hours for him but only getting 8-9 oz in a 24-hour period.  DS eats about 24 oz a day.  We've tried LITERALLY everything (including Domperidone and Reglan) to increase supply but nothing ever helped and my LC tells me that by 8 weeks, we are really in supply-maintaining mode, not supply-building mode.

So how do I transition my mind into supply-maintaining mode?  DS is a great sleeper.  He'll go 6 hours, easy, and I feel guilty if I go that long without pumping at night.  But I have started doing that because I'm exhausted.  What does a pumping schedule look like, long-term, for someone like me?

We've been getting donor breastmilk up to this point.  DH is worried that a)I'm wearing myself down tracking it down every few days and b)I'll loose it if we have to use formula.  We have to let go of something at this point or we'll go crazy.  Should it be this or should we keep at this?

I nurse DS a few times a day.  He has latch issues but he actually nurses much better at this point than he did as a newborn but I still use a nipple shield most of the time because I don't want to make myself too sore.  Pain has been a HUGE factor in all of this.  I am in pain all the time. Breast pain and nipple pain and I've been to several doctors trying to get it addressed.  I think the pump is causing a lot of my pain, plus a staph infection that I had.  I do have the right size flanges but I guess I'm just sensitive...and I'm pumping so often.  I pump about 20 minutes at a time but with nursing, I guess I should be able to pump a shorter period of time afterwards - maybe just 10 minutes?  I usually get out about an oz less after he nurses (I've never pumped more than 2 oz a a time - usually 1.5 so I get maybe .5 oz after he nurses).  Do I try something like the Lact-Aid to consolidate the process of breastfeeding, then bottle-feeding, then pumping?  Or is that crazy to consider a contraption like that when I am trying to SIMPLIFY my life?  I would love to replace pumping sessions with breastfeeding sessions but I don't know if not pumping afterwards when decrease my already-low supply.  I don't know how volatile my supply is - see how I can't seem to make that switch to supply-maintaining mode?

My LC said to talk with DH about a wish list of what we want life to look like for us.  I like that idea because DS will be our only child and I don't want to miss out on his babyhood.  (We did IVF 5 times and I don't have fallopian tubes so there's no chance of us conceiving naturally.)  DH knows I have looked forward to this for so long and don't want to have any regrets.  I feel like I will have regrets if I do give up some of these things and regrets if I don't.  I can't win.

I had other things that I looked forward to for YEARS....like cloth diapers.  We haven't even started that yet because there just aren't enough hours in the day.  I do have lots of babywearing gear that I use all the time and that's lots of fun.  I want to have fun with this baby but all I think about is the FEEDINGS...the FEEDINGS...the FEEDINGS.  Can someone give me some advice on how to make life livable again and how to enjoy my baby?

[poorlittlefish]

I had low supply with my first DD due to a breast reduction.  I was able to work up to a full supply but my life looked a lot like yours for several months.  I am very, very pro breastfeeding so please do not take this the wrong way but would you consider nursing and then supplementing with as much formula as he needs afterwards and just letting whatever happens happens?  I feel as though I missed my DD infancy because of all the reasons that you mention.  Your baby needs his mama more than anything else and these types of situations are what formula is for.

I don't want to be negative or bring you down but I can just feel my stress increasing reading your post because it makes me remember what it was like.  Could you set a goal to keep doing what you are until he hits, say, 3 months and then just nurse on demand followed by donated milk or formula?

Hugs mama, I have been there and you are doing an amazing job for your little guy.

[PatioGardener]

I would suggest a modification of what the PP suggested, and offer the following as an option. Nursing with a SNS/lact-aid kind of device, using donated breastmilk. That way baby would get your milk, enough milk, no formula and you could ditch the pump and concentrate on loving the feedings (as long as they aren't painful.)

[ILoveMyBabyBird]

yes try an sns/lactaid, it helps a lot in terms of feeling less guilty about giving formula. I had to give ds 50% formula due to probable IGT. I hated it, but ds needed to eat and that is what is most important. Almost due with #2 in a couple weeks and have mentally been preparing for every possible outcome and it is still hard, but just do your best and don't feel guilty about getting needed rest. At the end of the day know that you have given it your all and don't fee bad about giving your lo formula if he needs it and you can't find donor milk.

ETA: and i feel you on letting other things go, I too would love to start out with dd in cloth diapers, but because of my problems with ds and breastfeeding, I am not even considering them until dd is 3-4 weeks old and have plenty of disposables on hand because breastfeeding is more important than cloth diapering. Just do what you need to and when you get into a routine, then you can start doing those other little things that you want to it does get easier once you get used to supplementing and managing your time.

[SubliminalDarkness]

Well.... For me it looked like DS2 latched on and nursing about 20 hours a day, every day, for at least his first 10 months of life. We never supplemented, but he had to nurse A LOT to get enough to eat. But in my book, for my life, that was ok because it worked, even though it made me miserable and I was in pain all the time(still am, actually). 

I can't say what it would look like for you or anyone else. I'm glad I did what I did, because it was right for us. But obviously a working mom or something wouldn't be able to do the same thing. 

[gemasita]

So I've been thinking overnight about all of the comments here and it does seem that the pumping is my (and everyone's) least-favorite part of all of this.  I loathe pumping and I have so much pain when I pump so I'm just not sure it's worth it for such a small amount.  I am hardly getting anything when I pump - just an ounce most of the time.  So maybe I should consider the Lact-Aid and just enjoy feeding the baby and whatever's in the Lact-Aid - donor milk or formula - so be it.

I really appreciate you comments, poorlittlefish.  That's what I was thinking too...I am, of course, a big supporter of bf'ing, but maybe I need to just let what happens, happen.  One of my friends with low-supply said that she just nursed her babies whenever they wanted...and then fed them afterward if they were still hungry.  I would love to just let what happens, happen.  My body is obviously not able to feed DS entirely so maybe I should just go with the flow and nurse him on demand with the Lact-Aid...or even after nursing sessions with a bottle.  He's very laid back and takes a bottle fine and we nurse fine too, except for using a nipple shield.  He doesn't nurse any worse after introducing a bottle, I can at least say that.  He seems to love to nurse and loves to eat.  He's a patient nurser which is a great kind of baby for someone with low supply!   Anyway, this way I would enjoy nursing him and he will get fed.

Keep the suggestions coming...I would love to know what others do.

[Megan73]

I agree with PPs. I'd stop pumping, invest in some Lact-Aid units and focus on enjoying nursing and your little one. That said, I'd try to get off the nipple shield first (it can interfere with milk transfer) and don't offer unlimited supplement, whether it's donor milk or formula. Play with the amount until you get a satisfied babe and average weight gain according to Kellymom's info on infant growth. Too much supplement can mean baby isn't hungry to nurse and can further hurt your supply. I was where you are with DS1. Despite all the pumping and dom, he wasn't gaining without about 8 oz of formula a day. At two months I switched to the Lact-Aid and he never had another bottle. At five months I just could not pump any longer so I returned the hospital grade pump and only used my PIS when I missed a feed altogether. He nursed to 18 months and I still treasure every minute.

[lactatinggirl]

I've struggled with low supply in the past and with DD constantly eating (literally about every 60-90 minutes 24 hours a day during the first 6 months of her life because of bad reflux). Things I'd recommend are More Milk Plus (it's a combination of herbs and kind of spendy, but I've used it to "jump start" my supply multiple times), pumping on one side while nursing on the other (I always got WAY more when doing that), and be happy about how far you've already come. You've gotten further than most mothers. You've given your baby 8 whole weeks of breastfeeding. I'm not at all saying you should stop, but just remember that you're accomplishing something every day you continue to nurse (whether or not you're supplementing). 6 days is better than nothing, 6 week is better than 6 days, 6 months is better than 6 weeks, etc. 

[ILoveMyBabyBird]

http://www.fourfriends.com/cgi-bin/milk.pl?lbs

not sure on the accuracy of this but here is a supplement calculator

I tested it and does keep getting higher as the weight increases, but i suppose at that time (6 months or so solids would be introduced)

Anyway, it is how I plan to gauge the supplements when dd arrives. It is very tricky trying to figure out how much supplement to give. With ds we finally settled on about 12-15 ounces of supplement by the time i was done with the hospital grade pump when he was about 5 months or so. He was never a chubby baby, except at birth (9lbs), and is and has always been very tall and his weight proportionate to his height, more long and lean so I knew I was wasn't over-feeding him as he was growing well but not overweight...and he had a decent amount of stools and wet diapers..But it is true babies will eat more if you offer it, so try to offer less amounts more frequently and make sure your lo is getting sufficient time on the breast.

[gemasita]

Originally Posted by lactatinggirl Things I'd recommend are More Milk Plus (it's a combination of herbs and kind of spendy, but I've used it to "jump start" my supply multiple times), pumping on one side while nursing on the other (I always got WAY more when doing that), and be happy about how far you've already come.

I've done the More Milk Plus and the nursing on one side and pumping on the other.  I've done everything suggested to me and never really seen any change.  I did power pumping, pumping every two hours, domperidone, Reglan, oatmeal, tons of water.  No change.

Thanks for the encouragement.  I guess getting this much breast milk into him so far is an accomplishment.  I just don't know how long I can go living like I am.  Something's got to give.

ILoveMyBabyBird - thanks for the calculator.  It is so hard to calculate an amount.  I pump about 8-9 oz and he eats about 24 in a day.  Now we've been nursing and then giving him a bottle and then I pump.  I usually pump about .5 oz and he usually takes about .5-1oz less of the bottle.  So I don't think he gets much directly from me but some.

I am wondering why I am able to pump even .5 oz after a feeding.  Is that typical or should I be completely empty and not able to pump anything?  I want to make sure he gets everything out of me but when I pump and see a little milk there, I get to wondering why he isn't getting that out.  Maybe it's the nipple shield?  (Which I do take off when I can stand it.)  I'm afraid to NOT pump after he nurses but honestly, that is the part of this that is making me crazy - the pumping.

I am still a wreck.

[maryeliz]

Another low supplier here.  I was doing the whole hardcore pumping and feeding thing until about a month after my baby came home from the NICU.  I was hoping that once I got her home, and she could nurse on demand, I would see a real jump in supply.  That didn't happen and I felt like pumping all the time was actually making it harder to nurse her-I would pump, she would be hungry a half hour later but I wouldn't have anything for her.  So now I only pump on days when I am away at work.  I nurse first and then if she is still hungry (crying five minutes after she just nursed for a long time, or nursing really frantically for a long period of time) I supplement.  I supplement as much as she will take because she was a little 29 weeker with IUGR, so I really want her to eat as much as she can deal with.  For us, supplementing really hasn't decreased her enthusiasm for nursing-she seems to prefer breast over bottle, and my supply seems to be holding steady.

I've just had to remind myself not to let the perfect be the enemy of the good.  It has been much better for us when I just accepted supplementing. We enjoy the nursing that we do, but now I'm not freaking out about supply and whether she's hungry.

[gemasita]

I've just had to remind myself not to let the perfect be the enemy of the good.

Oh, I think I needed to hear that today.  One of my other friends said she would just nurse her babies whenever they wanted and supplement afterwards if they were still hungry.  I think I'm going to have to go ahead and do that.  That pump is sucking the life out of me.  My babe likes to nurse, no matter what he gets out (but he doesn't like to be hungry so I know we'll need to supplement).  For us, we are not even close to producing enough so supplementing is going to have to be a fact of life.  We haven't done formula yet, just donor milk, so I guess I should be happy about that.

[poorlittlefish]

I love that---not letting perfect be the enemy of good. I need to remember that :)  Anyways, I just wanted to check in with you today and say again, that you are doing a great job for your little guy.  My DD loved nursing, too--it didn't matter that I didn't make enough and that really helped me mentally.  Just that milk isn't the only reason that they nurse.  I wanted to recommend www.bfar.org.  It is a site dedicated to breastfeeding after reduction but also other low supply mama's.  The forums are full of very supportive women's that really helped me through my struggles (not that there aren't supportive women on here, but just another source).

Be gentle with yourself!

[gemasita]

poorlittlefish - thanks for checking in with me today.  I am not having a good day...I think the Reglan finally reared its ugly head and I am getting some depression because of it.  So I am stopping that.  DH is going to stay home from work tomorrow.  I don't know if it's entirely the Reglan or just all of this piling up on me.  I nursed DS today instead of pumping (and gave him bottles afterwards).  I really am at my wits end.  I feel like I have to make a decision about everything all at once but I guess if I nurse him some, I can make a decision about the Lact-Aid later.  It's quite an investment for us.  I need to slow down on this pumping though.  I just don't think I can do it much longer without getting much.

[maryeliz]

I've been thinking about you too gemesita, and I'm sorry you're having a hard day.  Just remember that you are exactly who your baby needs.  He is the baby who was meant for you and your husband and he loves you unconditionally, whether he gets his milk directly from you or from some other device really doesn't matter as much as the fact that you are his mom and you love him.

Tomorrow, can you and your husband carve out some time to do something you have been wanting to do-like getting the cloth diapers ready, or some fun activity.  Here at my house we are still in quarantine with baby, so we have been having dance parties (just us), listening to a lot of music, taking baths, reading books.  I've been trying to make sure that we do at least one thing everyday that is just fun.

[poorlittlefish]

I wanted to add to, that obviously the Lact-Aid or some other such device is ideal, but when I supplemented, I used bottles and my DD never developed a nipple preference.  She loved nursing.  Maybe just spend the day nursing on demand and letting your DH give an ounce or two via bottle when you are done.  When my DH used to do that, I used to feel like I was failing my DD, I would watch him feed her and feel horrible about myself.  I look back on that now and realize how silly it was, but when I was in the thick of it, the feelings were so real.  I hope that you can find peace with this situation and know, like others have said, that you baby just needs YOU. 

[PatioGardener]

Originally Posted by gemasita 

 We haven't done formula yet, just donor milk, so I guess I should be happy about that.

Mama, this is huge! With all these struggles, you have somehow managed to get donor milk for your little one. That is an amazing feat.

I struggled for the first 3 months postpartum. It is a hard, hard time for some women, and some babies. You have been through the wringer, but you are still working hard to figure out what is right for you and baby. That takes huge courage and determination. I am so sorry that you are going through this. And I admire how you are navigating this journey.

[gemasita]

Ladies, thank you all for your kind words.  We are still having a rough time (this depression hit me HARD) but DH is here to help and I think we will spend the day nursing and bottle feeding and put the pump to rest unless I get too engorged.  Hopefully DS will get some milk out though.  I usually only get a small amount out pumping afterwards so I think I can skip that for now.

Yes, he does fine going back and forth from nursing to the bottle so maybe I will wait to make a decision on the Lact-Aid for right now.  I can't handle more big decisions right now.

I really appreciate reading all of the responses and knowing that people out there care.  I really needed to hear that my son just needs his mom and nothing more  And she doesn't even have to be perfect - he doesn't care about that.

[happyhippie]

gemasita,

lots and lots of hugs and love. Mama, you are doing the best you can. Supplementing is fine. Your baby will grow and be nourished and happy. You do not have to choose between your sanity/emotions or nursing. been there done that. It sucks. If something isn't working, move onto the next. This saved my life and my child's.

I never did the sns. After all of the nursing struggles, adding another thing (decision) was just too much for me. I was almost broken mama. Be gentle with yourself. 

After I "let go" of the things I thought I had to do to be a good mom, I became a great mom and I am loving it more and more every day.

You can do both!!!!

[gemasita]

Thank you so much.