Help increasing milk supply

[clairebear3]

Could anyone give me some tips on how to increase my milk supply?

I delivered my daughter via c-section on 30/4/11, she seemed to take to breast feeding quite well from the beginning and starting gaining weight again before we left the hospital.  About a week later though she seemed to be constantly hungry and I was feeding her a half hour after stopping, she would also never sleep in between feeds.  She was fairly lazy at the breast and never did that deep drinking for more than a few minutes.  Then it turned out that she was barely gaining weight, 10gm in 3 days, panic!  It seems that she just couldn't suck the milk out of me and I had to start introducing formula and pumping my milk.

I am drinking 2-3 cups of breastfeeding tea per day and my midwife suggested I take Motilium, 3 tablets for three days, 2 tablets for three days and then 1 tablet for three days.  She said you could only do this once although if I look online people seem to be taking it for much longer.  She feeds every three hours so I gave her formula a couple of times so I could get a supply of milk stocked up and now I probably give her one formula bottle each day and the rest is my milk.  I pump after I feed her each time but I only get about 65ml and she needs 90ml.  Should I pump for longer or more often?  When should I stop because although it's not squirting out after a while it seems to slowly drip indefinitely.  When one breast is empty I switch to the other side the empty breast still drips.  I am wearing little silicon cups because I leak a fair amount and I want to save every drip!

Ideally I would love to breast feed 'normally' again because I really miss it, I have the feeling that I barely hold her at the moment but even if I have enough milk I don't think she sucks strongly enough to drink it and then the whole vicious cycle will start again.  I'm really glad I can pump what I can but there will probably be some situations where it will be difficult (family wedding soon etc), maybe then I can breast feed her and take an extra bottle so she has enough, it must be better for her to drain my boobs a little if I have to skip one pumping session right?  If anyone can advise me on the best way to pump that would be great, I've only been going for about three days, glad my husband can sleep through the noise at night!

I have a single machine that we rented from the health insurance from Ameda that you can adjust the sucking strength and the rhythm on.  Should I be aiming to set it all the way to maximum?  Anyone sure how long I should take the Motilium?  Any advice would be really great I burst into tears when told that she wasn't gaining weight and would have to have formula but I'm feeling a lot more pro-active now that she can still drink a lot of my milk :)

[rnra]

1) Double pumps work a lot better than single pumps.  Any chance you can get a double pump?

2) Are you doing a lot of skin to skin?  It can really help your milk supply.  If you're not, block out all other activities for a few days and keep baby on your chest all day long.  Baby should be only wearing a diaper and you should not have anything on your top half.  It's a good time to hang out in bed and watch reruns of Downton Abbey.  When you need to be up to make meals and such, use a wrap or blanket to wrap baby against your skin while you're standing up.

[clairebear3]

The pump I have can be used as a double pump if I get another set to go with it.  Do you think it would really help?  How do you actually manage it without three hands!  One to hold each pump on and then manage the controls...

We have a lot of free time this week in the afternoons and evenings so I think we will take to bed early and lay skin on skin.  If I pump before feeding her instead of after we can have a good 2 3/4 hrs like that together, i'm looking forward to the rest already!

Another problem I have is with the bottle feeding.  I bought Tommy Tippee bottles with the slowest teet possible but everytime I have fed her she has choked on the milk and I mean CHOKED, scariest thing I ever saw, she couldn't get her breath and I thought we would have to call an ambulance, it makes me dread giving the bottle.  This morning it went a little better, I let her take four sips then hook my finger in her mouth to break the vacuum and take the bottle out for a few seconds, it was the most awful thing to see, total panic!

Thanks for your advice :)
 

[LilMomma83]

Have you had your baby assessed for a tongue tie - including the hard to diagnose POSTERIOR tongue tie?

My DD seemed to have a "poor suck" and did not empty my breasts, lost weight for several weeks and also had tramendous dificulty with the bottle... a lot of times babies with tongue tie choke/having swallowing disorders, and do not transfer milk well. This sends off an alarm to me. Do you have any pain while nursing? Are your nipples round or kind of flattened when they come out of baby's mouth?

Playtex drop ins with a laytex nipple are slow, Dr. Brown's has a slow preemie nipple, we used wide mouth Nuk nipples...slow, but hard for her to suck from.

A double pump will help...it takes practice. If you are trying to increase supply, pump for several minutes after the milk stops flowing. You can also masssage and hand express.

I took 90mg of domperidone for a couple months, then upped it to 180mg for a few weeks, then got my DD's tongue tie clipped and I am successfully weaning off of it so far.

[rnra]

What position are you holding her in while bottle feeding?  Side-lying is a great position for babies who are just getting used to a bottle.  It allows the milk to flow into their cheek and then they swallow--rather than just going straight down their throat and choking them.  Here's a YouTube video that demonstrates the position:

http://www.youtube.com/watch?v=Bl_hNk3NoC4

[clairebear3]

I had never heard of tongue tie until I just googled it and now I really think this might be the problem.  If I pull her top lip back you can see the flap of skin attaches to the lowest point of the gum and then runs through to the roof of the mouth.  We have an appointment with the pediatrician in the morning so i'm going to ask her about it, hope she takes me seriously...  even when I nursed her practically all day I never had any nipple pain, strange eh?  If she's sucking hard and I pull my nipple out it looks kind of flatted with a line on it like a new lip-stick, not sure if that's normal or not.

I googled Tommy Tippee and choking and it seems that a lot of other people have had problems with these bottles so on Saturday we are going to look for some others, the midwife recommended Avent, I think they are 'normal' shaped bottles not breast shaped.  I don't get my second set for the pump until Friday but I worked out that I can wedge the funnel inside my nursing bra and don't need my hands so it should go really well with a double pump

I have 10mg of doperamide tablets and I just started taking them again three times a day, sounds like I can up that a bit, I might have to buy them at different pharmacists each time so they don't wonder why i'm so nauseous!

I was holding her perpendicular from me, on her back on my knees supporting her head.  When I watched that video it made so much sense to me it was like a light bulb going off that I should feed her in a similar position to breastfeeding but along my knees.  I tried it and it went so well!  No choking and if I felt like she was drinking to quickly I just angled the bottle down so that the tip would fill with air.  A LOT did leak out of the side of her mouth though, like she didn't have her lips around it tight enough.  I think they're just bad bottles, it's so hard to get the last drips out without pushing it against her nose or holding it vertically.

She had put on a huge amount of weight at the last weigh in 180g in three days so we're all a bit happier.  I still have to give her two bottles of formula a day but at least she's getting the rest from me.  The midwife suggested to breastfeed for one of the night feeds and let her fall asleep with us in the bed, this way I won't have to pump (would be great to get some more sleep) for one feed and because i'm feeding on demand again there is about 4hrs between night feeds and then I usually have about 90ml of milk, she should be satisfied enough to sleep.  If she wakes up earlier again to feed so be it!

Thanks so much for you advice ladies!
 

[rnra]

I'm glad the side-lying position helped with the bottle feeding.  It really does seem to work well for most infants.

It's normal to have a little dribbling, but she shouldn't be having tons.  You may need to help "pace" her.  That would involve tipping the bottle down more frequently so that she can establish a suck--swallow--breathe pattern.  One way to do this is to start off with three sucks.  Let her suck three times, then tip the bottle down, wait for her to swallow, and then angle it back up.  She'll eventually learn how to pace herself, but sometimes they need a little help at first.  You'll also need to figure how many sucks she does before she needs to swallow--I've seen it be anywhere from one to five sucks.

Having her evaluated for a tongue tie will be beneficial too.  Good luck.  

[LilMomma83]

That's great she is gaining weight!

The lipstick like nipple means baby's latch is too shallow...this often happens from tongue tie. Sometiems moms don't have any pain until their baby gets teeth.

[clairebear3]

Just to update, we went to the health visitor last week and our DD is now 3,760kg (birth weight 3,200kg) and she was just a month old.  She was a tiny bit under the curve but the doc said as long as she keeps gaining it doesn't matter if she's a bit under (she was still in the safe grey zone).  She also grew 4cm in 4 weeks which is way above the curve!

At the moment i'm supplementing with two formula bottles a day because I still don't have enough milk.  The pediatrician suggested offering bottles of 150ml and she drinks them straight down!  She drinks 150ml about 6 times a day (minus the 10ml or so that runs down her chin each time :) )

I have tried twice this week to BF her again, she took my nipple which was great but she quickly got frustrated and acted like there wasn't any milk left, pulling away with the nipple in her mouth or playing with it and whimpering, if I squeeze milk still comes out though.  I think my flow is just too slow for her because she's also really greedy when drinking the bottle.  When I have time I'm going to let her breastfeed, followed by a bottle, followed by pumping just because I really miss it.

My absolute goal now is to try and increase my supply, I'm drinking breastfeeding tea 3 times per day, plus one cup of fenugriek and 80mg of dom per day.  I dream of being able to start a freezer stash so that when I stop Bfeeding she could continue for a month of so, my husband has coeliacs disease so it's important to me that she bfeeds as long as poss to minimize her chance of getting it.

The pediatrician said she didn't have a lip tie, or rather 'no this isn't a problem', she didn't look under her tongue but let her suck on her finger and said she sucked really well...

I'm trying to pump as often as poss but it is tricky because sometimes during the day she won't sleep on her own during feeds and constantly needs to be held or have the dummie!

Thanks again for your help!
 

[PatioGardener]

Originally Posted by clairebear3 

The pediatrician said she didn't have a lip tie, or rather 'no this isn't a problem', she didn't look under her tongue but let her suck on her finger and said she sucked really well...

Sadly most pediatricians don't know about lip or tongue-ties, and have no idea how they can impact breastfeeding. I'm sorry she brushed you off without at least recommending someone who does know about them!

[clairebear3]

Yeah I had that feeling too, as long as she's gaining weight that's all their interested in, not how or why...

Sometimes I wonder if my problems all go back to the first week in hospital.  They make you wake the baby every three hours regardless.  Our daughter lost weight in the beginning but stayed within the 10% range and started to gain weight before we left.  I would have to wake her up and try to feed a really sleepy baby, who would then fall asleep at the breast, feed her for 40 min and then lay her back to sleep, obviously she hadn't drank enough and would wake up shortly afterwards, eventually I think she was just too exhausted from lack of sleep to have the energy to drink properly.  One morning we were all still asleep and it had been 3 1/2 hrs between feeds.  I thought I will let her wake up by herself when she's hungry and then she'll be really awake and have a good appetite, no chance, the nurse came in and removed all of her blankets to wake her up.  If i'd had more experience I probably would of stood my ground but when you don't know anything you just listen to the advice you're given...
 

[LilMomma83]

Could be possible I suppose, but, if it makes you feel any better, we let my tongue tied baby sleep because our doctor said she would wake when she was hungry....she would never wake...EVER. She lost a lot of weight and I think her energy went way down from not feeding enough...it got worse to the point we really couldn't wake her and did not improve until after we started supplimenting to get a little milk back into her. So it may have actually been good your baby was awakened often :-)

[Asiago]

Congrats on the birth of your baby!

I second what others have written, try to get an exam from someone, apart from your ped, to check for tongue tie. If all is well, it may just be that you and baby need to work on the shallow latch. Once you correct the latch, baby can efficiently tranfer milk into her body, and that will increase your milk supply. If you google shallow latch, Kellymom and Jack Newman have good info and you'll also find video tutorials.

Also, I would suggest to offer the breast as often as possible. Several times an hour is actually quite normal in societies where babies nurse at will and are kept on mother's body. Keeping baby with you, on your body in a sling or carrier and sleeping with her, should increase the frequency of feeds. Even if baby appears sleepy but is on your body in a carrier (or in arms) having her near your bare breast and gently bouncing or moving around should help her latch on.

The motion and being close to the breast seems to help babies latch on.

Best wishes.

Edited by Asiago - 6/6/12 at 2:44pm

[bigmommylove]

Definitely see if you can get a double pump. Ask the doctor, you might be able to get your insurance company to cover the cost of a rental.

Keep on with the herbs. They really make a difference, but you need to use them daily. I'm drinking a breastfeeding tea called Breastea from www.breastea.com and it has honestly made a big difference in how much I'm pumping. Keep taking a prenatal vitamin, eat well, and don't skip any pumpings! Even overnight.
 

[rnra]

Originally Posted by PatioGardener 

Sadly most pediatricians don't know about lip or tongue-ties, and have no idea how they can impact breastfeeding. I'm sorry she brushed you off without at least recommending someone who does know about them!

Yes, most pediatricians do know about tongue ties!  At least, the 30+ pediatricians I work with all do.  Their degree of concern/involvement with tongue ties varies, but they all are quite familiar with them.

[clairebear3]

Thanks for all your support, i'm really grateful!

Here's what i'm doing at the mo...

80mg dom per day

3 Cups breastfeeding tea, 1 cup fenugriek, 1 glass low alcohol dark beer per day

Still taking my ante-natal vits

Exclusively pumping with a double pump and supplementing

Last time we were at the docs she suggested offering bottles of 150ml to see how much she drinks, she now drinks 150ml 6 times a day.  I'm pumping 6 times a day and get between 550-680ml each day.

The last time I tried breastfeeding it went like this...

11.45 gave 150ml of my pumped milk, no pumping after feeding so I would have enough milk, 15.30 breastfed for 1 hour, 16.40 she wasn't content so offered bottle, she drank 60ml, 16.50 I pumped 55ml.  Sometimes she would drink well but she would keep pulling away from the nipple in frustration and banging her head against me.  Maybe because she has been bottle fed and has a pacifier for a few weeks?

I told the midwife that the doc had checked for lip tie but not visually checked for tongue tie (just put her finger in he mouth) and she said 'yeah but that's not the problem with you', I asked if her lips should both be curled outwards when she latches and she said again 'that's not YOUR problem' so what is my blinking problem!  I said that I didn't think she had enough areola in her mouth and she said that I had fairly big nipples and if I put anymore in it would choke her...I still don't know why I had this problem to start with, in the hospital she started to gain weigh, it just went wrong when we got home.  She did suggest that I breastfeed for the night feed because the pumping at night was exhausting me and taking so long.  She said to not even change her nappy (I change her every time before I feed her, at night she only pee's though) not to turn the light on and breast feed her and not pump after wards, but to continue doing like I am during the day.  I may start this on Monday.  I have just fed her at 14.15 and not pumped after wards and i'm going to give it another go.

Here's how her weight gain has gone...

Day 0 (30/4), 3200kg, day 1 3040kg, day 2 2940kg, day 3 2930kg, day 4 2980kg, day 5 2990kg

7/5 3010kg

9/5 3060kg

11/5 3120kg

14/5 3130kg

15/5 3230kg

18/5 3250kg

21/5 3440kg

24/5 3450kg

29/5 3790kg

7/6 4190kg

I googled the dutch word for tongue tie (i'm in Belgium) and it bought me to the LLL site with a list of docs who clip tongue tie's and there is one in my hosp!  I'm going to make an appointment to have her checked out, will be difficult though because his office is next to my normal docs!  If she doesn't have it I will ask someone from LLL to come and access how she's latching, apart from this I don't think there is anything else I can do, i'm supplementing with 2 150ml bottles a day but it would be so much easier if she could drink the milk I do have from the breast even if I still have to supplement.  I also don't know how to transition her back from feeding 6 times a day which isn't very much for a 5 week old.  My number one fear (apart from the doc telling me off if she doesn't gain weight!)  is that my milk will back off again because I def have more than when I first started to pump.

Sorry for the mega long post!!
 

[LilMomma83]

IT sounds like you are working really hard! Here is an article on reducing suppliment: http://kellymom.com/bf/got-milk/basics/decrease-formula/ of course you only should do so as long as baby is still gaining/peeing/pooing! I'm having trouble figuring out the conversion, so I can't tell if your LO is gainign well or not - sorry!

Awesome that you have a skilled tongue tie professional near you! Hopefully you can get some answers and help, it is so hard to pump and feed and suppliment, way to go sticking with it!

[clairebear3]

Thanks!   Yeah it does feel like I have a new full-time job!  My husband has coeliacs disease so it's really important to me that I try to give her as much breast milk for as long as possible.  I'm really determined (at the moment :) ) and a bit of a control freak so i'm giving it all i've got!

Good weekend ladies!
 

[PatioGardener]

Originally Posted by rnra 

Yes, most pediatricians do know about tongue ties!  At least, the 30+ pediatricians I work with all do.  Their degree of concern/involvement with tongue ties varies, but they all are quite familiar with them.

I should have been more explicit - many pedatricians don't know how tongue and lip ties impact breastfeeding. I've also found that posterior tongue-ties are often not diagnosed or the implications to breastfeeding not understood. Interestingly, I've had better luck with dentists than pediatricians getting tongue and lip-ties evaluated for breastfeeding issues.

[AndreaOlson]

The weight gain is a good sign! :) 

Based from your post, it looks like you're doing everything that should help with increasing your milk supply. Babies are really much more efficient at getting milk than a pump, so direct feeding will really help your milk production.

One thing that I sense though is that breastfeeding has somewhat become a bit stressful for you and your little one. From experience, I found that when I'm stressed, milk does not flow well. If I pump and I'm in that mental state where I'm thinking "I have to get X ounces in this bottle," the milk does not come. 

I hope that the doctor's appointment for the tongue tie will be okay, and remember, try to rest and relax, and hopefully, that would help a bit.