low supply...I feel like there is nothing left to try!

[sanguine_speed]

I've had a lot of trouble so far with breastfeeding...preemie who was bottlefed in NICU, latch problems, pyloric stenosis, mastitis, thrush, preemie stuff...now low supply. I've never been able to exclusively breastfeed. This time, I've tried harder than ever to be able to do so and it seems like there is always another problem. Now, we're at low supply. I keep trying to catch up with baby, but I'm not getting anywhere, In fact, I've just realized that he's wanting and needing MORE food as he's growing--and my supply is staying the same. So now instead of getting 20% formula, he's getting more as his need for calories increases. It's obviously still worth trying since he's getting at least half breast milk, but I really want to ditch the formula and bottle (and pumping constantly) routine.

Here is what I'm doing now to increase supply (with no success):
-Domperidone, now at 90mg/day
-Blessed Thistle and Fenugreek (2 caps, 3 times a day)
-oatmeal
-water to thirst
-breastfeeding until baby pulls of in frustration as I'm "empty" (yes, I know, producing more but it's coming far too slow at that point)
-pumping after every feed, getting less than a 1/4 oz as baby has emptied. This is pumping for 15-20 minutes after every feed.
(meanwhile, baby is having 2-4 ounces of formula after every feed)
-baby is sleeping 4-6 hours at night, so I get up in between feeds at night to have an additional empty (I pump) in the hopes of increasing supply.

What more to do?

I think that as his requirements increase, the percentage of formula he gets will increase. I can't seem to produce more milk than currently. I know it shouldn't matter necessarily, but my breasts did not change in size or shape during pregnancy or breastfeeding. I'm starting to wonder about glandular insufficiency. Someone here mentioned thyroid having an impact. Can anyone tell me more about this?

I keep holding on thinking it will get better but I'm losing hope.

[pinky]

One thing that occurs to me...how is he getting the formula supplement? In a bottle? Since you have supply issues, I would definitely be supplementing at the breast using an SNS if you can...maybe you've already been down that road, but I thought it was worth mentioning.

Sometimes when a baby is supplemented with a bottle after nursing, he knows that quickly flowing milk is coming, and gives up at the breast once the milk slows down...I know you're not getting much pumping, but the baby is much more efficient and could still be getting more.

Either way, more time at the breast is the an important part of building up your supply, which I'm sure you already know.

And just to be sure...you're using hospital-grade double electric pump, yes?

Here's a LLL link on milk supply. I'm sure you already know lots of the info here, but thought I'd include it in case there was new info of use to you; if you scroll down, there is an article on thyroid issues and milk supply.
http://www.llli.org/NB/NBmilksupplyissues.html

Good luck to you, and hang in there!

[sanguine_speed]

Thanks for your reply. Yes, he is getting a bottle. Though, we did work with a LC to learn how to do this the 'best' possible way....with a medela nipple, baby upright, etc. We did try a SNS but found it very awkward and difficult.
I'm fairly certain that my breasts have emptied when I'm pumping so little...I have pumped in the past without nursing (baby was in the hospital and not allowed to eat for a couple days) and was able to pump a few ounces at a time (i.e. I have had lots of success responding to a pump).

I really cannot get him to suckle longer than he already is. He is still very hungry at this point and I know that if I did not supplement with formula he would dehydrate and lose weight quickly.

I think I will ask my doctor to do a thyroid check as a last resort. Beyond that, I'm not sure what I'll do. I have seen lactation consultants in the past, and they're been sorta helpful in various ways (ds ended up with pyloric stenosis which explained why he wouldn't eat even though he was hungry and the LC's couldn't have known that). But, they cost $60 per consultation and I'm not sure whether they'd be helpful. I suppose it's worth another shot. Maybe his latch could be improved to maximize efficiency of milk extraction, though I do think his latch is fine. In fact, he empties pretty quickly with strong sucks and frequent swallows when there is milk to be had.

[Annie37]

I really don't have any advice to offer,as it seems you have done your homework & are already doing all you can. Sounds like you & your sweet little one sure have been through a lot already! Best of luck & to you both!

[Tofu the Geek]

Is there anyway you'd be willing to give a SNS another shot? It just seems that bottles tend to be a downward spiral, especially if babe is being satisified with the bottle. My friend's babe eventually gave up at the breast because it was simply too much work for her, since she was so used to the bottle. Then mom's supply kept dropping since babe wouldn't breastfeed, and that there was the end of their nursing relationship.

I wonder if you could point out the specific issues you had with the SNS and maybe other mamas who have used one, could see if they could help resolve the issues? Also, I think there is another alternative similar to an SNS, but slightly different, that others have had success with. Can anyone here help me with the name of that system?

[Tofu the Geek]

Originally Posted by sanguine_speed

-water to thirst

Mama, I am not sure what you mean by this line? So, forgive me if I am misreading, but if you are waiting until you are thirsty to drink, your body is already on its way to being dehydrated. A good rule is to drink 1 litre (I think that's around 32oz) of water for every 50 pounds of body weight. And if you can, make sure it is purified water (like distilled or reverse osmosis). You'll find water without fluoride, chlorine, etc. is easier to drink lots of, and easier for your body to use and process.

How many meals are you eating per day? I find that my milk supply drops if I am not eating enough or if I am spacing out my meals too much. I need to continually snack. Maybe this is something you could try?

[sanguine_speed]

Originally Posted by TechnoGranola

Mama, I am not sure what you mean by this line? So, forgive me if I am misreading, but if you are waiting until you are thirsty to drink, your body is already on its way to being dehydrated. A good rule is to drink 1 litre (I think that's around 32oz) of water for every 50 pounds of body weight. And if you can, make sure it is purified water (like distilled or reverse osmosis). You'll find water without fluoride, chlorine, etc. is easier to drink lots of, and easier for your body to use and process.

How many meals are you eating per day? I find that my milk supply drops if I am not eating enough or if I am spacing out my meals too much. I need to continually snack. Maybe this is something you could try?

What I mean by "to thirst" is that i don't over-drink. It's actually possible to drink too much water. I drink about 2L a day give or take. That's in addition to some fruit juice and tea. I am definitely eating enough. I'm so conscientious about this that I sometimes overeat and I have gained weight since having the baby.

[sanguine_speed]

Originally Posted by TechnoGranola

Is there anyway you'd be willing to give a SNS another shot? It just seems that bottles tend to be a downward spiral, especially if babe is being satisified with the bottle. My friend's babe eventually gave up at the breast because it was simply too much work for her, since she was so used to the bottle. Then mom's supply kept dropping since babe wouldn't breastfeed, and that there was the end of their nursing relationship.

I wonder if you could point out the specific issues you had with the SNS and maybe other mamas who have used one, could see if they could help resolve the issues? Also, I think there is another alternative similar to an SNS, but slightly different, that others have had success with. Can anyone here help me with the name of that system?

I do know what you're talking about...it's the Lact-Aid system which has softer tubing.

I'm not having a problem with the baby nursing until empty. There's no sign of him refusing the breast until the point of not getting more milk.

I will try the thyroid check then consider trying a SNS or Lact-Aid again.

[Tofu the Geek]

Originally Posted by sanguine_speed

What I mean by "to thirst" is that i don't over-drink. It's actually possible to drink too much water. I drink about 2L a day give or take. I am definitely eating enough. I'm so conscientious about this that I sometimes overeat and I have gained weight since having the baby.

Okay, it sounds like you drinking enough and eating enough then. My only real suggestion then is to see what you can do about getting rid of any artificial nipples for babe.

This is likely a dumb question, but are you giving babe a pacifier?

Wait, wait, one more suggestion, if you're not co-sleeping, start now! Babies love to suckle at night and this could help stimulate your supply.

[studentmama]

How old is your baby?

How frequently are you nursing in a day?

How long is a nursing session?

Does your baby nurse at both breast in a session? Or just one? Do you switch sides for the next session?

How frequently are you supplementing during any given day? Are you always using a bottle when you supplement? Are you supplementing after a nursing session or in between?

Where is your baby sleeping at night?

[Tofu the Geek]

YES, it was Lact-Aid! I am sooo glad you knew what it was! I wish I had used either and could offer you some tips! Some here has to have used one and could address the issues you had!

[sanguine_speed]

Originally Posted by studentmama

How old is your baby?

How frequently are you nursing in a day?

How long is a nursing session?

Does your baby nurse at both breast in a session? Or just one? Do you switch sides for the next session?

How frequently are you supplementing during any given day? Are you always using a bottle when you supplement? Are you supplementing after a nursing session or in between?

Where is your baby sleeping at night?

Nursing at least 8 times a day, trying more often.
Long as baby will nurse. I do not artificially stop a feed.
Yes, always try both breasts, then try again.
Supplementing after every feed as he's very obviously still hungry and does take another 2-4 ounces with lots of breaks and burping.
Supplementing only immediately after nursing, then pumping every time.
Sleeps with DP; I cannot sleep with baby next to me--I've had lifelong sleeping problems, having gone so far as to have extensive testing to try to treat it. I wish this was an option for us. For now, I set my alarm and get up in between feeds to pump.

[Breastfeeding Insomniac]

Do you have any endocrine problems? Sometimes a woman w/ thyroid issues or pcos can have a low supply. PCOS is often misdiagnosed, Drs will often overlook the symptoms and just address the weight issue.

Not all women with PCOS share the same symptoms. These are some of the symptoms of PCOS:

infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
fertility issues
increased hair growth on the face, chest, stomach, back, thumbs, or toes
ovarian cysts
acne, oily skin, or dandruff
weight gain or obesity, usually carrying extra weight around the waist
insulin resistance or type 2 diabetes
high cholesterol
high blood pressure
male-pattern baldness or thinning hair


In the event this is the issue, you need to see an MD, ask about a prescript for Metformin, you can also look into taking goats rue to increase the supply.

Does any of this apply to you?

Also this is another way to supplement at the breast, which may seem a little easier then an SNS:

http://www.drjacknewman.com/anthony/...tion%20aid.wmv

[movinmomma]

I don't have any advice other than things will work out. I had to pump for two months before my dd reached 6 lbs. and was able to exclusively bfd. (She was born at 31 weeks (emergency c) and was in the NICU for a month). Even though she could take from me, my supply seemed low since she was still hungry after nursing. So, I supplemented with formula and was concerned she would gravitate toward a bottle which was easier for her (no latch problems). Supplemented with fenugreek, which seemed to work for a while. Talked with a number of LC's at the hospital. Didn't know what else to try (pull my hair out?). Eventually, she was exclusively bfing and I no longer needed to supplement with formula. She bfd for two years! (I weaned her since we wanted another child and I didn't know about tandem nursing!).

Keep it up, you're doing a fantastic job.

Karen

[sanguine_speed]

I was hoping there was some magic answer, but I think the bottom line is that I need to have my thyroid checked then meet with another lactation professional (certified LC) to address my specific problems. It's just not some general answer like on a website: pump after feeding, drink more, offer both sides, etc...all the standards that are supposed to help. Not even supplements or Domperidone. There is something a little more complex going on and I think I've just accepted that I will need more professional assistance. So far I do feel like I've done all that I can, and if I continue to do all that I can and nothing improves, there will come a time when I have to accept that supplementation is part of our lives. It's been over two months of constant struggle at the expense of so much ($$$, time and energy for other kids, enjoyment of babe, relationship with DP, etc).

[sanguine_speed]

I wonder if I could visit Dr. Newman? I live in his province and would be willing to travel. Does he still run a clinic? My doctor did phone him once about my case, so I guess he's still practicing, at least for doctors to phone.

[studentmama]

Originally Posted by sanguine_speed

I wonder if I could visit Dr. Newman? I live in his province and would be willing to travel. Does he still run a clinic? My doctor did phone him once about my case, so I guess he's still practicing, at least for doctors to phone.

I think that is an excellent idea!

[Tofu the Geek]

Originally Posted by Blondimom728

Also this is another way to supplement at the breast, which may seem a little easier then an SNS:

http://www.drjacknewman.com/anthony/...tion%20aid.wmv

Wow, that was the CUTEST video I have ever seen! It made me cry, the sounds of the baby suckling and little mouth moving, just beautiful!

So, my question is, how is this different from an SNS? It kind of looks the same as an SNS system to me, except that the tubes aren't taped to the breasts like I've usually seen.

[Tofu the Geek]

So, they charge for lactation consultants in Ontario? I saw lactation consultants in Alberta and was never charged. My doctor's office had lactation consultants working there so if you and your doc thought you needed to see one, you just scheduled an appointment and that was it.

[studentmama]

Originally Posted by sanguine_speed

Nursing at least 8 times a day, trying more often.
Long as baby will nurse. I do not artificially stop a feed.
Yes, always try both breasts, then try again.
Supplementing after every feed as he's very obviously still hungry and does take another 2-4 ounces with lots of breaks and burping.
Supplementing only immediately after nursing, then pumping every time.
Sleeps with DP; I cannot sleep with baby next to me--I've had lifelong sleeping problems, having gone so far as to have extensive testing to try to treat it. I wish this was an option for us. For now, I set my alarm and get up in between feeds to pump.

How old is your baby?

How long does you babe typically nurse?

Let's say you nurse on one side, switch and nurse, and switch again, do you feel another letdown? What happens when you try to keep switching? Does babe just get really frustrated?
Have you tried breast compressions towards the end when it doesn't seem to be flowing as fast?

When you say you are trying more often, is your babe fussing and whants the bottle? Or just something else?

At night are you in the same room as babe? Or another?