low milk supply folks: need your advice, suggestions

[aentwood]

My friend has a 5-day old and has been supplementing with my milk since he was 3-days old. They just had a pedi visit and she wants them to supplement more so I am taking them more milk this evening and they are starting to look for other doners (who live closer and have younger babies).
It seems that she might not have enough glandular tissue and that's why she isn't making enough.

So, my questions to you:
1) what can I say/not say to be supportive? I am afraid I might say something wrong! Like, I don't want to build up her hope for her supply but I also don't want to just write-off her supply, you know?

2) what questions should we ask about milk donation from other people? smoking, drinking, drugs, medication, communicable diseases? anything else?

3) what are some quick suggestions that I can give her. I skimmed a little last night in the low milk supply tribe thread and caught domparidone. Is there anything else? She's using fenugreek.

I hope this all makes sense. I am writing fast b/c I need to make some phone calls to locate some more milk for her. I'm just looking for any advice, opinions, words of support for me to pass along to her. I know she is very sad about not being able to feed her baby and I want to cry for her every time I think about it!

Thanks.
Aubrie

[MarcyC]

I used formula to supplement, so I can't help you there. I had a few offers of donated mik but they were from mamas I didn't know very well and was concerned. Not so much about disease, I guess, but about allergies - peanuts, dairy, soy, etc. I was probably a little too paranoid, but you never know who's out there.

The best thing for her to supplement with is an 'at the breast' supplementer - either an SNS (Medela) or a Lact-Aid. This will be sure the baby does not get nipple confusion (preference, really) and the baby will begin to equate breastfeeding with fullness and contentment. If the baby begins to realize that the breasts to not equal full-ness and contentment and that every "breastfeeding" is followed by a bottlefeeding, the baby may begin to fuss at the breast and fight until he gets a bottle. Babies are very smart!!!

Domperidone is a prescription drug. It's not available easily in the US. It is available in the US if she can get a compounding pharmacy to make it for her. It is available without prescription from several overseas pharmacies. Reglan is more readily available in the US but I've had bad side effects on it :dizzy: . A lot of other people I know have had adverse side effects as well.

As for herbs - there are plenty - Fenugreek, Marshmallow root, Blessed Thistle, Shatavari, geesh...I can't remember them all right now. Check the kellymom web site. At one point I was taking 8 different herbs. I had the 8 bottles all lined up...it was crazy.

Tell her to eat oatmeal, drink oat milk (Pacific Foods Oat Beverage), and eat leafy greens and drink Mother's Milk Tea.

Goat's Rue (herb) is also good for insufficient glandular tissue. And I've heard other people have success on Metformin (prescription drug).

Give her lots of moral support if this doesn't work out for her and introduce her to the concept of "bottle nursing". If she's at her house and it's time to give the baby a bottle, offer her a quiet private room if she wants it, low lighting...whatever you would normally offer a nursing mom. Same as if you're out in public. If the baby is hungry and it's bottle time, see if she's wants to feed wherever/whenever or if she'd like to have the baby alone for awhile.

With a little effort, bonding can take place over a bottle.

[MarcyC]

Oh, I forgot - make sure she knows it's about love love love love love! That breastfeeding is superior nutrition but the baby is going to know mama loves him! No matter what!

Also encourage her to not use bottle feeding as an excuse to leave the baby or let someone else feed the baby. If it's feeding time, it's mama time!!!

[TurboClaudia]

Aubrie:

I saw your post on the breastfeeding forum a few days ago also.

going to answer #2 & #3 first:

#2) personally, i would be most concerned with the smoking, regular drinking (a glass of wine or a beer once or twice a week would be fine with me), any pharmaceutical medications or recreational drugs, hepatitis a, b or c, any type of herpes, and other communicable diseases (can't think of any specific names). i would also ask them casually about their eating habits (for example, where they do their grocery shopping might tell you about their food intake, i.e. a natural grocery or health food store versus a larger grocery store, or asking them how they are managing making lunches and dinners with a baby around while sharing it was so hard for you to do that).

#3) oh geez, there are so many, and from my experience and meeting other moms, different things work differently for different people. has her milk come in yet? some mamas with early low supply simply have late and slow to come in milk production, while others do have true low supply. it's hard to tell which it is for her.

www.mobimotherhood.org is a great first stop for info. MOBI stands for Mothers Overcoming Breastfeeding Issues. they have brief info about herbs and foods that are milk-promoting.

the things that come to mind as first steps are fenugreek (for building supply), fennel, blessed thistle (both for improving milk ejection reflex/ letdown), goat's rue (for building breast tissue and supply). there are certain foods that are lactogenic, most notably oatmeal because of its high content of inositol, a sugar molecule that is a building block for milk production. it doesn't have to be a bowl of oatmeal, either; it can be oatmeal cookies, oatmeal snack bars, oatmeal whatever. whole grain oatmeal like steel cut oats or scottish oatmeal seem to be better, but rolled oats are okay, too. instant oats would be a last and not as acceptable choice since they are very processed.

if she has any food sensitivities or allergies herself, tell her to avoid those foods as completely as possible.

and now back to #1...

if you don't know what to say, tell her that. tell her that you want to be supportive of what she wants and needs and that you will help her get the information she needs as much as possible.

tell her to take each day one at a time. it's overwhelming to think of needing to try all these tricks and supplementing your child's intake for a long period of time, and it's really okay if she decides along the way that it's not working for her family. she may decide that she is really committed to this and she is willing to go for a long time, but there will undoubtedly be days where she feels like giving it all up. she may decide that at a certain point she can't imagine going on anymore with their current routine because it is affecting her enjoyment of her baby and her family. my personal strategy for making decisions was this: if i really felt like i couldn't go on with our routine, i would agree with myself to give it one more day and see how i felt about it the next day. i would usually have a better day the next day and the feeling would be transient. when the feelings lasted more than a day, i would have a good cry, talk to my partner, talk to my good friends who knew of my struggle, talk to my mom, simply allow myself to feel whatever i needed to. for me, i made it through to the point where we stopped supplementing our son at age 9.5 months because of a huge increase in his interest and ability to eat more solids. our son continue nursing until he decided he was done at age 18.5 months. i was amazed when we reached one year, and every day after that was a bonus.

i know you are on the east coast, but if you think it would help, i would be happy to talk with you or your friend via phone, my dime. it is so much easier to communicate lots of information in a shorter amount of time and we can be responsive to each other's questions and conversation.

the one thing i would really recommend your friend look into at this point is an at-breast supplementer like a Supplemental Nursing System (SNS) by Medela or the Lact-Aid. it is an extra step in preparation for feeding, but with her commitment to giving her baby mama's milk, it would preserve their breastfeeding relationship by giving baby much needed calories and stimulating her breasts by baby latching on. a lactation consultant knowledgable with at-breast supplementers would be worth the searching.

big hugs to you for being such a wonderful friend and supporting her in the ways she needs... :hug

oh, and i just remembered about your question about a mama donating milk who has an older baby. there isn't much research done on donated milk, but the anecdotal stuff that is out there shows that many babies receiving donated milk from an older baby may hit some developmental and physical milestones earlier than other babies, i.e. they may get teeth in sooner, they may learn to roll over sooner, desire solid food earlier. it doesn't appear to work conversely, meaning babies getting donated milk from mamas with younger babies don't show regression or delay.

~claudia