Combination feeding - sudden fall-off of supply at 4 months

[sycamore54321]

I've been breastfeeding and also supplementing with bottles since I was hospitalised with complicatio s four weeks after the birth. I never put in the work to reestablish exclusive breastfeeding after I was released fro hospital and was happy to supplement like this; it was working for both of us. I recent months, we had settled into a pattern where my baby would take four or five breastfeeds a day, and be supplemented by a bottle feed after most of them. Plenty of eet and dirty nappies, sleeping great, etc so all was well. Inthe last two weeks, since the Christmas madness really, my baby has become much morereluctant to breastfeed during the day, eeven though I evidently had lots of milk for him. He was then down to about three good breastfeeds a day, night time, morning and one other during the day, plus another one if he woke during the night. This worked fine for a fortnight or so and now my milk supply has almost completely plummeted. I am doing all the things they suggest - porridge, pumping multiple times a day, etc. But I feel as though there is now virtually no milk for him. I would love to continue some level of breastfeeding, at least until winter cold/flu season has passed - has anyone any ideas for me? Thanks so much.

[VeryPunny]

There is a massive growth spurt around 4 months, so your DC may just be hungry. Why do you feel your supply has dried up? Nice to see another combi feeder :-)

[sycamore54321]

Thanks for your reply. This past ten days or so, my breasts feel constantly soft and empty - I hadn't been having that massively engorged feeling since the early days but if I touched my breasts a couple of hours after a feed, they definitely felt heavier, more solid and full or semi-full. This has completely gone.

I should have specified my son is 4 months and three weeks. I think we had the growth spurt bang on the four month mark and so I don't think it is this, but I could be mistaken or it vould be an additional spurt. But even so, I'm not sure what to do about it. My baby seems to sense when there isn't a lot of milk there for him and will have almost no interest in suckling, even for a short time when I'm 'empty'.

Also, has anyone any tips for increasing skin-to-skin time? My baby has an independent streak and doesn't like masses of cuddles, plus my creaky old house is pretty hard to heat so it can be hard to keep him warm! Am I missing some great tips on how to get some more skin to skin time in in the midst of winter with an Atlantic wind rattling the windows?

[RedToothBrush]

syacamore, DS is EBF but via bottle and breast. I had a lot of problems breastfeeding so for the most part he is still feed mainly by expressed milk. This gives me a bit of a different view point than most as I'm able to see how much breastmilk I a) produce b) DS is eating, a lot more easily than someone who breastfeeds or combination feeds.

DS is 19 weeks so about a week younger than your son I think.

Since Christmas, there has definitely been a change in the pattern of his feeding. He has become very fussy about bottle and breast, preferring one over the other and then changing back. Its very difficult. He has also become a lot more hungry and is eating more. Perseverance and patience seem to be the order of the day.

Your breasts feeling 'empty' do not mean there is less milk in them though. It means the milk is a different consistency. I've had the same thing re engorgement, and although DS is breastfeeding more than he was, and I'm less engorged I'm expressing MORE milk. It sounds counter intuitive but actually less engorged breasts means the milk is higher in fat/calorie content (and they don't necessarily need as much). Equally, if he breastfeeds there is ALWAYS milk there. It just means that the speed of production is different. A sure way to test if you have milk is simply to hand express. If you have no issues with milk coming from hand expressing then you have no issues with supply. If you are managing to express a few times a day, I strongly suspect you are still producing milk.

If your son has a preference for bottle over boob, I would suggest looking at the flow of the bottles you are using first. One reason he may prefer a bottle is if he's lazy and he gets formula more quickly as the bottles are fast flow. Try changing to a slower teat.

As for growth spurt, DS grew a bit a couple of weeks back. He noticeably seems to have grown over the weekend too though.

[NickyEds]

It may be that a better measure of your supply and how much bm your ds is having to look at how much f he's taking? If he's still only taking small top ups he may just be becoming more efficient at bf but if he's taking more he could be displaying a preference for bottles.
As for increasing skin to skin, can you get a bath together? Bathrooms are generally smaller so easier to get warm and you can mix playing with cuddles/skin to skin. Whilst I think it's lovely I'm not sure how much use skin to skin will be at this stage. It's demand that fuels supply. But everything may be fine- he could be more efficient and just taking what he needs.

[sycamore54321]

Sorry for all the typos. Thanks everyone for your answers. I'm afraid I am pretty sure it is a supply issue - yesterday I succeeded in feeding him only once, for a short feed. I expressed about six times during the day and got about 8mls in total -a few weeks ago, I could get 10 or 15mls from a single pumping session, as well as four or five full breastfeeds in the day. He is definitely taking more formula to compensate. I am still using the newborn teats, I have never changed from those.

Thanks for suggesting the bath as skin to skin - usually my husband does the bath but that is a good idea to try it myself.

I try putting him to the bresst whenever possible but he makes it very clear when he is not interested and he cannot be induced to feed if he doesn't feel like milk is there. I'm not sure it is a case of him preferring the bottle, I feel in my heart that if I could get my supply back up again, then he would happily feed. I guess I'm looking for some magic bullet that probably doesn't exist.

Thanks so much for reading and for your help.

[NickyEds]

I don't really know what to suggest. When Ds was very small we cut the top ups way down by gradually reducing them each feed, so I'd do one boob, then the other, then top up (maybe 2 oz) then try again on the first boob. Then giving 1 oz next time before returning to the breast. At that early stage DS would always latch on though.
TBH for us it was around 4.5 months that bf started to tail off(maybe 1 un-supplemented feed and two others), until at 5.5 months there was only really the first feed of the day (always our "best") left. I think my ds definitely got used to bottles during a growth spurt at around 4.5 month. I only ever wanted to bf for 6 months as we really wanted to ttc so when I felt it tailing off I didn't take any measures to stop it. Nct helplines will have more ideas on how to protect your bf if you could give them a try??

[Countryside14]

Over as my supply really dropped. I bought ground fenugreek and mix one teaspoon full with a little bit of water 3 times a day. By the 3rd morning I was very full with lots of milk. You have to keep up with regular feeds to make sure it works and you will smell like curry but it works very well.

[RedToothBrush]

I have found fenugreek does work. It can take a couple of days though.