Increasing supply at certain times of day

[LeggyBlondeNE]

Gosh, I'm on here a lot atm!

My 6mo was late gaining weight, did really well between 3 and 5 weeks, but then in the last week didn't gain again. We've been giving top ups for a while now and have been advised by our local BF coordinator at the hospital to increase top ups again until her weight picks up once more.

Anyhoo, I've been finding for a while that I seem to run out of milk late morning and late afternoon. In contrast now that the baby's sleeping longer I'm getting over-full and uncomfortable at night, and am often desperate to feed her by the time I manage to wake her up (we're also on no-more-than-3hour sleeps until weight improves again).

So what's the best way to increase supply during the day without increasing it at night?

Actually to add to this -

I have joint concerns that either
a. my supply is too low to meet her needs at these times (in which case, top up and pump?)
and/or
b. use of top ups have given her greater expectations than I can meet. (so stop top ups and deal with the tantrums?)

Are either of these likely and what's the best response?

six MONTHS old or six WEEKS old?

Are you pumping at the minute?

Switch feeding, whereby you feed on one side for a few minutes then swap and repeat back and forth is a great way of increasing supply.

oops! 6 weeks!

I am pumping but I don't find it easy to produce that much at a time for the pump, plus I try to prioritise her feeds so it's usually done after a feed while her dad is giving top-up.

With switch feeding - so not switching over every time she unlatches but more often?

How long does she usually feed before coming off?

Anywhere from 10 to 30 minutes usually, and will usually go back on same side a couple of times if I offer it.

Right, you need to always offer the other side, v. important when increasing supply.

Usually, they stop feeding as enthusiastically after a few minutes, after the let-down and then popping them off and onto the other side will stimulate a let-down and then repeat.

How often is she feeding?

oh yes, switch feeding is GREAT for supply. I used it as late as 16 weeks to increase supply.

Oh I do always offer both but had been encouraged to offer first breast at least once more to ensure hindmilk was drunk before switching. Paeds initial theory for static weight despite no dehydration was she was coming off too soon.

Either way - switch when she falls off or force her to switch after the gulping rate drops?

I'd switch before she starts to fuss at the breast (if this is what she's doing). So maybe somewhere between the two points you mention i.e. before she falls off, but somewhat after the initial let-down guzzle? I must admit when I did switch feeding I did it by the clock (swapping each 4 minutes worked for me, but that was partially a consequence of watching DD's behaviour at the breast).

How does she behave at the points at which you get the impression that you 'run out'? Does she keep sucking and get frustrated, does she move on to chewing her hands, does she start yelling?

Re: the weight issue, how frequently is she now being weighed? Same scales? Is she dropping centiles or just not gaining at the rate she was? I'm just wondering whether the formula top-ups actually set her on a false weight trajectory because she ended up consuming a greater volume of milk than she would have done electively?

Re: feeling over-full at night, that makes sense as our bodies produce more prolactin at night - so that combined with the fact that she spaces feeds more at night would explain it. Could you bear to pump a little in the night so you could top up with that during the day?

Finally - sorry if we've discussed this before and I've forgotten your answer, but have you got any views about considering fenugreek or domperidone?

FrozenNorth: I have just googled it and phoned my brother who is a pharmacist, and it is definitely considered highly toxic to be taking domperidone while breastfeeding. It may increase your milk, but as it passes via the milk to the infant, it has the possibility of poisoning the child. Fenugreek is advantageous for milk production but domperidone?
LeggyBlondeNE: please talk to your doctor before considering suggestions from mners here. Myself included. Always seek medical opinion from your midwife or gp just to be on the safe side. Take care xxx

I really wouldn't worry about hindmilk, milk is milk, especially if you have low supply it's about getting quantity up.

Keep putting her back to the same breast will not increase production, which is what you need.

And feed frequently too.

I don't have experience of Domperidone but have seen it mentioned several times.

Of course medical advice is important, but as long as we bear in mind that the majority of GPs, MWs and HVs know sod all about breastfeeding and finding other sources of information to cross reference with is the sensible course of action.

Frozen - when I feel low on milk she gets fussy and frustrated and pulls at the nipple and comes off and re-roots etc. To be fair I'll always still have some but it can get quite thin and watery looking which may be what she objects too. If she's just taking a pause or becoming satisfied she'll just detatch herself, which she usually does well before she starts getting fussy.

FedUp - I've actually been given domperidone by my GP to try it out and she didn't seem too bothered. (Mr Frozen is a GP as well and seems okay with it - maybe a doctor/pharmacist difference?)

Right, will give swtihing a try...

"fedupttcnosuccess Sat 09-Oct-10 22:45:46

FrozenNorth: I have just googled it and phoned my brother who is a pharmacist, and it is definitely considered highly toxic to be taking domperidone while breastfeeding."

Sigh Sorry, but that is just not true. GPs prescribe this galactagogue fairly frequently nowadays - including my DH. Many paediatricians do it too, including the ones that have been involved with both my DDs. It has fewer side effects for the mum than the previously widely used galactagogue metaclopramide. In fact my DD1 was on a rather high domperidone dose for a long time for her own reflux from a very early age.

Although I know you meant well I feel pretty concerned that you have probably scared a lot of mums taking this drug with your statement. The use of this drug it comes up fairly frequently on this board. So I will state it again - under medical supervision it is absolutely fine to use domperidone to increase milk supply. Please tell your brother about this, since I would hate for him to give inaccurate information to any of the people he prescribes for. It is a doctor / pharmacist difference: pharmacists inevitably err on the side of on-label uses only. Doctors have the expertise and knowledge of emerging off-label but safe uses to employ. Believe me, I don't recommend even considering the use of drugs on this forum unless I'm 100% sure I'm not about to contribute to the poisoning of someone's infant :)

Sorry for the thread-hijack Leggy - it sounds like the switching is worth a go. I think you're doing an amazing job with DD and can't wait for bf'ing to become easier for you.

"He prescribes for" - sorry, meant the people he compounds and dispenses for.

Meant to add this link from the British Journal of Clinical Pharmacology (concludes "The amount of domperidone that transferred into breast milk was very low, and the risk to the breastfed infant is minimal.")
Link HERE It's a small study but it is the only randomised double-blind placebo controlled trial of a galactagogue that I know of.

Gah, nearly 4 hours of semi-continuous feeding later (well there was one decent 45 minutes where she slept and the odd five minutes where she can be distracted by her papa) and am so sore pumping is in no way on the cards.

If she's having a growth`spurt the same weekend as I've been told (be feeding coordinator) to replace two feeds a day with formula and pumping, then I can't see this going well...

Oh no, sorry you're so sore. Did Chris ever get back to you on using a supplementary nursing system? What was her logic on replacing the feeds with formula and pumping, since pump tends to be less good at getting milk out than baby? I'm around tomorrow if you'd like someone to top up with the syringe / walk around holding her for a while / try to be distracting / make you a cup of tea. It does sound a lot like C and R's 6 week growth spurts but that in no way makes it better for you. How is her latch at the moment? Are you sore most days still or just particularly sore today because of the endless nursing?

Her latch is still poor, although Chris told me she didn't think it was much of a problem a few weeks back, but it only hurts when she's uber-feeding as now.

I don't understand why the replacing feeds has been suggested. I'm wondering if it's back ot the paeds idea that she needs a lower-effort source of calories than bf to help her gain weight... (of course we use BreastFlow bottles which do require effort!)

Got HV and cleaner both coming tomorrow (!) but will call if I'm going to crazy in between!

FrozenNorth and LegggyBlondeNE: sorry to have passed on what I learnt! Didn't mean to scare anyone, hence did say that LBNE should consult with doctor/midwife.As with most things it is not recommended to be self medicating, especially so with a young baby.
Well done for persevering Leggy. Hope that things settle down soon. Sorry for you having such a tough time recently. x

Fedup, you have just discovered why many people with experience on these boards will always take health professionals opinions with a pinch of salt!

Well one day attempting switch-feeding and we get a greeny-tinged nappy (too much foremilk, yes?) so methinks I'm getting it wrong!

On the other hand, that plus domperidone and I'm much happier with the supply side of things today already. It's had more of a blanket effect than I would have liked but I'm sure things will sort out eventually.

She's also gained 3.5oz in 3 days so just need to try and get to a point where we don't need these top ups.

3.5 oz is loads! Well done.

One green nappy doesn't mean much, and doesn't necessarily mean too much foremilk anyway.

The amount of fat in the milk ie. hindmilk is related to how long the milk has been in the breast, so a 'full' breast where the baby hasn't fed for a few hours will have a greater proportion of less fatty 'foremilk'.

As the breast gets emptier, the fat percentage goes up.

If the baby feeds an hour later, the milk it gets will be fattier to start with.

So it's good to feed every couple of hours.

Apart from the slow weight, do you have any other concerns. My LO had a week with no weight gain, followed a week with just 1oz, but that was just the way it was. She very rarely put on more than 3oz a week, but she was alert and plenty of wet nappies so I tried not to worry and accept it.

No, no other concerns but all the health practitioners up here are rather worried by the weight. She was looking a bit too thin early on before we started top-ups and some weight went on, but despite dropping down weight centiles even now, she's still on the 91st centile for length so she seems to be growing rather than bulking up.

dropping 25% is within normal, but it's hard when the hcp's are on your back as well.

Sounds like things are going well. I think there was thread a while ago about green poos, where many people were saying that's just part of their DCs normal behaviour.

Our LO is a skinny bean, but very active, crawling a few days after turning 6 months, rolling over at 12