Expressing advise please

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DD was 4 weeks old yesterday but only just back to birth weight. Seen BF counsellor yesterday. Everything seems fine apart from the fact that it would appear I have poor supply on the right. She's advised expressing on that side to try to increase supply.

Yesterday (before said advise) I expressed from both (though largely the good left side) and got 2 oz. Today I've tried to express from the bad right side. I've been expressing whilst feeding DD on the left. Over 3 feeds I've barely got 1 oz.

I know I'm doing it to try to increase supply but it all seems like so much effort for such frustratingly little gain. How long to see an improvement?

The expressing should be increasing your supply but the pump might not actually get it out (IFYSWIM). And your baby will be much better at getting milk out than the pump is - so she could be getting the benefit of you stimulating your breast without you seeing the milk. Rather than worrying too much about how much you're getting out it might be better to focus on whether she's got lots of good wet and poo-ey nappies, and seems satisfied after a feed.

As another idea, can you try a different breastpump? Our local NCT can rent ones (you don't have to be a member) so you can try different ones before committing lots of money to something that doesn't suit you.

What makes her think you have poor supply on the right?

What are the nappies like (lots of pee and poo?)

FWIW I can very rarely get more than a few ml out when expressing. I'm just shit at it.

DD only reached birth weight yesterday at 4 weeks after a rubbish 2 oz gain in 1 week.

EVERYTHING else seems fine. She's always latched well, eager to feed, no nipple cracks/pain/problems. Plenty on wet and pooey nappies. Growing (at least height wise - has gone into 0-3 month babygrows cos couldn't straighten her legs in newborn ones). etc etc.

When feeding on the right first, after about 10 minutes she starts shaking her head, bending her knees, clawing at me, as if she is frustrated, as if she's not getting enough out. In addition the BF counsellor thinks she has a short tongue which makes it more difficult for her to feed. This and seemingly low supply on right we're postulating as cause for slow weight gain.

Plan to express from right and am trying a nipple shield when feeding on right so she's got more to latch on to.

I am, however, getting a sinking feeling that this is all starting to go pear shaped and that we're going to end up on formula :-(

So are you expressing after the feed, inbetween feeds or instead of?

I've heard of people successfullly BF with just one breast, somehow it seems an odd explanation for low weight gain.

Some babies are born to be smaller than birth centile, some babies are slow gainers. Can you speak to someone one in RL or ring one of the helplines.

Hopefully someone more exert will come along, but I would def seek RL help as well. Even if it's just a second opinion stating the same.

Only way I seem to be able to get anything off the right side is to express while feeding on the left, managed a whole 1/2 oz this morning in 15 minutes. It just seems so labourious and such a faff for so little gain. Plus, in the future it might be nice to be able to express a bottle so we could go out for a few hours and leave her with grandma - doesn't look likely!

Are you right handed? I always used to have more trouble feeding from the right and I'm convinced it's because I'm right handed and couldn't position her as well with my left hand.

I always fed from the right first when she was at her most hungry and more willimg to work for it.

It may seem a long way off, but from around 8-10 weeks it didn't seem to matter, I guess she was big enough for it not to make any difference.

Feeding with a nipple shield risks making any potential problem worse, not better because it can interfere with effective milk transfer.

Fussing at the breast can be entirely normal. Have you tried taking her off, winding her and putting her back on? Alternatively use that fussing as an indication to offer the 2nd breast. Are you offering both breasts at a feed?

I think you need a 2nd opinion from one of the helplines or another BFing person.

Liloosmum - yes I think I had difficulties with the left hand so for the last couple of weeks have been feeding underarm on the right to avoid this.

Jem - yep wind when she fusses / sleeps, then back on. ALways offer both breasts.

I'm at a loss really given that everything but weight gain is fine.

Just expressed with second feed but from left side when feeding off right and now have 2 oz to top her up with tonight.

As PP said, some babies are just slow gainers. Try not to worry, she IS obviously gaining and from what you've said doesn't seem unhappy. Certainly no reason to introduce formula at this stage.

Still think you should get a second opinion though. :)

so does she then do on to feed on the right side after you've expressed. If so, just the expressing action will help increase supply for her to have.

DD weight gains were normally 2-3oz per week, and it wasn't unusual for it to be lower. It's normal for babies to go up/down two centiles, so a slower weight gain is not necessarily a issue in it's own right. It does mean you're more aware of ensuring they have open access to food, and I understand is stressful even when everyone else says it fine, as there's no margin for things getting worse. I judged how she seemed and if that was alright then she was alright even when she didn't gain for two weeks.