Increasing milk supply

[Jodiesmum]

ANyone got any tips? I would like to breastfeed dd2 exclusively but have never had enough milk so have to give her regular bottles to top up - usually 4 small ones in 24 hours. I know it's a vicious circle and that I should ideally cut the bottles out but am finding it impossible as dd2 is really hungry and goes mad with frustration when sucking on an empty breast. Also as dd1 is 2 and very demanding I can't spend all day sitting on the sofa. I know where things went wrong - dd2 was premature and spent her first 2 months in hospital unable to feed at all (was fed intravenously. During this time I expressed every day but I guess my heart wasn't in it sufficiently to keep things going. I really thought my milk would increase when she came home but it never really has. Because of everything's that happened, it's especially important to me to be able to feed her myself to help us both get over her bad start. Also she has gained weight so fast it's got everyone at the hospital worried (how ironic) and I'm sure it's because formula is more fattening. Any tips would be much appreciated.

Domperidone is the medicine advised to increase milk supply. It is, according to Mears, our blessed online midwife, totally safe and sold over the counter as Motilum. Very effective apparently. THe other thing is to let your dd suck as often as she likes - your breasts are never 'empty'. However, if she's gaining weight that fast, it seems you do have enough milk but not enough confidence. Why do you think you don't have enough milk? What are the 'symptoms' - the only real signs of lack of milk are dehydration in babies and failure to gain weight, and neither seem to be the case with you and your dd.

When I asked about domperidone at the chemist they said they had never heard of it for breastfeeding - it is prescribed for something completely different.

A traditional natural remedy is fenugreek seeds - usually taken in capsule form. I have used them to keep up my supply because I am expressing exlcusively. You can get them mail order from
www.shop-naturally.com

Also make sure you are drinking lots of water, and eating well. Try and feed her as much as possible and maybe pump between feeds for a few days to help increase the supply.

Thanks v much you two. Aloha, the reason I think I haven't got enough milk is that my breasts never get at all full in the way they did with dd1 and are completely empty well before dd2 is full. I do see what you mean about the weight gain but I guess we got the amount of formula wrong during a crucial period when she really piled it on (giving her a lot less now). I'm really interested in the medicine you mentioned though am slightly baffled as when I looked it up just now, it seems to be for "bloated queasy stomachs" - no mention of breastfeeding. Is the effect on milk supply just a strange side effect then? Throckenholt - I will definitely try the fenugreek seeds too, sounds nice and natural. The expressing I will probably give a miss as I did so much of it when dd2 was in hospital and the very sight of a breastpump would probably make me cry. Shame as it would probably help, i know.

motilum is for bloatedness but a side affect is increasing the milk production. Mears has posted dosage on lots of threads I will search and find it. Have you tried going back to breast 1 at end of feed eg feed from first breast till finished offer other side till finished then go back to 1st breast again. or if you have a pump try pumping after feed (you may be suprised to find some milk) I wish Mears would post as she will have loads of tips! Have you contacted Bf counciler? BfN, La Leche or NCT may have other tips.

also you dont have to be full to have enough milk. You could try reducing one bottle by 1/2oz each time until it is gone then try another bottle?

Yes, one of the possible side effects of domperidone is increased milk supply.

I can't remember exactly how they word it in the patient leaflet included but my 7yo is currently taking it in the hope it will help with her swallowing.

The BNF (British National Formulary - the big book your pharmacist refers to also available online at www.bnf.org.uk) says under side effects: 'raised prolactin concentrations (possible galactorrhoea and gynaecomastia)'

galactorrhoea = the excessive or spontaneous flow of milk, persistent secretion of milk irrespective of nursing (cancerweb's dictionary)

gynaecomastia = An excessive development of the male mammary glands, even to the functional state (also cancerweb's dictionary)

Domperidone (Motilium) is for bloatedness, gastric discomfort. A side effect of it is increased prolactin levels which increases milk production. It is prescribed in our maternity unit for mothers with milk supply problems - mainly those mums who are expressing for babies in the special care baby unit.
The dosage is 10mg, three times a day for 10 days.
Definately start decreasing the top-up by 1oz a day. What you can do prior to doing that is express in between feeds in order to boost your supply. You coulsd then start giving her any milk you express as a top up till you wean her off them completely.
TBH - it sounds as though you have plenty of milk but need a boost in confidence. Babies will always take milk that is offered in a bottle whether they are truly hungry or not.
The breasy is never empty - the breasts can feel pretty soft when they are efficient at producing milk.

If you decide to try the fenugreek (which is what I used with success) the way to find the dosage is to increase the amount you take every 2-3 days, until your perspiration starts to smell of maple syrup, then decrease the dosage every few days until you stop smelling of maple syrup. The correct dosage is the minimum you need to take in order to smell of maple syrup. It's not an unpleasant smell!

Drink pleanty of water when you take the capsules, as the fenugreek absorbs a lot of water. I think you shouldn't take it if you have diabetes because it can have quite a strong effect on blood sugar levels.

Jodiesmum I used domperidone with great success with my third baby and am still bf him at 19months.

Jodiesmum I used domperidone with great success with my third baby and am still bf him at 19months.

Thanks everyone. I've bought fenugreek today and am going to give that a go first, then try domperidone if no joy. It was really helpful hearing that confidence may be part of the problem - I hadn't really thought about it but the whole feeding experience with dd2 has been incredibly demoralising, also a big shock as breastfeeding dd1 was a really straighforward and happy thing. Today I've managed to give dd2 about half as much formula as usual, just by assuming she can handle it. It's gone really well though don't know how the night will turn out!

You won't see an effect of the fenugreek for a couple of days - so don't get impatient ! Normal dosage is 2 or 3 capsules 3 times a day - but you need more or lesss - experiment !

Good luck.

I know everyone hates Gina Ford - but... I think that her programme to increase milk supply through expressing is excellent. It is in the CLBB.

I second mimm's suggestion for GF - worked very well for me.

THanks again everyone, I think the fenugreek is starting to work! Not that noticeable yet but hopefully will increase if I keep going. Weird the thing about making you smell like maple syrup - I didn't believe this till it happened! I'll bear the GF expressing thing in mind if I get desperate but really hope to avoid ever doing that again after the hospital experience (trying to keep the milk going when dd2 was too ill to be touched, let alone fed- truly awful)

Just discovered mumsnet - what a fantastic place. I have discovered so much interesting and useful information. I've been on computer nearly all afternoon and evening and have completely abandoned children, housework, kids tea, our dinner, and the ironing! Have got 14 week old daughter and already have son-6 and daughter no1.-4. I am breastfeeding exclusively and my milk supply has definitely gone downhill recently, and was interested to see you recommending Fenugreek seeds for increasing supply. I'm going to give that a go first and then try domperidone if no luck. Have never heard of taking these things before, Health Visitor always says to drink more water and rest a lot(she hasn't got 3 small children!). According to her blasted centile chart dd2 is not putting on enough weight (those ghastly HV's make you feel so guilty) although I feed her every 3-4 hours in the day and last feed at about 10.30pm and she goes through to about 6.30am. She is a perfectly happy and alert baby and I personally have no worries but I am getting her weighed again on Thursday and scared what the HV will say if she hasn't gone up a bit on the centile chart. Thanks for all your tips

I was told to drink fennel tea and eat Halva ( really sweet, you get it from health food shops)by my midwife. Good luck!!

Karensara - please do not worry too much about your milk supply. Having got to 14 weeks it is well and truly established - well done you It is not unusual for babies' weights to plateau at this age and to be honest, if she is bright and alert, peeing and pooing I would not be concerned about her weight. Weight alone is not an indicator of a baby's wellbeing and to be truthful, regular weighing of babies can have a detrimental effect on breastfeeding.
It is highly likely you are not aware of having full breasts because they are now so efficient at producing milk they look and feel softer and less tense. That is normal. If you were truly worried about a reduced milk supply then offer feed 2-3 hourly for a couple of days and it will increase. The way to make more milk is to feed more often. Domperidone is brilliant but is usually used for women who have problems with their initial supply. The other thing you can do is feed or express in the middle of the night for a few nights. Your prolactin levels are much higher during the night and therefore feeding then stimulates more milk production. Domperidone increases prolactin levels but is best reserved when frequent feeds and night feeds have not solved the problem.
I also breast fed with 2 young toddlers in tow and you find that the third baby (and in my case 4th as well) tends to be more relaxed about feeding and waits until you can fit it in. I remember dragging no.4 in and out of nursery with her brothers having only had half a feed. The constant motion would make her sleep so she wouldn't ask for feeds. Then I would get a jolt thinking 'gosh, I haven't fed you properly for ages'. Her weight gain was pretty crap overall when she did get infrequently weighed.
So to sum up, my advice would be - increase your feeds to 2-3 hourly for a few days. You will get a response to that of increased milk production over 36-48 hours. If you are still concerned do a few night feeds. Most importantly, avoid the scales in the first place

Thanks so much for your tips. When I have tried to feed more often, she either takes it and promptly pukes it all up or refuses to take it in the first place, which is obviously an indicator that she doesn't actually need any more. I will try to steer clear of those scales in future! Now I really must get off this computer and get some work done!

If your baby is going down the centiles on the UK chart, then have a look at some other country's charts on the internet. My ds would look a lot better growth wise if he lived in Australia! Your HV probably isn't using a chart for bf babies. You don't have a milk problem - you have a HV problem.

Karensara - sounds as though your baby knows what she wants and that you have plenty of milk Carry on as you are and well done

Here here Bobthebaby. Our dd fell off the bottom of the uk chart a long time ago and has now done the same to the Swiss equivalent. Call me a cynic but is it a coincidence that they are sponsored by formula milk companies. Avoid the HV unless you need advice, by 14 weeks you would know if there was a problem.

I had my argument all planned at the 3 month check.

If babies start to drop down the chart they are often advised (or decide) to supplement with formula. So they do and the baby goes up the chart again. Job well done, handshakes all around. Except that now the chart is wrong because instead of reflecting reality the mother has made a conscious effort to acheive a desired weight. With each group of babies that do this it becomes harder to stay on a line whilst breastfeeding, so more temptation to supplement or introduce solids early. No coincidence at all that the formula companies are involved IMO.

In the end my HV said the chart was just a record, not something to aim for and my baby was perfectly in proportion. All my carefully considered argument not needed. Ho hum.

Obviously the mother decides - not the baby.

My daughter was 6llb 9oz at birth, then at six weeks her weight started to tail off, and she started to go down the percentiles on the growth charts. My doctor has now instructed me to make sure she puts on 2lbs in five weeks. I started expressing after every feed to inc. milk supply but does anyone have any other tips for putting weight on purely breasfed babies? She is a very happy, alert and active child, and if it weren't for the doctor, I wouldn't be worried about her at all. HV says she looks fine but to consider weaning at 5 months - any thoughts?