Genuine low supply problem?

[Hopefully]

This is an out-of-interest question really. DS is on referral to a paed for incredibly slow (minimal) weight gain - he is now 13 weeks, and just barely scraping along the thrive lines. He was ebf until yesterday, when he had an ounce of formula (topping him up for a few days has eaten through my meagre expressed supply).

Anyway, I'm just wondering if I can suggest that I have genuine low supply and ask for something to increase it? There are drugs you can take, right?

Since DS2 was born, here are some of the things I have done to ensure I have maximised supply:

• Co-slept from day 1
• endless skin to skin at birth, and frequently since
• Fed at the teeniest squeak - apart from the time it takes to park a car, he has never ever had to wait for a feed
• no dummies/pacifiers of any form
• LOTS of switch feeding, pretty much since the first week
• Breast compressions
• Seen two BFCs and various HCPs, who all agree he has a good, deep latch, isn't tongue-tied, is developmentally normal (he is a very cheery little baby)

DS2 still feeds a lot - today, for instance, he fed from 7-7:30, 7:50-9am, 9:30-10am, 11am till right now (so he's only been off me for 1hr 50 mins since 7am this morning, having fed from 5am-6:30am as well).

I have never leaked a drop, never felt engorged, never been able to express much - I know that these things by themselves don't suggest low supply, but paired with everything else? I stopped feeding DS1 suddenly at 10 months (he was on 5 feeds a day by then) and I only had to express once ever to relieve pressure, then never again.

I have produced two babies that gained very very slowly - DS1 only really chubbed back up once he was on a good quantity of solids and a mixture of formula and BF

I'm just interested really. Is there a 'normal' curve of production that I am at the lower end of? I don't know how much research there is into average supply/genuine low supply, but I'd be interested to read anything that is out there. I'd like to know if there is anything more I could have done, or if I simply will always struggle to ebf a baby for any length of time.

Incidentally, my boobs appear 'normal' (whatever that means) - they just look like boobs.

Sorry for the essay, this has been on my mind a lot in recent weeks, and I have flummoxed every HCP/BFC with my perfectly latching, perfectly content (as long as feeding constantly) but not-gaining baby, for the second time.

I hope someone knowledgable comes along soon, like TikTok, but in the meantime - I think my supply was a bit feeble, it was hard to express much etc, but I found that persevering with the pump made the most difference; I used to pump as much as possible after each feed and while DS napped. It took a while but soon my supply got much better.

Good luck

How often does he feed at night time? The night feeds are the ones which stimulate the milk production most so, if he doesnt already, it's worth trying a few nights of feeding every couple of hours in the night. This worked for me with DD1 who, even though we co slept, very rarely fed much. In fact with her I think the co-sleeping made her less interested i feeding if that makes sense.

Thanks for replying Mistress - I've been pumping to top him up but (a) it's hard to find the time to pump when DS2 feeds such a huge amount (although I am managing a couple of ounces a day) and (b) both times I have got into any kind of pumping routine, I have developed mastitis within a few days. I have a vague theory that the pump stimulates my supply, but doesn't remove the milk as effectively as a baby. No idea if that's the case though.

Juggling every couple of hours would be a huge luxury! He feeds at least every 90 minutes, and has a decent feed pretty much every time (very occasionally it will be a quick feed and back to sleep - perhaps every third feed or so?)

He doesn't cluster feed so much now, but still feeds reasonably constantly until around 8:30pm, has a little sleep, then feeds from around 11 (or whenever he wakes - has been a shade later with giving top ups after feeds) for at least an hour.

Why have you been topping him up for last few days?

Juggling Doctor's advice - I physically can't really feed him directly any more (he already feeds about 90% of his awake time), and he is scarcely scraping the thrive lines, so this was felt to be the best way to get a bit more into him. Have been pumping and topping up, but fell a couple of ounces short yesterday so he had some formula.

GP originally wanted me to express and bottle feed every feed. I made lots of faces at him

Ouch to the mastitis, you poor thing. Does he do lots of poos? Could it just be that this is the way your babies are? . Could it be an absorbtion issue rather than a supply one? (clutching at straws)

Not a lot of poos. DS1 had various other gut ishoos and only went once a week or so (and was constipated), DS2 goes more like every 2-4 days, but has relatively normal BF poo, maybe a bit thicker. He isn't enormously wet, but is wet (not leaking) in a washable within 4 hours, which seems reasonable.

I am reasonably sure that if I was able to keep him latched on as much as he is atm, he would be able to be ebf till 6 months, would probably be pretty skinny by then (his weight is on 0.4th centile, length and head are 50th &75th respectively, so he's already fairly scrawny!), but would doubtless survive. The main problems I have are (a) it's bloody hard work! Have DS1 to look after, and although DS2 feeds in the sling etc, it's actually fairly hard feeding 12-14 hours in 24 and (b) despite resigning myself to that, DS2 still isn't really thriving, which makes me wonder if it's an actual physiological supply problem, rather than a transfer problem, iykwim.

Oh, and neither DS has ever posseted, at all, ever. Not eveen a few ml. There is no excess!

Have had mastitis 5 times across 2 babies. am a veteran! Also blocked ducts with DS1, but he actually didn't have a great latch until he was a few months.

not an expert, but if you develop mastitis whenever you pump regularly, doesn't that suggest that your breasts respond to the pumping by increasing supply? which would suggest supply is not low, but perhaps milk transfer is inefficient? though I'm not sure how that works if lots of bf experts have seen a perfect latch etc.

btw my ds1 fed ALL the time. It's tough to keep that up with older dc about. well done.

DD's latch in the early days looked fine to MWs and BFCs, but wasn't deep enough for her. We had to use firm cradle hold, rather than the cross-cradle everyone kept on suggesting. I randomly saw an infant feeding specialist and she suggested cradle hold.

There are drugs to increase supply - domperidone being the most common.

Have you read the info on low supply on Kellymom?

Perhaps it's not a case that you don't have enough milk but that you don't produce milk quickly or your breasts don't store much so you have to feed little and often rather than big regular feeds.

Much of what you say rings true for me - can't express a drop; never, ever leak; if my DD comes off during a feed, there is no spray of milk as others describe.... I ebf my DD for 6 months and hardly ever saw a drop of milk but, incredibly, she thrived and was OK. She used to feed all the time too which would suggest that I too, don't store a lot of milk.

I wouldn't dismiss yourself as having no milk and give up bf. Your DS is thriving, he's gaining weight although slowly. He's not starving to death is he? What if you were living in the Amazonian jungle or a village in Somalia? You would keep on bf as you are doing and your DS might be a bit smaller than other babies but he'd be fine and presumably his weight would catch up when he weaned or it might well be that he's just a smaller/lighter child and he is following his natural centile.

I do appreciate that feeding all the time can be boring and a hassle and if you want to give a bottle from time to time to alleviate the pressure, then that's fine but I think you should only do this if you want to rather than because you've been told to by a HCP.

I know you said he's been checked for tongue tie, but an awful lot of posterior ones are missed (some aren't even visible). If you haven't seen someone experienced in diagnosing posterior ties I would look into it. Also, the book Supporting Sucking Skills in Breastfeeding Infants (a Lactation Consultant textbook) is excellent and describes many other physical malformations which can affect milk transfer (which is much more likely than low supply in non-tuberous breasts). It also suggests solutions, such as unusual feeding positions etc.

Am not an expert but was thinking what tryharder has said. Iirc tiktok said something on the "is breast best?" thread to the effect that some women have less storage capacity, if that makes sense. So over 24hrs they produce as much milk as any other woman, but do it more on a "little and often" basis. So their babies feed more frequently...? Hopefully she'll be along soon...

Well done on keeping going. Can't be easy with another dc.

Also i think posseting is more to do with the immaturity of the sphincters(and therefore random) than to do with getting too much milk. But may be wrong.

Thanks for all the replies, it's really interesting.

Mama pumping does increase my supply, (and cause mastitis), but I wondered whether the 'transfer' problem in that instance was more to do with my boobs than the baby (since it's happened with both babies). Maybe my ducts don't like actually releasing their milk! Especially since latch appears perfect.

Japhrimel read the information on Kellymom, but I think I have tried everything suggested (including oatmeal etc, just on the offchance!).

Tryharder and Moonface that's interesting about low storage capacity - it would maybe help explain why I never feel 'full' and why DS feeds all the time.

The bottle is partly to give me a break and partly to assuage doc, tbh. I am pumping again, but following it up with hand expressing on the advice of a fellow mastitis sufferer, and fingers crossed it seems to be keeping me illness-free. Pumping successfully means that I only need to make a whopping 1oz of formula up in order to give a 3oz bottle every day, which somehow doesn't seem as bad as a full bottle of formula!

sc no idea if bfc checked for posterior tie (or if she's experienced in it). Seeing her again on wed to discuss paed referral, so will ask then.