do I just accept I have low milk supply?

[MacMomo]

I have struggled with low milk supply since DD was about 8 weeks old. I spent 4 months on fenugreek and then added domperidone which really did work; however, I've been reducing the doseage and I'm now down to 30mg a day and the milk has gone again. the doctor won't keep me on this medication any longer as I've been on it for 3 months already and I'm getting some side effects (dizziness, wired feeling). DD is now 8.5 months and I go back to work in 4 weeks. We are feeding 3-4 times in the night and 4 times during the day, but there isn't much for some feeds and dd comes off frustrated and hungry. I try to pump between feeds to increase supply but it doesn't amount to much. Latch is good and she's a strong sucker etc but - do I just need to accept that I have low milk supply and supplement for one or 2 feeds now?

MacMomo - how frustrating and distressing for you :(

Have you called anyone on any of the bf lines for support?

The things that strike me are that you are 'catastrophising' - which is totally understandable after all these months of worry. But your milk has certainly not 'gone'. You are clearly meeting the majority of dd's needs for milk and I'm assuming she is having some solid foods and is thriving... and maybe the times she comes off 'frustrated and hungry' are just the normal aspects of an 8.5 mth old's life, where feeds can be short, where feeds can be in competition with other interesting and engaging things she wants to be part of, and where the crying and pulling off could just mean 'I've had enough - don't make me stay on'.

What do you think? I might be wholly wrong, I know.

I wouldn't bother supplementing at this late stage, however I avoided formula as it is expensive and not needed once they are one anyway, so seemed pointless introducing it.
How is she getting on with her solids? The feeds where she is hungry is it worth giving her some solids?
It sounds lke you are feeding plenty, if you can cope I would keep going as you are, what duration is she at the breast for? Have you tried switching breasts to encourage more let downs?
I went back to work at a similar age and fed Dd twice a day on a work day and three times on a day off, more if she was ill, however my milk supply was ok by this point (another story when she was 4months!) and the feed especially in the morning was quite a long one.
You have done so well to feed so often and cope with low supply. :)

thanks for the replies. I feed her down to sleep for naps during the day, so she is quiet and focused and not pulling off to play, she sucks and sucks and clearly wants more. I swap sides etc and keep her on sucking for as long as she'll stay. I suppose I'll have to up her solids to make up for it. Perhaps I should just be grateful that I have been able to bf for as long as this! We had a difficult start which probably contributed to the low supply. It was so great when I was on the higher doses of domperidone, to finally have plenty of milk and dd had long feeds and was clearly satisfied, coming off when there was still milk left (and she slept longer at night between feeds because she was getting more milk).

MacMomo - still nothing in that last post to make me think this is still a supply issue!

She sucks and sucks at some feeds - that's ok. Then she comes off at some point and on some occasions, cries? You switch sides, and she cries again. So you switch back and she gets crosser....she could simply be saying 'I'm done and I want to sleep but I don't want to feed to sleep this time, thanks' :)

One thing to try would be just to 'read' her and respond instead of trying to keep her sucking for as long as she will tolerate.

Long feeds are much less common in older babies - very uncommon, in fact - and her shorter feeds are not an indication of insufficient milk. Ditto 'still milk left' - that obvious 'extra' is not there with well-established, longer term bf.

She might have slept longer at night because of developmental reasons, and be sleeping less at night for the same reason. It's not necessarily because she was getting more milk and is not getting sufficient now.

I think upping the solids will help with any actual hunger and the good feeds in the days sound ideal. She may well be getting enough milk as in recommended amounts, just is a fiend for it. It will definitely make you question whether you have enough when the domperidone was boosting your supply so well and now you have less. Andyou have done really well, a definite achievement getting where you are. Well done :)

I have to say, I am absolutely certain I have low supply. My bf advisor agrees (she runs a national bf charity and is extremely experienced), and I have read many books, I even have several as-yet-unpublished chapters from Jack Newman's new book - I have taken a huge interest and educated myself (from necessity, it was always difficult). I have always felt let-downs (usually the first 2, not subsequent one) very strongly; I still feel them strongly, but they take ages to occur. DD is resorting to pulling and twisting to stimulate (it works, too, eventually) and eventually the let down comes, but she's finished it very quickly and then the swallowing stops and she's back to working at it to get the next let down. She goes at it for a while then gives up; I swap sides and the same routine goes on. AFter a (shortlived) let down on the other side, she gives up. As an experiment, I have offered her 2oz of EBF at this stage and she goes at it furiously (she won't contemplate taking a bottle unless she's hungry), finishing it all.

I have been very aware whilst on the medication that the letdowns were giving milk flow that carried on for ages, the long slow sucking and swallowing etc. My dd has a very definite swallow, you can't miss it, it is very easy to tell when she's actually getting milk. At night she finishes both breasts each time, every 2 hours or so.

Anyhow. Assuming I'm right and there is low supply (that is, only enough milk to satisfy at some feeds), I see 3 options: add formula; increase solids; go back to fenugreek. I'm wondering if there were any other options I hadn't thought of yet (bf advisor away for a month)?

I can see there has been a supply issue for sure, OP....and you have researched it thoroughly from what you say.

It's not going to be possible for anyone here to be sure if the behaviour you're describing means you have only sufficient milk at some feeds and not others - 'cos the behaviour you describe does not mean only that. In a baby of this age 'goes at it for a while then gives up' could equally be 'goes at it for a while and then stops (because she's had what she wants for the moment but is happy to take from the next side)' . The bottles of EBM which she downs enthusiastically and finishes have no definite meaning, either.

It's got to be irritating for you to feel sure the low supply is there, and for someone like me to question it - and of course I am not saying I am definitely right, how could I? :) I could be 100 per cent wrong.

The other option is to continue what you are doing, and follow what she seems to be wanting to do, without struggling to get her to feed more often, without expressing and just feeding her when she 'asks'....but I sense this would be worrying for you, as you might feel concerned the supply would drop.

Might be worth speaking to someone else in real life as well, for other views?

Yes, I am afraid that the supply might drop further. Also she won't nap if she's not boobed first! I don't know what I was hoping for from the advice forums really, maybe a miracle solution! t

As a matter of interest, have you had your thyroid levels checked?

No I haven't. Interesting - my sister has been diagnosed with low thyroid and is on thyroxin. Does that sometimes lead to low lactation levels?

Probably totally unrelated, but I had very low levels of amniotic fluid (yes, I drink lots of water) - altogether makes me feel like I'm a bit dried up and past my best!

Yes, untreated low thyroid levels in a breastfeeding mother may result in a decrease in milk supply. And it's not uncommon to experience temporary low thyroid levels in the first year or so postpartum even if you don't have a family history. Obviously I'm not trying to diagnose you over the Internet, but I'm surprised that as you have a properly identified supply issue no one has even mentioned the possibility to you or suggested a blood test.

Agree with Elephants - persistent low supply that doesn't respond to the usual self-help measures of frequent feeding and so on should always alert an HCP to the possibility of thyroid issues.

Thanks for mentioning it, I will ask my gp about this. As people say, it doesn't make sense for my milk to keep dropping off, it's not normal. Ive gone from DD bra to B cup in the space of 10 days, and period pains today. I'm sure it won't completely stop and i will able to keep up with 2 feeds a day, but I'd like to understand what is wrong for next time. Thanks again ladies, I really value your thoughts.

I was just going to say the same about thyroid, it affected my supply when undiagnosed

Any chance you could be pregnant? Thats how quickly my supply went with DC's 1 & 2 when I became pregnant with DC's 2 & 3.

Ha! No chance I'm pregnant! Seeing the gp tomorrow, will ask for thyroid check.

Thyroid function normal. I guess I'm just not a milky mummy :(

I agree on the thyroid issue. But just wanted to note, it is very common after 6 months not to feel the letdown much at (sometimes not at all) when feeding. I had oversupply in first few months with all of mine, but once it was established I often couldn't feel my letdown at all.

And yes, 8.5 months is brilliant by the way!

No, it's not that I can't feel the let down. There isn't much (sometimes any) milk. There really, genuinely isn't. I'm not imagining the problem.