Question about increasing supply

[citymonkey]

Sorry this is long....

My son is 19 weeks and has generally been EBF. For the last couple weeks I have been feeding him around 7/ 10:30 / 2 / 4:30 / 6:45 and then a dream feed at 11pm ish. He has just started to sleep through from 11pm til 7 without needing to be fed.

For the last couple weeks I have been expressing for the dream feed and my husband gives this. I usually get (almost exactly) 4oz when I express at 10ish but as he will take 5-6 I have topped the 4oz up with formula when I have no ebm left.

The last couple of evenings the little man has got angsty and frustrated at the bedtime feed - last night after not long on the boob he was crying and pulling away which he's never done - swapped from side to side but no difference. He was really angry and I was quite freaked out so I offered him formula and he took 7oz!! I expressed straight after the feed and got 2oz. Today I tried swapping him from boob to boob at each feed (which increased the total time he spent at the boob) to help increase supply and he was much less angsty tonight but still took 2.5oz of ebm after he had finished feeding (he is a quick feeder and I can never tell whether anything is coming out after the initial gobbling frenzy - doesn't seem like he is swallowing that frequently).

As a general note he is not a voracious feeder and is not angsty between feeds. He feeds pretty quickly, average feed between 10-15 mins. He has always been this way. When he was newborn he was slow to latch (totally fine after first 24 hrs) and sleepy - I had to wake him to feed every 3 hours until he was about 4 weeks.

My questions are:

1. if I am getting only 4oz at the 10pm expressing, is this indicative of how much he is getting per feed? It doesn't seem enough. Am bit worried about his weight as since 9weeks he has trended from his birth centile of 50th down to 25th.

2. if I want to express to increase supply, how often and when is the best time to do this? Also if I express between feeds in the day won't my boobs be emptier when he feeds? I think maybe the resson the bedtime feeds angsty is because the 5pm feed is too close?? My boobs are pretty I'll in the morning so am going to start expressing then too.

Sort of freaking out as I don't want to end up giving him more and more formula but at the same time don't want him to be hungry! Though this bedtime angst is pretty recent (last few days).

Hiya

I would recommend you to check the kellymom.com website.

I had a period of paranoia when I thought my supply wasn't enough and a lot that I read I remember would apply to your questions:

• The amount you express isn't necessarily how much your baby feeds. Your baby can extract milk far more efficiently than any pump out there.

• To increase supply, the key is the frequency more than how long you feed and express for. Make sure your breasts are empty after each feed.

I tried to find where on the site I read that there is a reason why a baby will take a bottle after a breastfeed but I cannot find it!

If your baby is 19 weeks you have gone a long way with breastfeed and I am sure you have done very well. Mine is 18 weeks.

Mine was born a big girl and is now at a healthy 6kgs 700grams. She also dropped the same centiles as yours but that is normal.

If your baby is gaining weight and is not drowsy, is playing well and achieving his developmental milestones you have nothing to worry about.

Continue the good work by making sure you feed the baby as often and for aslong as she likes from both breasts.

Good Luck x

Pumping doesn't = supply just how much the pump could get out.

Do you only bf 5 times a day? That may not be enough to keep supplies up (you say your Ds sleeps from 11-7 but that you don't bf from 7-7 and pump at 10).

Are you feeding on a schedule/routine or going by baby's cues (looking and licking, licking lips, mouthing, wriggling, etc)?

I would generally expect a baby to need around 8 bfs a day (if not more) until they were well established on solids.

If you want to carry on bfing, stopping the formula (or limiting it to one time of day at a push) is the only surefire way to do it. Depending on how long you have been adding in the formula feeds, and how frequently you have given them, may mean you have to do it gradually rather than suddenly. As for each time you use fm rather than bfing that tells your body you need less milk, if it's been going on a long time your body will need to catch up.

If you want to express more to increase supply then expressing after baby has fed is a good way (it might not get much out but the additional nipple stimulation will signal more milk to be made in the future).

You could try talking it through with one of the bfing helplines, so that you have a clear idea of what would work best for you.

Hope you get some answers that work for you.

Thanks :-)

I read the Kellymom stuff - to be honest I don't agree with the article about why a baby will take formula after a BF, for my son anyway; it basically says that often formula is offered when the fussing would come to an end anyway and that the wolfing down formula is a reflex action when one suck leads to another. For us, he was not tired / coming to the end of fussy stage and when he doesn't want to take from a bottle he won't (we have seen this at the dream feed quite a lot!). I think in this instance he must have been hungry??

I do try to make sure boobs are empty between each feed (though other than in the morning they always feel pretty empty but I assume this is just because my supply has adjusted) but I guess maybe am not feeding frequently enough?? He doesn't seem to want more frequent feeds though... Is just at the bedtime one the last few days he has seemed grouchy!

I am - other than the last couple days when have twice had the bedtime angst - only giving an ounce or two of formula which is added to the ebm I get for the dream feed. So always at 11pm feed.

I am following a routine I guess but he doesn't seem to exhibit hunger cues for additional feeds - I was previously feeding him at totally random times of day on what I thought were his cues (now wondering whether Iwas just feeding him each time hesqueeked!) and he was much less settled. He seems much more content now being fed at the same time each day?? His day and night sleeping is much better too.

Oh and to be clear in those last couple of days when I have offered him formula when he has been seeming really angsty, I have offered him the boob before then for as long as he would have it in his mouth!

Yes he has five direct feeds a day and one expressed, so six in total. Eight BF a day to maintain supplies? So if a six month old is sleeping through 7 til 7 that means it would be feeding every hour and a half or thereabouts? Isn't that newborn frequency? Sorry if I am really ignorant here! Is just of the other babies I know who are BF and sleeping through, none of them are feeding that frequently? Also that would mean they never get a long sleep in the day?

Hi i'm a midwife and agree with Truthsweet, you need to feed more often to increase your supply. Also, a hormone called Prolactin that is only produced at night ensures you milk supply is up to speed. If you could move your last feed to say12.30 at night this would help and bear in mind your greatest supply is around 4-5 am in the morning (not at 11pm at night). Another way of increasing your milk supply, especially if your baby is going through a growth spurt.. have a breastfeeding day and go to bed with your baby and try and feed all day. by putting in the hard work that day the following day you'll have built up your supply. Good luck

Thanks guys. Will have to work on getting a few more feeds in from the sounds of things!

Do you both think that it sounds like I have low supply in the evenings?

Hi Citymonkey - I am having something pretty similar with my 18wk old DS. Do you think it could be a growth spurt? My DS is EBF and I have never topped up with formula/EBM, so I am planning just to push through this, but it is hard! By evening time my DS is so frustrated he won't settle to feed properly, my breasts seem very soft and DS keeps pulling off and shouting.

In my case, I've always had oversupply and DS has only ever had one side per feed until last week. This meant that milk built up in the other side and there was always a gush when he latched on. Now he's just started taking both sides at a go and wanting to feed again an hour later, so of course no gush...and boy is he unhappy! Like you I am keeping him on the breast as long as he will stand, but at the moment that's not long. I know there's some milk in there because I can slowly express an ounce or so even after he refuses to stay on. Instead of topping up then, though, I'm distracting him for 20 mins or so (hard work!) and putting him back on the breast until he gets frustrated again. Would that possibly work for you instead of the top ups?

Sorry not to have more suggestions for you...I'm struggling with this too but am really hoping it's just a growth spurt phase.

Hey there - I had oversupply too and he would only have one side until about 10 weeks though he then started to take both. A gap of 20 minutes wouldn't achieve much for us as I don't think - as we are talking about the bedtime feed he would start getting really tired.

I considered growth spurt but for us it is really only at bedtime feed?? He is just not that bothered during the day - today after about 6mins on first side (usual for him) he started chatting to himself and making mmmm mmmm noises which though v cute was frustrating as I wanted him to eat!!

How frequently does your LO feed?

I have been expressing after morning feed today (2oz) then at about 12:15 (previous feed started 10:30ish) (1.5oz) and he has fed at 2ish, then will feed 4:30 and 6:40 ish so am hoping by extra stimulation supply will inc a bit over coming days and I will also have more ebm to give him at bedtime feed if he wants it. I will also express right after the bedtime feed, and then again at 10ish for dream feed.

I think it mite help if you both understood how milk production works. After the first few week's, milk prodution is controled completly on a supply and demand basies. The more milk that is removed from the breast the more you will produce.

A breast that feel's hard and full is actualy a bad thing, this actually slows down milk production. When a breast feel's soft and empty milk procution speeds up. Most women with a well estabished milk supply don't feel full and don't leak (although there are always some exeotions).

Pumping is no wear near as efficent is direct feeding and if you have only been pumping at the 10pm feed and then baby is going all night without a feed this could be casusing your problems.

Reasrch has show that baby's will take more from a bottle, it also seem's to be the main factor in why bottle fed baby's (doesn't matter what's in the bottle by the way) are more at risk of obisity. Due to the faster flow from a bottle and not being able to control the feed as easily as from the breast.

There is more info hear on Kellymom website about milk production www.kellymom.com/bf/supply/milkproduction.html

It's a very good website and well worth a good read.

Hello again - my DS is like yours and feeds about 5 or 6 times during the day, but then feeds a few times at night as well (in fact at the moment is waking very frequently to feed, although a few weeks ago was sleeping 7-hour stretches). Again like you I'm finding he is most fussy in the evenings and gets frustrated much more quickly on the breast. My milk flow is definitely slower then than in the mornings, when he is a lot happier during feeds. My breasts do feel much emptier in the evenings, I think because he clusters a couple of feeds together around then. My current policy is just to offer feeds more often throughout the day and increase supply a bit that way - and distract him when he gets annoyed with slow flow.

Thanks MigGril - I could try BF him for the dream feed but I stopped doing this because he would fall asleep after a v short time... Now he is sleeping through after 11 I am obviously loathe to wake him for a feed!

This might be too much info but I am keen for the views of you BF gurus...

This morning my period came back - this is the first I have had since getting pregnant. It has been about ten days since I totally stopped feeding the little one through the night as he is sleeping.

Could this account for lower supply last couple days?

It could well do - I had my period back at 9w pp with DD1 (she was only ebf from 8w) and from then on I had a fussy day or so at ovulation and just before my period. I did a bit of research and tried Calcium/magnesium supplements but I didn't really notice any difference personally. Might be worth looking into for you (DD1 is nearly 6y so there may be new research/info out now).

With DD2 & DD3, my periods came back at 11m pp with both of them and I didn't have those fussy days.

Thanks TruthSweet - am furiously googling. V interesting to hear your experience!

Hi again Citymonkey - bizarrely my period also came back the day after my last post on here (annoyingly early). I hadn't made the connection, but now that I've seen your post I'm wondering if that was connected for me as well... Off to do some googling too!