Lack of milk

[Keziahhopes]

Hi. After delayed lactation, now have reduced lactation (birth - general anaesethic and EMCS) and after urates shown in nappy at 3 days old and over 9% loss in weight by day 3 I started pumping, as well as breasfeeding and got milk day 5. So far he is taking bottle and breast, but I would love to have enough milk to breasfeed. Am keen to breasfeed especially due to some medical problems I have myself to hopefully give him whatever goodness I can and have been very upset that feeding advisor said I probably would never have enough milk to just breasfeed. I will be discarged from her in a few days time, but our baby only put on 10g in last 3 days. After that under health visitor with fortnightly weigh ins.

Just wondered if anyone had any advice on how to increase milk supply, or whether they successfully managed to combine breast and bottle. Baby is now 11 days old.

It's great your baby is still only 11 days, 'cos this means it's easier to turn things round.

First off, probably no need for you to have started pumping day 3. Weight loss was within normal limits; urates in nappy WNL but a sign you need to pay attention to frequent feeding.

Whatever, without knowing the medical issues affecting you, you can improve things by keeping your baby skin to skin for as much as you can day and night; switch nursing (see archives or google) so the baby gets several 'sides' each time; breast compression (google it); limited formula/ebm (how much formula/ebm is your baby having) if you can.

How is he being weighed - naked, digital scales?

Why did the feeding adviser say that to you about never having enough milk?

A call to any of the bf helplines might also help.

Get thee to a breastfeeding clinic. Keep feeding, try co sleeping if you are comfortable with it, certainly lots of cuddles. Lots of rest and drinks for you too. In my experience people who failed to produce enough milk after a difficult were asking their bodies to do too much. Spend two weeks drinking, feeding, sitting on your sofa, having something like a yogurt and drink during night feeds. Also, I found visualising the milk flowing (sounds a bit hippy but it helped me) as I fed increased the flow.

Thanks tiktok - will certainly look at switch feeding etc that you mentioned, as never heard of it or breast compression. Am bit concerned about just been under health visitor, having met her (bottle is easier approach!) Am doing lots of skin to skin, so good to know that might help. I have immunological issues, meaning I can't fight certain infections well - which our son may have, but hope now, although we can't test until he is at least 6 months old.

He is weighed naked on digital scales each time. The added formula stopped weight loss but not really helped gain much since day 7.

He is now having up to 60ml formula each feed, told to feed on demand now after been told to feed every 3 hours till now. Until now was having different amounts each day of formula.

No idea why advisor said what she said, apart from diagnosing me with reduced lactation that hasn't really benefitted from motillium tablets either.

Also it's normal to produce colostrum (highly concentrated milk, think double cream) for several days. Baby's tummy is too small to need greater dilution. My milk came in on day 4 but anything up to a week is normal. Think about the weight of meconium your baby has lost, this seems to be greater if baby was over due and is one of the reasons for weight loss.

If baby has plump skin, good colour and is alert and content every day then don't panic.

Thanks HappyCamel - not heard of local breastfeeding clinic, will look into one now! Think increasing drink at night will help, as good in day but perhaps not so much at night.

NCT and La Leche may have breast feeding groups but the NHS can do some too. There were two sessions a week in my local church hall, it was written in my red book but I know it differs from area to area.

That's a lot of formula for a baby of 11 days, Keziah - up to 60 mls at each feed could mean, what.....um.....an average of 50 mls 8 x a day? That's worrying....with this much formula there is simply no room for bf, so do check this out with someone knowledgable (at the bf clinic, maybe?).

Try not to think of episodic 'feeds' - your baby is best off just feeding ad lib, backwards and forwards from side to side, whenever....with naps in between 'sessions' of course.
How much formula exactly is he having - how much so far today, for example?

Your own drinking and eating makes no difference to bf, but drinking and eating what and when you like is good for you.

Titktok - the feeding advisor, a senior midwife at the hospital, is the one that told me to offer up to 60ml each feed. He feeds 7 times a day (have lovely spreadsheet full of data courtesy of dh!) and days 7-10 he had to be offered 90ml. However days 3-7 he had set amounts I had to give him (in hospital, so did it!) at least now I offer it and if he is sleepy or refused he doesnt' get it or all of it. He is averaging 30-40ml each feed today, with 7 feeds probably.

I think that amount of formula could be worth a second opinion, Keziah.

Sometimes, babies need formula, that's for sure, but there should always be a plan to reduce it once the crisis is over (that seems to have been in place at least initially if you were giving 90 mls at first - a very large amount for a newborn - now reduced to up to 60 mls.)

30-40 mls x 7 x day is still a lot of formula.

As I said, a second opinion....from someone who can support you to increase and enhance your breastfeeding at the same time.

Hope things go better for you.

I would too want some advice re the formula, not least because for every bit of formula he's having he's not having breastmilk and that means you're not producing it. Also, the more bottles he has, the more likely he is to decide breastfeeding is too much like hard work.

Is there an IBCLC near to you who you could see? Or try your NHS BF clinic.

Thanks tiktok and midori about formula amounts - will try and find a second opinion or clinic next week for advice and info. In meantime am working very hard at not offering more formula than DS is asking for (but agree my biggest concern is he will find it easier and give up breastfeeding!)

Meet health visitor next week also, and see what she says about formula.

Can you offer breastfeeds at some of the times your DS is asking for formula? Switch nursing and breast compressions as advised will help. The more time he spends at the breast the more he will stimulate your supply. Have you also had the basics like positioning and latch checked?

If you google IBCLC then a list will come up and you'll be able to speak to someone in the short term who can either advise over the phone or visit you at home, although they may charge. Or ring one of the helplines? It's easier to go into more detail on the phone.

Yes midori I am offering my breastfeed before every formula - only once has he totally refused me. They checked my position in hospital, a tick sheet form.