Low milk supply - baby not getting enough hindmilk

[marshmallowpies]

I have a DD who is 9 days old and on being weighed by the midwife today, it turned out she's now lost 13% of birth weight, which is enough of a concern for them to suggest she has some amount of formula daily as well as BFing.

My BFing was very slow to get started in hospital and we had to use donor milk and some formula while we were there. First few days at home seemed to be fine, and we'd phased out formula - then we were getting to a stage where she was feeding for hours and hours without ever seeming satisfied.

I have also tried expressing and never seem to get more than 15-20ml over a half hour period of pumping (after doing massage, hot flannels etc beforehand to get it going).

MW also asked what colour the baby's poo was - at the moment it's still brownish rather than the yellow colour we should be expecting. MW said this could be a sign the baby is not getting enough hindmilk in the feed - and based on the small quantities I'm getting when I express, I'd say there isn't enough milk full stop. The milk I am pumping is thick and yellowish, though, not watery, so it looks like hindmilk to me.

I'm taking milk thistle and fenugreek, and will carry on massaging, pumping, etc and keep putting her on the breast first before giving her formula, but has anyone else had a similar experience or any advice for getting milk volumes increased?

(P.S. DD was a C section birth after being breech, which may be another contributing factor).

Can't post a lot as on the hop. Others will give more info I'm sure, but:

How much you express has nowt to do with what baby is getting. Baby is the most effective 'remover' of breast milk.

New babies DO feed for hours at a time. Best way to tell your boobs what they need; HOWEVER if weight gain (or lack of it) is an issue it may be that baby isn't transferring milk very well. Sounds like you need real life support with someone who'll watch a whole feed from start to finish to help you out with latch & positioning.

Do you offer both breasts per feed? And swap again if baby wants more? The foremilk/hindmilk thing is very often misleading and downright wrong. I'm sure someone will be along to give you the lowdown on it.

Weight loss is an issue and formula shouldn't be ruled out but if you want to bf (and it sounds like you do) every formula feed you give is one feed your boobs don't know they should make. Can you find a local bf counsellor/lactation consultant who can help you and your baby get the most out of each feed?

Most of all - congratulations on the birth of your lovely bairn!

Thanks mombo - I've already been to a BF cafe and will go back next week.

The MW there did give me advice about positioning/latch and I think it did improve my latch a lot - but evidently not enough.

In terms of which breast I've been offering - DD has always been less happy on the left breast and I've experienced more pain with the nipple on that side, so I've been pumping from there more often and feeding less, but I do put her on there at least once a day.

In terms of time spent feeding - as an example, last night I started feeding her at around 6.30pm and it carried on until midnight when she finally went to sleep. Any time she wasn't on the breast during that 5 1/2 hour period (e.g. while I was wolfing down my dinner in 10 minutes flat) she was crying out for more food. So that's quite a long sustained time nursing as far as I can see!

I was also told in hospital that I had flat nipples AND milk ducts that were quite far back - a bad combination meaning she has to work extra hard to get the milk out. Feel so sorry for the poor girl working so hard and seemingly getting so little in return for her efforts!

Sounds like you've been given some incorrect info and some misleading. Is there a lactation consultant in your area? That would be the best person to contact. Most midwives are not very clued up about bfing at all.

In the meantime put baby to breast as much as possible.

Could you get some real support from a breastfeeding councilor?
It sounds to me like the mw's information may be a little outdated, and may not help you as much as someone who has up to date training.
Has your baby been checked for a tongue tie? This can be tricky to spot, and can cause an inefficient latch.
Could you try feeding her in a different position on the left side so she's more comfortable? If you are only feeding her once a day on that side you may find the supply goes down on that side. Pumping isn't nearly as efficient as a baby feeding.

I hope you get this sorted out :)

Are you getting some sleep? Are you making sure that you're drinking enough - you need to be drinking a LOT, and eating really good food? Your body is doing an important job and you need to be taken care of.
Have as much skin to skin time as pos, you've only been doing this for 9 days and it's normal for babies to lose a bit of weight to begin with. You'll learn how your breasts feel when they're full and when they're empty and when to swap your baby over.
Get in contact with La Leche League or similar as the latch on your left may not be as good as on your right, which might be why it's uncomfortable that side.

Don't worry about how much you can express, it's very ineffective in comparison to a baby.

Thanks for all the advice - yes I probably need some advice on latching on the left side as I tried her there just now and she wouldn't latch at all, just grizzled, but happily latched on the right hand side and fed there happily for around 50 minutes.

One of the issues I've found is you end up seeing so many midwives and each has their own ideas or pet theories, none of which are necessarily wrong, but may not all apply to me. Definitely going to investigate lactation consultants, have got the LLL book about BFing and will look into my nearest local group.

Sorry you are having a struggle, marshmallow.

Firstly, while it is true to say expressing is not an indicator of anything, it works both ways ie a pump can be 'better' or 'worse than a baby. If a baby is not transferring milk effectively, a pump may do the job better, and it is totally appropriate from what you say here to express while your baby and you are in this little crisis. Expressing protects* your milk supply and yes, you need to be doing it at the moment.

You need a good pump, and to express many times day and night, and with the right technique - a breastfeeding counsellor will help you with the right knowledge of this. It's not so much the time on the breast, as following the 'signs' your breasts give you - when the spurts become a trickle or drips, swap sides, and then swap sides again and again, over a period of about 20-30 mins.

Secondly, you intake of fluid and food has virtually zero effect on quality and quantity of milk. Far, far more important than this or herbs or magic or anything else, is effective and frequent removal of milk from the breast.

Thirdly, yes, the continued brown poo does indicate insufficient hindmilk, but that is because she is getting insufficient milk - once her volume of milk is ok the foremilk/hindmilk sorts itself out without you needing to do anything :)

She needs plenty of practice on both sides - offering the 'bad' side once a day or so won't cut it but if you do no more than this, you must express often (at least 8 x) to make up for the lack of stimulation.

A call to a breastfeeding helpline will enable you to check out all the info you find here and on the internet and help you work out what is the best strategy for you.

Meantime if you are using formula, that may be necessary temporarily so she has the energy to learn to bf well - working on getting the bf right will sort it :)

I had a low milk supply too although a pump exclusively. I am now taking Domperidone which is helping.

sorry to hijack.

Tiktok, would brownish poo in an older baby (mine is 9 weeks) also indicate insufficient milk intake?

kansasred, in a baby who's beyond newborn, who appears healthy and who is thriving, I wouldn't worry about the colour, to be honest....but ask your HV :)

I'm assuming everything else is ok with your baby, kansasred.

I have started another thread tiktok - would you mind having a look?

www.mumsnet.com/Talk/breast_and_bottle_feeding/1465264-Please-help-me-decide-what-to-do

you must keep feeding her "as normal" from the left boob - i had the same prob;em with DD - i think it was because I couldn't hold her as well as i could on the right side.

i just used to do a longer feed on that side to get used to how to hold her.
also, maybe try the rugby ball hold? (dd same direction as for right boob, and tucked under your armpit)

I fed last night & this morning from left boob successfully and could feel the right one was a lot fuller so switched back for the afternoon feed. She's just fed for about 50 minutes & gone straight to sleep in bed next to me so I'm very pleased!

Definitely not tongue tied in my case: MiL is a speech therapist & the first thing she did was check DD's mouth for any sign of it!

I was trying the rugby ball hold at first but DD seems not to like it now. I do still try it if she is refusing to settle in the cross-body position.

Thanks again for all the good advice so far!