Not enough milk - what else can I do? want to b/f exclusively

[osaenlondres]

My baby is 8 days old. Had skin-to-skin with her immediately after ELCS (and my husband had her on his chest as soon as she was cleaned), colostrum appeared within the first hour, breastfed in hospital all the time. Milk started coming in on day 4 but in small quantities. Never had the much-described engorgement. On day 5 DD got jaundiced and visiting midwife recommended using formula in addition to b/f. We used the bottle for a day and then switched to using a syringe instead. DD is ok now, less jaundiced and stopped losing weight. Two days ago the NCT b/f class counselor came to help me improve the latch. She suggested b/feeding and pumping afterwards - doing this combo every 3 hrs, which I am folllowing. My diet is good, I am getting LOTS of help from my DH and my mum. I was hoping to produce more milk but after DD nurses for about 15' on each breast I get between 3-6ml of milk with the pump (hired industrial Ardo pump). After nursing my DD still has appetite for 30ml of formula, which makes me think I produce tiny amounts only. Has anyone had this before and managed to get their milk supply to a required level. what else can I do to improve the supply? I alternate between being optimistic (thanks to my DH's support) and feeling guilty (unjustified, I know).

osaenlondres, sorry to hear about your difficult start :(

I am not sure why the midwife suggested formula on day 5 - sometimes babies do need more milk because of jaundice, but her first suggestion should have been to feed your baby more often - both by increasing the frequency of feeds and by offering two, three or four or more breasts each time ('switch nursing'). This boosts the supply and of course gets more milk into the baby. An 8 day old baby can easily come to the breast 12-15 or more times in 24 hours - the more times your baby removes milk, the more milk you will make :)

The other way of getting more milk made/into your baby is to feed and express, which you are doing...but you might want to call the breastfeeding counsellor and ask about doing the feeding more often/switch nursing things instead, or at least reducing the expressing which is very time consuming.

At the moment you are feeding in the most difficult way :( - direct, expressing and topping up with formula. The small amounts of formula you express are not a guide to how much milk you can make (as 'performance' with a pump is variable) but you are right to be concerned about making sure your supply is maintained....30 mls of formula at every feed is a very large amount, and while it's not a good idea to simply drop the formula altogether, you, the midwife and the breastfeeding counsellor need a plan to reduce it, so your breastmilk has a chance :)

Hope this helps.

Sounds like great advice from others. Just wanted to add that dc3 is now 6 weeks. Tried expressing at 3 weeks to give nipples a break and I got literally nothing. Had a v good double electric pump so I know it should work. Anyhow, he has put on a good amount if weight so i can look back and realise that the amount I was getting from expressing was not indicative of what he could get out.

If yiu want to improve supply I would just try to let her feed more often.

Don't feel guilty, whatever you end up doing. There's enough to cope with without that as well!

Oh OP I could have written your post word for word 5 wks back. Hang in there, DS is now 6wks, EBF and a very happy baby.

Good advice above and thank god for good support from DH as it's a very stressful time but be sure you can do it. I struggled with conflicting advice from every midwife who visited and ended up just choosing a path which seemed sensible to me. Breast feeding, offering the top up (was too afraid not too after midwife #2 said he wasn't gaining) but only c20ml then back to breast for as long as I could with lots of skin to skin. Took time but we got there by end of week 3. I also take fenugreek supplement and drink fennel tea, not sure if it helps but anything was worth a go!

Good luck and congratulations!

thanks a lot everyone. I think we are getting there - albeit slowly. Had another midwife visit just now, thankfully this mw did not have any suggestions - every single one of them had her own view conflicting with the rest....their senior midwife advised me to give a baby 100ml(!!!!) formula at each feed - what was she smoking?!!!.... anyway, all day y'day and half the night of skin to skin and demand feeding resulted in happier baby. still gave her formula (to make sure she does not lose weight) twice in the past 24 hrs - 15ml at one dayfeed and then 25ml at night as she cried until we gave it to her.will continue with skin to skin and frequent feeding/pumping now. still wondering whether I should expect engorgement at some point or gradual increase will result in fuller breasts and more milk without sudden big inflow of milk?

ah, and DH is on his way to Holland&Barrett to buy fenugreek and fennel tea. Fenugreek was also suggested by the NCT breastfeeding counsellor who recommended switch feeding and expressing afterwards. We are planning to go to the drop-in session with this counsellor tomorrow as well.

thanks a lot for the advice and support!

I would completely ignore the 3 hour thing, stop expressing and topping up and just feed her whenever she shows the slightest sign of asking. The best way to increase suppy is to feed. Maybe just stay in bed with her and cuddle feed all day if you can?

I could never express however hard I tried- and I was hardly ever engorged, but I fed both of mine exclusively for 6 months. Good luck!

osa, things sound a lot better :)

You may find you notice a change in your breasts, but then again you may not - your guide is your baby, her weight gain, her poos (should be several soft yellow ones each day now), her contentment and her willingness to come to the breast.

You are right to gradually decrease the formula.

I am shocked at a midwife suggested 100 mls top up of formula per feed. That would be a lot for a solely formula fed baby, but for a bf it would scupper bf very quickly.

For what it's worth I never really noticed much change in my breasts, however there was a gradual change in DS which gave me comfort all was going to plan. Nothing nicer now than him pulling off with a lovely milky drool face and sigh of contentment

If a baby is feeding well, then you may not experience engorgement at all. That's a good thing, engorgement is very unpleasant!

Has anyone talked to you about breast compression? That might help, as well, and it's less faff than expressing ...

Yes, the b/f counsellor from the NCT ante-natal class came in and showed me breast compression. I am doing it now but will also going for a drop-in at her place tomorrow to check whether i am doing it right. I can definitely see some swallowing when i do this. Today midwife registered 80g decrease in weight compared to Saturday. Might be real decrease or difference in scales (different midwife, different scales) or even difference in the weight of the nappies (none has suggested taking a nappy off in all the weightings). am thinking that maybe I should buy scales to measure the progress myself?

The midwife weighed the baby with a nappy on?! [shocked]

Do you know where your local well baby clinic is? I would go there rather than trust these midwives who are weighing babies in nappies. Children should be weighed naked until they're 2 years old!

Skin to skin time is still really valuable now, it's not just for post-birth. Spend lots of time relaxing with your baby and having that skin to skin, allow free access to the breast, whenever she gives any kind of clue she would like a drink, let her have a go.

Day 8 is still very early days for breastfeeding and it sounds like you're actively seeking support. Good for you, you will get there in the end

Very poor practice to weigh babies with nappies on :(

Scales and weighing should be accurate - otherwise what on earth is the point of doing it?

Would be a good idea to have her weighed at the drop in tomorrow, if poss, so you have some idea if she is gaining.

You've had excellent advice from other posters. I agree - offer your breast as often as you can and then the other one. Feeding signals to your body that more milk is needed. I'd give expressing a rest for a bit - babies are normally far more efficient than breastpumps. Even now at 8 months sometimes I can struggle to express much at all. Engorgement is common but if you think of it like your body calibrating the required supply, then you're working your way up to the right level of supply, rather than working your way down from too much. I'm sure you'll get there.

I agree with everyone here - when I was getting back to EBF ( LO was EBF, then had to add formula/EBM, then soley formula, and back to EBF. and now mixed fed but mostly BF, it's been a bumpy few months!), I found the best thing was to switch sides constantly. Everytime he 'popped off', I'd see if he needed burping and then offer the other side. Feeds would sometimes take over an hour, but it was worth it because I really wanted to make it work!

LO also lost weight, and on day 3 we were advised to give him 54ml (yes, 54 exactly :/) of top up after every feed.

I agree that weighing with a nappy on is bad practice.

just to totally hijack, both my DSs were weighed in either nappy or even nappy + vest after they were a few days old.

i always thought it would be a bit inaccurate. I get the impression the HV wanted to either save time or avoid poo and wee on the scales! DS2 got weighed fully clothed (zip up jumper and all) at 5 months last week, he is kinda huge and healthy so maybe accuracy not thought important by some?

jaggy, it's not that uncommon for this shoddy practice to take place - weighing is an intervention, with clinical implications, and needs to be accurate, otherwise it is a pointless waste of time at best, and at worst, it can lead to misleading conclusions.

A huge and hearty and clearly thriving 5 mth old like your ds does not need to be weighed at all - so it's a pointless waste of your time and the HV's time.

Feed, feed and feed.

Tbh I think the absolute minimum you should be feeding is every three hours. You should be feeding frequently and on demand. If baby is unsettled try boob first.

And as others have said pumping is no indication of supply.

that was my bad tbh. we are encouraged to pop in occasionally for weighing if we want. i never intended to bother, but he is so huge compared to my oldest i was fascinated to see what he weighed. no scales in my house.

Agree with Itsall - if she makes the slightest peep, stick a boob in. Found this to be a fab technique when getting back to EBF.

Hijack again - my LO always gets weighed completely nude, he was last weighed a few weeks ago, aged 4 months. HV always offers, and it reassures me (and paranoid Dad) that he's growing well. Only takes a couple of minutes to whip all his clothes off and on again.

Really sorry to hear you've had a difficult start, OP. I also started with top ups alongside BF after an EMCS. We gradually weaned DS off the top ups, just as you are doing, and we are still BF 13 months later!

I didn't get that 'full' feeling until about three months in.

My HV hated weighing DS (naked). He weed every single time. Once, he managed to pee straight into her cup of tea. It was a bloody marvellous shot !

Not sure that I would recommend buying your own set of scales. I only say that as someone who got incredibly fixated on weight. It made me really stressed and unhappy.

Very best of luck with it all.

"Children should be weighed naked until they're 2 years old! "

Healthy children don't need to be weighed at all once past little babydom!

Healthy Child Programme policy to weigh and measure under 2s naked.

No, if they're healthy, they don't need to be weighed very often at all, even in the early weeks but a lot of parents find regular visits to Well Baby clinic very reassuring and they're also a chance to get out of the house and see other humans but are less intimidating than a mother and baby group. The value of them shouldn't be underestimated.

I would breastfeed at any signs of baby wanting it, being awake, stirring, rooting etc. Also, I would keep my eye on the time and try to encourage baby to feed at least every 2hrs. If baby falls asleep at breast I would try to rouse gently, changing nappy always helps I find, and offer again.

Basically the more you feed the more milk you will produce. Also feeding at night stimulates supply so as tiring as it is, feed as much as possible then too.

When the baby has started to gain well, then you can go more on demand but until then I'd be actively encouraging baby to feed.

I don't think I'd offer the formula unless baby is obviously unsatisfied. I'd keep switching breasts for as long as you can manage too. Should be a fair few wet & dirty nappies (check kellymom website for amount) and baby's lips should be moist.

Drink lots, eat well & rest with baby between feeds.

Let us know how you get on

Soory to hijack but very interersting thread. I too am having problems feeding. It was so bad that dd was readmitted to hospital on day 5 due to a huge weight loss. At the moment she is going on the breast at least 4 hourly but also as soon as she wakes if before. Also topping up with formula.
Will certainly be taking tip of switching breasts. I do this when I pump and it seems to help.
I am also wondering if its worth taking medication to help increase supply.