Why don't I have enough milk?

[JaimeLansinoh]

My DS was born 4 weeks ago by EMCS at 40+13, skin to skin and latched on within the first couple of hours of birth and at first it seemed like breastfeeding was going well, feeding 8 ish times per day, 20-30 mins on each side, cluster feeding, good latch, strong suck, no tongue-tie (all confirmed by BF specialists), poos and wees all as expected. BUT he didn't gain any weight at all after the first week and was still a lot under birth weight at 3.5 weeks so we started topping up with formula after every feed 5 days ago. The difference is dramatic and he is so much more settled and gaining weight so he clearly wasn't getting enough from the breast. I have started expressing with an electric pump but struggling to get more than 30ml in a 24 hour period from 4 pumps (10 mins per side). He is still on the breast at least 6 times a day for 30-60 mins each time switching sides with bottle given afterwards.

I am now taking 60mg/day domperidone plus 3600mg/day fenugreek and looking to get a hospital grade pump next week. I have tried breast compressions but have small boobs so this is interfering with his latch and impossible when pumping.

Everything I have read says that there is no reason why there wouldn't be enough milk unless various medical conditions/medications were the reason. None of these apply to me so I (and my lactation consultant) are a bit confused as to why the supply is so low. Does anyone have any ideas of what else I can do or why I have ended up in this position?

Are you very stressed by this? Try to relax, which, I know, is much easier said than done.

Sometimes supply just is low, for no apparent reason. Mine was. Dc1 got on average 10g of milk during a 1 hour feed. The poor thing was starving, until one clued up nurse finally twigged and he went from nightmare to dream baby within a couple of feeds.

Persevere, by all means, but ff is not the end of the world. Good luck xx

Thank you :-) I wasn't initially stressed as it all seemed ok but I have been recently as things have got worse! I know stress doesn't help but is it really enough to dry up supply entirely??

I know ff isn't the end of the world and I'm v relieved we're doing it now as DS was clearly starving before but I want to give bf my best shot while I can.

Are you drinking enough? It's being very warm, perhaps dehydration is a problem?

Don't feel guilty about formula feeding if you need to, it doesn't do any harm and baby's food intake is more important than where it comes from.

you say your setting a lactation consultant right. but you say your baby was feeding 8 ish times a day. That is the minimum you'd expect from a newborn (timing is irrelevant) painfree feeding is important. Your looking for more like 10-12 times and some will feed more.

I would qestion weather he was actually feeding enough to stimulate your supply enough with the lack of weight gain. If things like tounge tie have been ruled out and your site of this. Then feeding more is the most effective way to increase supply. You may well need to temporally supplement but doing this at the breast is the most effective way to increase supply. Ask your location consultant and using a supplement nursing system. Which will allow you to give extra milk and breastfeed at the same time.

was he gaining weight after the first week? It is now know that if babies who are born too mum's who have fluids during Labour as you would have with a CS. Can have an elevated birth weight some experts now think babies should be weighed for 24hours to allow them to lose the excess fluid they take on due to this giving a mute accurate weight. But we still weigh at birth in the UK.

DrJackNewman has some really good information on this on his website and Facebook page he's a Canadian pedeatration. He doesn't really believe in expressing to increase supply because, no pump is as efficient as a baby with a good latch. And it makes a lot more work for you. Have a look, another really useful resource is kellymom website.

sorry about the garbled post I really shouldn't try and post on my phone.

Thanks for the insight Mig, initially I was feeding on demand but he was sleeping for 3-4 hours at a stretch and I was really conflicted as to whether to wake him up or not and received mixed advice on whether to or not as was told he needs sleep to grow as well as food. That and it was really hard to feed him whilst he slept despite stroking feet, undressing etc. Also, with feeds lasting the best part of an hour each it didn't really occur to me he wasn't getting enough boob time. I was then told to leave 2 clear hours between each feed to ensure he was truly hungry and not just snacking so that took us to 3 hour cycles/8 in 24 hours. During that period he was screaming for hours on end between feeds so not sleeping either. Before topping up with formula he put on pretty much nothing between 1 and 3.5 weeks. He was 6lb8oz at birth so already quite small for almost 42 weeks.

I will investigate a supplement nursing system, I haven't heard of those before. The paediatrician made me feel bad for keeping him on the breast as 'he's putting all the effort in and getting nothing out' but it seems to comfort him even if there is nothing coming out so I have continued but was continuing to pump too.

It felt right at the beginning so am gutted to think I was doing things all wrong. Can I correct it now or is it too late?

Jamie, it is not too late at all!

The fact your baby's weight improved with formula is helpful, paradoxically, because it shows that the only thing wrong was simply not enough milk, and nothing underlying. It is very likely the help you got was not useful - it's rarely correct for babies to be made to wait to make sure they are really hungry, and this advice has been given by hcps who don't understand how bf works. Not your fault.

It's likely that more frequent, effective feeding will be the basis for improving your supply and your baby's intake and therefore growth.

You may need other interventions, too. You might be helped by finding a knowledgeable person in real life to discuss options. Any of the bf helplines would be useful here.

Thanks tiktok, It was actually an NCT breastfeeding advisor who suggested the 2 hour breaks, at the time it seemed logical, he's snacking on foremilk during the hot weather and not getting the hindmilk so not putting on weight, clearly not a correct theory! It was reassuring when he got so much better after topping up and I'm still hoping it will only be temporary.

What would you suggest in terms of frequency/length of feeds? And how to manage feeds when he's sleepy?

I honestly don't know why she would have recommended that. Normally we really don't have to worry about babies 'snacking'. To restrict feeding to make sure the baby does not get too much foremilk is a misunderstanding.

For now, frequent feeding, switch nursing and breast compressions are prob the way to go but it would be good to have someone you trust and who knows about bf to discuss it in real life.