DC3 - help me get bf right this time

[Bewildened]

So I’ll start by saying I have 2 DC who were ebf - DC1 to 13 months, DC2 to 18 months.

But I had an awful experience in the early days with both and I really want to avoid that this time.

Both were born very healthy weights - DC1 75th centile, DC2 90th centile, but both dropped 2 centiles and didn’t make it back until weaning.

Both had tongue tie. DC1 was not diagnosed - only realised when he was about 6 months even though it is extremely obvious! My nipples were shredded and bleeding but I thought it was normal. I assumed this was the reason for his slow weight gain so got a lactation consultant for dc2.

DC2 had her tongue tie cut at 4 days. But she also didn’t gain as fast as expected. Lactation consultants said all was fine.

I now know that I have mild PCOS (regular cycles, normal bmi, no outward physical symptoms but the right hormonal profile and cysts on ovaries) and I think I also have mildly hypoplasic breasts (widely spaced but normal shape and size). I have hypothyroidism though it is well-managed with thyroxine. I understand that all of these are risk factors for low milk supply.

Other things that are/might be relevant are that: my breasts do grow during pregnancy but I have never leaked milk ever and cannot express more than a few drops when pumping. I tried power pumping with dc2 and it was miserable.

I really want to breastfeed dc3 so I want to set myself up as well as possible this time. Does anyone have any recommendations for specialists who can help me? Will domperidone make a difference? Is it possible I’ll make more milk this time as it’s baby 3? Or should I accept that I need to combi feed and start this from the beginning?

Bumping this

Hi OP, I have PCOS and had gestational Diabetes with 2nd baby now 3 months. EBF going much better than my combi fed first baby. I found there to be a lot more support with GD than low risk pregnancy.
Few things to help- talk to midwife about expressing atenatally from 37 weeks onwards. mostly for practice and you may even see and able to collect colostrum. keep hand expressing skills in hand as this is the single most effective way to bring supply up quickly after baby is born and any colostrum harvested can be given to baby by syringe if there are latch issues and you need to work through them.
Breast compressions early days and weeks especially with sleepy babies
if pumping, measure your nipple and make sure you are using the right flange size. Use hand compressions while pumping to improve output.
Remember end of the day- fed is best and seek support early from your local BF support group.
And congrats on DC3! good luck :)

Congratulations on baby three.

Some advice that comes to mind...Join a local NCT breastfeeding support group towards the end of pregnancy. Book in for tongue tie assessment as soon as baby is born as it's very common to run in families. If you can find a local infant feeding coach I'd also invest in some support, otherwise follow people like Sarah Ockwell Smith, Kathryn Stagg etc who do a what to expect day to day of early bf. I had home visits from my local breastfeeding support service most days the first few weeks with one of mine and have gone onto feed all of them until 3. It's great you're thinking ahead.

Thank you @Poupoush31. One of my main problems is that I’ve never been able to express or pump really any milk at all. I know that I do make some milk as I did ebf both DCs, so I think that pumping just doesn’t work for me.

I’ve been considering trying a hospital grade pump but not sure if it will really make a difference - is it worth a try or am I just one of those people who can’t pump?

I will definitely get this one checked for tongue tie again @5475878237NC as all the babies in the extended family have had it.

I just have this lingering feeling that I also have low supply, because DC2’s tongue tie was sorted very quickly, I did all the right things with breast compressions, frequent feeding on demand, pumping to stimulate supply, I know what a good latch is etc etc, and yet she still dropped down the centiles and gained more slowly than she should have. I didn’t ever supplement her because she actually refused a bottle and once she went onto solids she ate really well, but I hate to think that she was hungry! I was also very stressed and miserable (also had PND and it was during covid so hard to access support and pretty awful all round).

I am desperate to avoid that situation again so want to do whatever I can to prepare in advance.

You're right its very possible to not be able to pump but still successfully EBF so don't sweat if this is not possible. I used a hospital grade pump first time around but finding my manual pump working much better this time- go figure. It unfortunately depends on so much. However I will still advocate for hand expression as technique is everything. WHO have excellent videos. Boob School on Instagram also has very good for resources
Try not to be anxious- hard I know! but anxiety may not help with supply. You sound like you will be an amazing mum and your DC are very lucky to have you!

Lots and lots of skin to skin.
Get tongue ties assessed and sorted
Reduce stress to encourage milk production.
Nipple shields and creams.

As you can tell by my user name I have walked the walk with low supply ! Fair play to you for keeping going. The good news is that if you do have hypoplasia, then feeding builds breastfeeding tissue so your supply is likely to grow with each baby. Of all the supplements I tried I found moringa best (do check this with an expert). If you do need to supplement then try a supplemental feeding system. But honestly you sound like you've done an amazing job twice already!

Thank you so much for the replies.

@BfwithIGT how did you find out you have IGT/hypoplasia?

That is amazing to hear that feeding builds breast tissue - fingers crossed that is the case for me. Did you try domperidone?

I was diagnosed by an IBCLC who I attendee during my 2nd pregnancy. There was no doubt in my case, very visibly obvious. I only made 1/4 of my son's needs using a hospital grade pump etc but better than nothing! Motillium / domp didn't do much for me, moringa did. There's a good book called Making More Milk with more details

Thank you @BfwithIGT that’s amazing you could do 1/4 💪🏻.

I have seen various lactation consultants in the past but none of them ever looked at my boobs! (Well, they did watch me feed but no one ever properly examined them or said anything about it.) Even among lactation consultants it seems like there is massive variation in expertise and it’s so hard to get good quality advice, which is partly why I’m starting now.

My feeling is that there are lots of things that probably all play a part for me in making low supply - endocrine issues, physical issues, and issues with the baby.

I can sort the latch and any tongue tie out, and am now taking myoinositol and will follow a pcos diet which I hope will sort the endocrine issues, and I guess I’ve just got to hope that those things together + a hopefully slightly boosted supply with dc3 (helped by some supplements of some kind) might mean I’ve got just about enough milk this time round.

I loved breastfeeding my babies despite all of the above so really hope I can do it again.

Just bumping this in case anyone has any more insights.

Purely anecdotal, but I read oats help to increase milk supply, so had porridge for breakfast and made flapjacks for afternoon snack. (I bf dc1 for 12mo, dc2 for 21mo and dc3 for 30mo).

Thank you @daisydalrymple - I am a big fan of porridge fortunately!

Does anyone know whether it is worth pumping (maybe with a hospital grade pump) even if I don’t really produce anything with a pump?

I had similar issues when I started breastfeeding my DS (PCOS, wide-spaced breasts, almost no leaking, and I wound up in hospital shortly after my DS was born which knocked my supply). I got absolutely nothing from medical-grade pumps but did get on ok with a basic manual pump. Bear in mind it's definitely worth making sure you have the right flange size - often the flanges supplied with pumps are far too large. I think if you're not getting much even with those changes, though, then pumping might not be worth it since you're not removing much milk.

I also took Domperidone which worked really well for me, although I know lots of women get on well with moringa supplements instead. There's a Support for Mothers on Domperidone group on FB which you might find useful to look at if you are thinking about that route. The other supplement that I felt made a big difference was goat's rue, which I took to increase breast tissue.

Best of luck to you this time around! You've done an amazing job already 👏

Thank you @lovelylight this is very helpful and reassuring. Did you take goat’s rue when you were pregnant? And was your GP happy to prescribe domperidone? Did you manage a full supply or did you need to supplement? Which manual pump did you use?

Sorry so very many questions!

Not at all, happy to help if I can!

I didn't start taking goat's rue until DS was a few weeks old and I definitely think I experienced growth in breast tissue but only in the first week or two of taking it. I finished the bottle just for the sake of completeness, but I think it's something you could stop if and when you see results rather than having to stay on for a good while.

I did manage a full supply eventually but it took a good wee while. By the time I came out of hospital DS was essentially exclusively formula-fed, in that he would latch on to me and feed for a bit but he was getting all his calories from formula. We dropped that very slowly over the course of about 10 weeks, to the point where he was having just one bottle in the evenings so that my DH could do that feed and I could get some sleep. I started off by expressing for that bottle but I eventually found that so time-consuming and stressful that I stopped and we went back to formula for that feed. My DS is now 2 and still breastfeeds although obviously supply issues aren't a concern any more.

I used the Medela Harmony manual pump which was about £20 from Amazon and it worked much better than electric pumps, but it does require you to have two hands free and 10 minutes when you won't be interrupted! As I recall I don't think I bothered to change the flange size on the manual pump - it might have been smaller than the one that came with the electric pump anyway.

Domperidone was a bit trickier... my GP did prescribe me a small amount on the recommendation of my midwife but I got the impression he didn't really want to, and I think it was because I'd been in hospital away from the baby rather than just because I was struggling with low supply. I'll PM you with a few more details about my experiences there.

Thank you so much @lovelylight that is all so good to hear.

Im really hoping I have a bit more milk this time round as it is dc3. It’s such early days (I’m only 7 weeks pregnant!) but I’ve already had to stop wearing my normal bras so feel like that bodes quite well. I’ll look into the manual pump too. I have one of the silicon ones that you stick on but that never really did much for me.