Pumping Less - Help

[Keggles36]

I've been pumping really successfully for a week or so. This morning i got 150mls off. This evening I've barely got 30mls and I don't know why. Baby has on off fed all evening but I'm really worried my supply has suddenly died.

Don't worry, it is may just temporary and could be due to a variety of factors. How long after baby feeding did you pump? And what do you usually pump in the evenings? This happened to me a few times and then it just went back to normal.

Make sure you are really hydrated, eating plenty and if desperate, there are even special breast feeding teas! I also found that taking my mind off it and not thinking about it, bizarre as it sounds, helped!

How old is baby? And how much do you typically pump in the evening?

I’ve had two sudden drops in supply, once after a really, really stressful week & the other after a blockage.

I’m directly breastfeeding but pumped after each feed to ensure my breasts were fully drained, it took five days or so but my supply went back to normal.

@BFhelp2024 @Louve thanks for your replies! Loads pumped overnight and I've woken up massively engorged so not sure what's going on but ouch!

Baby us 6 weeks... We pump as she has been gaining really slowly so she gets a bottle in the evening and other top ups if she feeds badly. I pump 3 times/day - morning, evening, middle of night. Yesterday she had cluster feed for 3 hours before pumping so just wonder if there wasn't much there.

I normally get 60-90 in the evening, and anything from 90-150 at the other two.

I'm considering scrapping one of the expresses as I just hate it.

The best way to increase your supply is to stop pumping and breastfeed constantly.

baby is far more effective at getting milk out than a pump.

If she was cluster feeding non-stop and you pumped fairly soon afterwards, this could well explain the low amount. There is also a growth spurt at around 6-weeks. Hang in there, it shouldn't last long!

Hi.
Hope you are doing well. I'm a midwife, but I'm more labour and delivery, so I'm not an infant feeding specialist, but there's a few things I know off the top of my head.
Things that may help with the milk supply:

• put the baby skin to skin with you for periods of time. By skin to skin, I mean strip the baby down to nappy only, and their skin directly in contact with yours, then a little blanket or something over both of you. Put skin to skin while pumping if possible, maybe get partner to support you if this is difficult.

• frequency of pumping. Milk is produced from breast depending on how much is removed. When the breasts fill to near capacity, there's some kind of inhibitor produced to slow production so you basically don't keep producing when there's no space. A bf baby would feed about every 2-4h ish, so

• what are the reasons for pumping over breastfeeding? How necessary are they? E.g if baby has a cleft palate, or is on the NNU, that's pretty hard to work around, but other reasons might be less vital. Breastfeeding directly is more effective than pumping for milk production. If this can done, that would help supply.

• there's a medication called 'domperidone' that increases milk supply as a side effect. I'm not specifically recommending it, the risks/benefits would be something to discuss with a GP/doctor. But that is potentially an option if this hasn't been explored.

• get a meeting with a lactation consultant. A quick Google suggests cost might be around £180. However, cost of formula feeding over time would significantly exceed this.

• are there any friends, relatives ect that you could ask to help you with things around the house, to allow you to more of your limited time to focus on getting the feeding sorted? Consider who you're asking - i.e if it's a relative who formula fed all her babies, and you think she might tell you every 10 minutes that you should top up with formula, this might be counterproductive.

Hope this is somewhat helpful. I've got a book called 'the womanly art of breastfeeding', I think it's meant to be kind of the ultimate guide. I'll have a quick look once I get out the bath and see if there's anything else it recommends.

Hello again.

Sorry I didn't realise there was a second post, I'm pretty new to this Mumsnet thing.

• so from your second post, you mentioned you'd woken up engorged. Once you get engorged, the inhibitor starts to kick in to stop you producing more milk than there is breast to fill with.

You probably need to pump or feed before the point you get engorged, so think about how long it took to get engorged vs last time you pumped/fed pre-engorgement. Maybe set an alarm for during the night to pump or feed and go back to sleep after.

• with how milk supply works (the more milk is removed from breast, the more is produced), if giving formula top ups, do this after you've fed from the breast. Or the baby takes less, because they're less hungry and it makes your supply reduce because less milk is removed from the breast.

• key points from that book (Pg 396, chapter milk supply):

• is it an issue with you making enough, or baby taking enough? I think it's hard to know for sure from one pump session, as pumping is not as effective at removing milk as a breastfeed.

• is it an issue with the technique/how the feeds are going? E.g way baby is held at the breast could affect this, how baby is attaching, how long/frequent feeds are. All of these would affect how well milk is removed from the breast; if milk is not being removed effectively, you end up making less milk, so your supply reduces.

• could it be from an undiagnosed issue, such as a tongue tie? For this point and previous one, you may need specialist support. ie, from lactation consultant, health visitor, breastfeeding group. Could also ask health visiting team - although I know what HV support is available is very patchy across the country.

• less commonly, there can be issues with the mothers hormones like their problems or pcos. Or structural issues, if you have had breast surgery.

• it mentions that you should increase milk removal by pumping/expressing, so that's great that you're already doing that. More milk removed from breast = more milk produced.

• it talks about concept of 'galactagogues', which is a substance that increases milk production.

• there are medication galactagogues, such as domperidone which I mentioned in the other post. These are things you would need to discuss with a doctor. Other medications also exist which do this.

• there are herbs which are galactogogues. The book mentions goats rue, shatavari, fennel and alfalfa and fenugreek.

• foods that are galactagogues include barley, brown rice and oatmeal.

• book mentions some things have the opposite effect of a galactagogue, ie reducing milk supply. This includes parsley, sage and peppermint (in large quantities.

• apparently, someone wrote a book completely on milk supply 'the breastfeeding mothers guide to making more milk' (west and marasco). Can get e version instantly about £9. Paper copy about £3-5 off eBay.

@MrsBlob thank you so much for your reply
. I feel ridiculous admitting this, but I am also a midwife 🤣 i work on triage and birth centre (and often get pulled to delivery suite) but feel completely out of my depth at this point 🤣

She had a tongue tie which was seperated at 11 days old. At day 5 she'd only lost 7% and was never jaundiced, so we thought everything was going well. On day 14 she wasn't bsck to birthweight and had only gained 10g/day. She got back to birthweight by three weeks but really slowly and they'd started me triple feeding to increase supply. This was not sustainable.

We introduced formula at 3 weeks but she only had 3 top ups before my supply increased and was able to top up with EBM.

I've seen a lactation specialist, cranial osteopath and specialised infant feeding teams who all think she latches well - but she doesn't gain weight without the top ups 😓 so that's why I'm pumping.

I've started getting blocked ducts in my left side every other day and it's agonising, and the left nipple keeps vasoconstricting and bring agonising.

I take breastfeeding supplements and fenugreek.

I spent a week pretty much in bed/on sofa in skin to skin trying to establish breastfeeding but it doesn't seem to have worked.

I'm really grateful for the advice, it's really good advice I just feel like lots of it isn't working for us for some reason.

I'm diagnosed PTSD from a sexual assault in my 20s and this is beginning to take a toll on my mental health. I'm considering cutting out all pumping and giving formula off she's still hungry, and if my supply dies and she's a formula fed baby then I've tried my best. I'm just so sad.

Wow what a small world. I'm sorry you're having such a hard time with the feeding, it sounds like there have been quite a few challenges for you.

A lot of the things I've said might be a bit like teaching granny to suck eggs in that case,A thing to remember though, is that we as midwives are trained and deliver advice on INITIATION of breastfeeding - not on keeping it going successfully. I'm pregnant myself, about 30 weeks, that's why I got that book in the first place, to try and improve my knowledge on it.

Please don't beat yourself up if it doesn't work out for you in the end. I think nearly all mothers make the feeding decisions they do with their babies best interests at heart - based on the knowledge they have, the resources they have, cultural values and support from their network. The second two I think are sometimes actually detrimental to breastfeeding.

But bear in mind that midwifery is more focused on actual childbearing and initiating lactation, rather than the long term feeding. Therefore, the one factor you can really influence out of those 4, knowledge, might not be as one would assume it to be, being a midwife. So please don't feel bad because you're a midwife finding it hard to bf - it's not actually our specialist area.

I don't think there's really much more I know that I can share; i'd just advise to exploit specialist sources of information as much as you can.

@MrsBlob thank you and congratulations!!!