Let-down problems, 15mo, help/advice needed please!

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I've recently returned to work part-time (working at home) and now have problems with let-down. Maybe returning to work isn't the cause, but the problems started right after I started working.
Milk just won't flow, even if the breast is full, especially at night and sometimes in the evening. My DD normally feeds to sleep, so not getting any milk at night when she wants to get back to sleep is pretty frustrating for her - she will get off the breast and try to sleep but will keep to toss and turn, then eventually will start to whinge, etc
So far I was trying to relax as best as I can in order to get the let-down (breathing, drinking water, etc), but sometimes nothing helps.

Can it indeed be related to work? Because if it can, i might need to stop working, as it's causing too many problems.

Or can it be just a normal thing that comes with time? (as suggested by HV)

And what can I do to help it? My HV suggests that I stop BF altogether, which will involve a lot of crying for my DD since she's feeding to sleep at the moment. I don't like this idea for obvious reasons, but my HV failed to come up with any alternatives.
Is there anything else that can be done?

And is feeding her to sleep as vicious at this age (15 mo) as my HV says? HV implies that I'm not letting her become independent this way. I'd like to hear from those AP inclined re this.

Thanks in advance!

Oh, bloody HVs (sorry to the good ones - I know you're out there)! Hasn't she come across the WHO guidelines yet?

I don't think she could show you any evidence that it's a 'normal thing that comes with time'? Your body does change over your breastfeeding life, however. Have you been well recently? Sometimes colds, viruses, other life changes can affect your body and as breasts are attached it could affect them too!

You're right, relaxing can help but it's very hard to relax on demand, and knowing you have to relax can make you anxious, iyswim! You could also try:

Gentle massage before feeding - if you go to kellymom.com there are good instructions for manual expression, and you could use the first few stages of that to see if it helps.

Warmth - tried feeding in the bath recently? Putting a warm flannel or a hot water bottle on your breast before feeding?

Visualisation - close your eyes for a couple of minutes before feeding, and imagine yourself looking down at your babe feeding
Leaning forward a bit to help with flow (lots of cushions behind the back)

Changing position - perhaps as your DD has grown her latch has changed and your currently feeding position isn't encouraging as good a latch as it used to?

These are all good for daytime but not as much help at night, of course.

My DD fed to sleep until she was about 20 months, then stopped spontaneously. If it works for you, ignore the HVs dire warnings (which aren't based on anything other than the conventions of the last 100 years or so). I don't follow AP religiously, but have an extremely independent, confident, sociable nearly 3yr old who co-sleeps, breastfeeds and was carried loads. So yarboo sucks to all those who said I was creating a clingy, fearful child. It seems in my highly biased opinion that if you let a child fulfill their need for contact, cuddles, babyhood in general, they can move on at their own pace (assuming you're able to do that, and I do understand it's not always possible) and it seems to be very good for them emotionally. Your daughter is 15 months old. She isn't independent and isn't supposed to be. She's still a baby! The feeding to sleep thing is only a problem if it's a problem for one of you.

Sorry, that was a bit of a rant .

As for work - only you know if it's stressing you out. It would be very hard to prove cause and effect. Good luck in trying out a few things and perhaps it's worth talking to a BFC?

Oh - sorry, meant to ask - do you know for definite that you do actually have a problem with let-down? Just wondering if your DDs behaviour might be due to something else, rather than lack of milk.

I went through phases of being able to feel let down, and then not feel it for months. And expressing isn't always a good guide.

Also, if you do want to nightwean at any stage, if you google Dr Jay night weaning you'll find a page of useful ideas to try to minimise the upset.

HTHs

Mij, thanks so much for your advice!

I'm sure it's the let-down problem, as I both can feel it and can hear my DD swallowing milk when it starts flowing (it has always been 'overactive', so there will be a strong flow with let-down for a short time and then almost nothing till the next one), so i'm sure she's not getting anything (well, not a milk flow she's after anyway).

You are right, all those things that are good during the day can be pretty useless at night. Though I'll try visualisation.

As for position and latch, there was a point a few months ago, when DD would just take the breast and wait for her milk without sucking. It was pretty frustrating for both of us and I had no idea how to encourage her to suck, but it didn't last long.
Maybe you are right and she grew out of this position, as it's approximately the same position i've been using from the start. She has been fine with it and doesn't attempt to change it, so I wasn't changing anything too.

The problem with most HVs, GPs and paeds i've met so far is that they are supposed to know better, but they not necessarily do. But I haven't got any knowledge either, so sometimes they can sound pretty trustworthy, especially if they say that something is better for the baby and we are all eager to do things that are best for our babies.

Was your baby a calm laid-back one from the start? Or was she clingy and afraid of everything? I know, it won't help me much, but if she was a bit like mine, that would give me more reassurance that I'm doing the right thing with her.
As for being unwell myself, I wasn't explicitly unwell, though has recently had problems with hair, skin, etc, so might be related too. And I don't think I've fully recovered from PND yet, so there can be a whole lot of reasons for the problems I'm having now.

And thanks for a hint on hightweaning. Though I hope I won't need to use it! I feel pretty reluctant to do anything that will go against what DD needs or wants, but I think I just don't trust my feelings and therefore am so sensitive to what wrong HVs have to say.

Thanks a lot again!

"Was your baby a calm laid-back one from the start?"

Calm and laid back? Oh lordy, no, never has been, doubt ever will be! She wasn't clingy or fearful either, but has always expressed herself very strongly - was a very unsettled baby in the traditional 'collicky' stage (I don't interpret that as clingy or fearful - I interpret that as having a very strong survival instinct, and to survive you need food and protection, both of which Mum provides, and need it 24/7. Therefore being glued to Mum 24/7 is an extremely rational need/desire!) and took several months to relax into the world. Not sure if that's what you needed to hear or not!

No, I was asking about being clingy and fearful.
My DD too has always had a strong knowledge of what she wants/needs and she has therefore been pretty determined to get things her way. So was a very unsettled baby and only got a bit more relaxed when she turned 6-7 months or so. But she's been very fearful too and is still afraid of people, can't socialize and won't let me do that too.
But anyway, it's a separate subject.
Thanks for you help!!!

Sorry, got the wrong end of the stick. That sounds hard to deal with, and I'm guessing there isn't an obvious, external cause (like bad experiences with strangers or even family members) or you'd know what was going on. Sorry I can't help with that, but I bet there's someone in another forum who can.

Oh forgot - I came back to check the thread cos I realised I didn't mention nipple stimulation as a cue to let-down, the one thing that might be more possible to try at night.