Milk supply depleting

[Nicolab23]

Hi, this is my first post, I'll try to be as concise as I can.
My son was born prematurely at 28 weeks in July. I immediately started to express for him as I was quite rightly advised that my milk would help his progress. My supply was always good, and i was even asked if i wanted to donate milk at one point. Due to his prematurity latching was a problem, although nipple shields offered a solution. Sadly, I wasn't keen on them so continued to express and feed him by bottle. When he came home 3 weeks ago, I returned the ameda pump that i'd been hired and bought a medela swing. I then noticed that my milk was not as abundant and hired another ameda from the community breast advisor. I have tried so hard to express frequently including during the night but have found that my supply has only improved very slightly, from about 15ml to a maximum of 30ml per session. I feel so stressed and wonder whether that is affecting my supply?
Also, on another thread I noted that some mums hadn't had a period for months, or even years. Mine returned within 6 weeks of my sons birth and I am now menstruating again, could that be related to my depleted milk supply.
Sorry this thread has gone on a bit!! Can anybody help or advise me? Can I get my milk supply back up again?

The short answer is YES!

Think tiktok will have more advice for you.

Are you still using the nipple shields? They can act to decrease your supply. If you are, can you wean yourself and ds off them slowly?

If you have stopped using the nipple shields, then we need to consider some other possibilities. I know that for me expression was not always a good indicator of how much milk I have.

Stress can of course affect your supply (and somehow it is worse when the stress is already related to supply!).

There are various "home remedies" that can help with supply:
*drinking lots of water
*drinking fennel tea/infusion
fenugreekhomoeopathic remedy urtica helps (but needs to be used carefully as the same treatment also stops milk supply; recommend looking at Yehudi Gordon, Birth and Beyond for dosage or of course contact a qualified homoeopath

Domperidone can also be used to help increase your supply (once you have tried other things like correcting latch, using breast compression to increase intake of milk, expressing immediately after feedings to increase supply, etc).

You should also try calling the La Leche League Helpline

0845 120 2918

The helpline is 24hr, breastfeeding counsellors who have all breastfed for at least a year. They should even be able to send someone to the house. Also they will recommend local groups.

Another helpline (not 24 hr though) is NCT:

0300 330 0771

And in case you are still using the nipple shields for feeding, here is some advice for how to wean off:

here

Also here is something about supply issues:

here

Do call LLL. It might be good to have a RL voice to talk to about this.

Good luck

Also for more visual help try these:

dr newman video clips

This should help you understand about compression.

Nicola - you have had a hard time

No, stress doesn't affect supply (millimummy - it really does not. There is good research on this. Its also not good for people to stress about stress...just makes the stress worse!).

The main way to improve supply, and really, the only evidence-based way, is to stimulate the supply more often. It is frequency that drives supply, so an effectively feeding baby and/or an efficient pump removing the milk* often at least 8 x in 24 hours inc at night is essential.

Anything else is frills - herbs, potions, remedies....frills. Domperidone will help but only if supply is stimulated as above.

30 mls expressing per session can probably be improved on, I agree - frequent, effective expression will do this. You may have to change pumps again.

I agree with the suggestions to get good real life help and to work on direct bf.

Stay in touch!

BUMP

Thanks for all of your responses. I am reluctant to use any medication/herbal remedies but am open to any other suggestions.
I am trying to put DS to my breast as frequently as I can to try and stimulate milk production but find that he takes a full feed from a bottle afterwards. At the moment it is EBM that he is having by bottle but will soon be fed with formula as my frozen supplies are nearly gone. This is causing me so much distress as I have watched him thrive from a tiny prem baby to the 5lb 6oz that he is now on my milk.
I do occasionally use nipple shields but that is more because he "latches" onto them easily and also because I can see residual milk in them which reassures me that milk is being produced.
I am also trying to express as much as I can, I don't think the pump is the problem as it is the same make as the one I had from the SCBU. This morning I managed to get 50ml which I was thrilled with, but the next time it was back to about 30ml.
I regularly see a counselor as I still struggle with having a very prem baby and she is going to refer me to a BFC who I have met before. She was very good and I'm hoping that she'll offer me some constructive advice.
Also, does any one think there is a link between menstruation and reduced milk supply or is it just coincidence?
Sorry I've gone on again

@tiktok

from the beginning of time women have been using herbs to increase milk supply. Some women find they work. There is surely no reason why nature should not be capable of producing compounds that act in similar ways to modern medication.

In the Mediterranean and some Middle Eastern countries, women favour fennel. In India, fenugreek.

Stress can affect letdown. OP sounds like she has had a very hard time of things. But I would be interested to have the references for the research to which you refer please. Many thanks.

Nicola, I hope that you have got some help. As I originally said, it is possible to get your supply back up.

when you're breastfeeding him, do you notice him sucking and swallowing? does milk ever leak out of the corners of his mouth?
Agree from experience that the way to up supply is feed feed feed - hope you can get it sorted.
Well done for building up such a premature baby btw - you have done brilliantly!!

x post with OP

re- menstruation. I would think that there would be a dip in supply around the time of menstruation. But would have thought that the baby would compensate by feeding more frequently.

Usually it is missing out nighttime feeds that brings back menstruation (that is a very simplistic explanation) but you seem to indicate that you are still feeding at night.

Another way to stimulate supply is to switch breasts very often during the feed. Switch feeding. Start nursing from one breast, five minutes later swap to the other, then switch back and continue this way throughout the feed.

If you do not want to use medication, then we come back to my original advice about correcting latch, using breast compression to increase intake of milk, expressing immediately after feedings to increase supply...

DO keep in touch

millimummy - I am not against women using herbs or homeopathy or even magic spells or keeping their fingers crossed to improve milk supply...all of which, as you say, have been used by women faced with this issue. I pointed out that the only good evidence of something working is more freq. effective removal of milk (plus domperidone used in conjunction with more freq. effective removal). Deliberatelt increased water intake does not affect supply.

Refs for stress having no effect on supply (yes, it can have a time-limited effect on letdown - but that's not what you said. In fact you said 'of course' it can affect supply):

J Hum Lact. 2006 Aug;22(3):305-14.
Mood states and milk output in lactating mothers of preterm and term infants

West J Nurs Res. 2005 Oct;27(6):676-93
Psychological distress and milk volume in lactating mothers.

There are other papers, too.

In addition, we know from knowledge and observation that stress does not generally reduce supply - the human race continues to undergo enormously stressful experiences. This is the norm for our species.

It makes no evolutionary sense for the nutrition of the most vulnerable members of the species to be dependent on a lack of stress in the supplier .

Nature happily over-rides stress in order to keep our milk production chugging over - though letdown as I say can be affected in the short term (this is thought to be because the biochemistry of acute shock and fear interferes with the biochemistry of letdown...prob as mammalian leftover, a protective measure in mammals, so if you were running away from a predator, you would not leave a trail of dripped milk. Speculation only).

Hope this helps. What definitely does not help is telling women not to be stressed or their supply will be affected - disheartening, and wrong

If you aren't drinking enough, so a bit dehydrated, then deliberatly increasing water intake must help boost milk supply surely?

If you're uncomfortable taking herbs or prescribed drugs, eating oatmeal can help to increase milk supply.

If you are thirsty, then drink. If you are not actually thirsty, but feel like a cup of tea, glass of water, whatever....then drink. You probably need it. It's very common for mothers to feel like they need more fluids when breastfeeding - the body 'knows' what it needs.

But deliberately drinking more fluids will not make you produce more milk....why would it? There are many fluids in the body, and the body ensures their production quite happily without me remembering to drink more. My cerebral fluid, for instance...will I make more if I drink more? My lymph? My blood? My digestive juices?

My body will take what it needs from the fluids I take in, and I will pee the excess out.

Oatmeal - fine to eat oatmeal. I don't know of any studies that show it makes more milk. But that doesn't mean it is ineffective at this. I can't think why it would be useful, though. But go ahead. If a mother enjoys oatmeal, then eat it!

There aren't any scientific studies that examine the effect of oatmeal as a galactagogue, but there is anecdotal evidence that it works. Certainly seemed to for a couple of my friends. I personally can't stand the stuff though, so stuck with good old 'feed the baby as often as you can' .

Just to let you know about periods, in case you need reassurance on that front.

My periods returned when dd was 13 weeks. I was bfing on demand day and night. She had never gone more than 2hrs between feeds. My supply was abundant (she put on 1lb a week for a long time and was off the charts for weight and height, no supply issues). Some women just get their periods back earlier.

I do have a slight dip in supply when I have my period and dd just fed/feeds more often. She's 2.5 now and I fed exclusively for 7 months and obviously carried on. My periods do have a very slight tangible effect but not enough to compromise feeding.

Ovulation, on the other hand, causes blocked ducts. Research sample of 1. I have a blocked duct every 4 weeks on the day before I ovulate. Even before my cycle settled and ovulation was unpredictable, the blocked duct was on the day before ovulation. Tiktok, do you know why this is or have you ever met this before as a problem?

Just to be clear while DS was in SCBU I was expressing milk frequently, however I didn't always express during the night...I'm afraid I was a little smug and felt that as my supply was really good, I didn't need to bother getting up at night time. Perhaps that will explain the early return of my periods.
I am now afraid that it's like locking the stable door after the horse as bolted!!!
My current practice is to offer DS my breast when he wakes for a feed during the day when I am not exhausted and topping him up as required. I am also expressing frequently post feed, every feed regardless of whether breast has been offered or not.
I really feel like I'm letting my DS down by not being able to offer breast milk completely but perhaps need to accept the inevitable. Regardless of what happens I need to give him some formula milk as my frozen supplies are almost gone and I have nowhere near enough to sustain him. Is formula milk the end of the world???
BTW, when I offered the breast earlier, he did sneeze and milk came down his nose so he's getting something!!!!!

i don't think there's anything smug about anything when exclusively expressing - it's so hard you deserve to be smug about anything you like!!
your plan sounds good - keep offering.

If it helps, I've a very good friend who's still bfing her baby at almost 3, and she got her periods back after about 3 or 4 months, so it doesn't necessarily signal the beginning of the end. Since it's effectively a supply and demand mechanism, I'm pretty sure that, unless you've lost your supply completely, there's no 'locking the stable door after the horse has bolted'. You'll be able to boost your supply. Good luck.

@tiktok

You are right to correct me on the "of course". I should have explained more precisely but was time poor when writing. I did not however tell OP not to stress. Have found that being told that is counterproductive.

Thank you for the references - I shall read them.

And I should have included oats in the list of galactogogues!

@Nicola
Glad you will be seeing BCF who will be able to see a feed/discuss face to face.

You're welcome, millimummy...sorry, I did not mean to imply you had told the OP not to stress. It was just a comment I made, because often, women are told (by others) not to stress

tiktok, did you see my q? Just wondered if you'd heard this before...?

Ghost....never heard of this, sorry!

Interesting, though.

Oh well.

Thanks anyway.

I also get hiccups when I ovulate. I'm just odd I think.

Hi ladies. Thank you all for your words of support and advice. Here's where i'm at today. I am still expressing as frequently as I can but have only really noticed a very mild improvement on milk supply. However, this morning I did have 60ml instead of the usual 30ml. In addition I have been putting DS to the breast as frequently as I can. I know you don't all approve but I've been using a nipple shield. DS is still very small, only 5lb 6oz and he struggles to latch on so I figure that it's better that he helps himself via the nipple shield than not at all. We fed from both breasts today and after each I noted that there was milk pooled in the shield...surely a good sign that milk is available and he did have milk all round his mouth. He woke for a feed about an hour and a half later but only took half a usual feed and seems quite content. How does this sound? Good?
As I said previously, my milk stock in the freezer is getting dangerously low and I have bought the emergency supply of formula milk so is it acceptable to give DS formula and breast milk? Will there be any benefit to him having a limited supply of breast milk? As he was prem, I just want to get him through the flu season with smoe sort of protection but will mixed feeding provide any protection/benefit? Hope that all makes sense!
And finally when i first started to express I was advised to massage breast and nipple. After a while I stopped massaging as my milk flowed quite freely, should I perhaps start again.

Nicola, but you are doing much better...you have gone from a 30 ml tops expression to 60 ml. Other signs things are getting better are freq soft yellow poo from your baby, more eager, more freq feeds.

If the midwife has confirmed he is transferring milk ok with the shield, and you feel he is doing better with it, and the shield fits your nipple well....then it would seem ok to continue with it.

Whatever breastmilk your baby has is of benefit to him Yes, antibodies are still active even in partial bf.