Expressing milk for prem baby - poor milk supply

[ladylush]

Had dd 10 weeks early 2 weeks ago. Having problems with my milk supply. Can only produce half of her daily requirement of milk. Has anyone got any tips on how to improve milk supply?
I express 7 times a day and once at night. I've tried looking at a photo of dd when I express (makes no difference), drinking lots of water, alternating breasts when I express, fenugreek (only since yesterday), cotside expressing, skin to skin contact. The most I express is 50ml and often it's less (20ml).

it's soul destroing isn't it? such hard work - i have to say you're doing amazing fitting in 7 times a day - think i managed 4 / 5 times, and have to admit i failed miserably on the night time one. dd2 was 13 weeks early and i expressed the whole 11 weeks she was in SCBU. i certainly wasn't a prolific expresser - usually plenty first thing and then it tailed off by the end of the day - but we did come home bf. do you double pump - sure that's meant to be best and far more efficient (assuming you're using a hospital grade pump?). think i read that oats are good too - big bowl of porridge first thing. i'm not sure how well your dd is - but from v early on dd2 was put to the breast at every possible opportunity, certainly from just over a week old, and she was only just over 2lb then. if she was well enough, she would come out of the incubator at feed times - i mean she didn't do much - a bit of nuzzling and licking with an occasional latch, but i'm sure it helped with the expressing. sorry, not really much use but i remember those days only too well and hoping it all comes together for you. oh yes, domperidine (sp?) - reflux med i think, is supposed to help, maybe ask one of the nnu nurses?

ds was in nicu and I had to do all the looking at photos while hooked up to hideous machine. Really feel for you it is soul destroying.
Keep at it, you are doing everything right and a fab job, but at the end of the day if you have to give formula don't beat yourself up. I had to (he was tube fed) and I felt a complete failure, but at the end of the day he was well fed, started to thrive and we were both less stressed.
Good luck

Thanks both of you. Yes I do feel bad about it. Also I have a horrible feeling that my failure to produce enough bm will delay her coming home They don't like giving formula to babies under 37 weeks (she is 33). I asked about domperidone but GP said she will only px in conjuction with the SCBU (who as yet are holding off). I am using the Medela Symphony (hired) and now wondering whether another pump might be better - some women seem to find the Avent Isis electric pump quite good. I had the Avent manual one with ds and it was rubbish (imo). Have also tried the Ameda hospital grade pump and never get more than 30ml. She was premature, I had c-section and General Anaesthetic (not by choice, but because the hospital had given me a blood thinning drug a few hours before I went into labour)so I know a few things are going against me but other women manage it and I am determined to give it a go. What I won't/can't do though is express every 2 hours (day and night) because I have a 5 yr old ds to look after before I go to the hospital to see dd and I cannot sleep in the day time so I need my sleep at night. It is hard enough getting up once in the night.

Its crap isn't it. I can't offer much help because I was never much good at it either.

Things that helped a bit:

smell - I put a muslin in their cot and swapped it for one I kept at home, every visit. Then I'd sit and shut my eyes and smell their smell on it before/during expressing. Sleeping with the muslin made me produce loads at the night-time one.

distraction - looking at photos made me think of my baby needing milk and me not providing enough and I'd get stressed and not make any. I did better when expressing while watching mindless tv (with no babies or pregnant women in the storyline!)

domperidone worked for me - unfortunatly I didn't get it until ds2 was home and starting to bf, and it made me overproduce and I couldn't get rid of all the milk - hadn't time to express it off and feed him and look after the older two - so that was a bit grim too!

You have my total sympathy - I remember all the stress. All I can say is that one day this will be a distant memory (and you'll be stressing about how to get him to eat his veg instead )

Sorry, her veg!

I just had a look at the dreaded red book. When DS came out of hospital after a month he was on 30-50ml at feeds and he was a reasonable size full term (just v poorly)
It is so difficult but at the same time the unit will not let her starve/go hungry - wherever the milk comes from. She is early so will only need tiny amounts. If we could measure what 'normal' babies take at 2 weeks it would probably be very small. Easy to say, very hard to do, try and relax and get into a routine that suits you and other ds best. Can a friend have him to play so you can nap in the day?
Perhaps even a warm bath while you think of beautiful baby and put some warm flannels on your boobies? You've been through the mill and need to get over your own operation as well as emotional. Have you had a good chat with one of the scbu nurses? Usually there is a BF counsellor on hand too.

Thanks fruitful Yes, I long to worry about her refusing her veg rather than about my rubbish milk supply Off to express now [yawn]

Frimbly - yes I did speak to one of the bf counsellors there. She had a look at me expressing and said my milk is very thick and high in calories (don't know how she could tell just by looking!) and says milk is in the breast but let down is affected by the thickness of the milk.

I do have friends who have offered to help but I am relying on them to help look after ds while I visit dd. The neonatal unit have a no children policy at the moment due to swine flu. It's just unfortunate timing that dd decided to come at the beginning of the school summer holidays!

I am seriously thinking of trying another pump to see if it makes any difference.

Ladylush - have posted lots of stuff on the other thread but in case you see this first...

When you pump are you double pumping - ie pumping both breast each time? If not then try that. It's recommended that all women of prem babies who are expressing double pump to basically over stimulate and produce more milk ready for when baby is feeding properly.

It's fab that you are pumping 7 times a day and that you have other DC to look after but if you can increase to 8-10 times a day which is how much a newborn would be feeding anyway then you should find that your supply increases. The night expressing is the real killer but I found that if I expressed before bed at about 10pm and then at 3am it was a decent length of time to sleep wihtout goign too long wothout expressing.

If you express more now it will help get your supply up and then you can ease off a little.

Having a prem baby is so hard and I know how exhausted you feel.

Could your older DD 'help' with the expressing - might sound mad but a friend of min who I met in NICU had two other children and her son - aged 4 used to 'help' hold the cups on as she expressed. Made him feel useful and helped her to relax and spend time with him at the same time. Must have been quite a sight tho lol she said that he often got distracted and would twist the cups as she was expressing.

Also sitting and stimulating your breasts before you express or starting off my hand expressing before you use the double pump can often help. (have posted more on this on the other thread)

Feel free to email me xx

You are doing amazing and have already given DD the best start possible xx

Hi MHIS - yes am double pumping. Tbh I find the milk just seems to stop after a short while and then my nipples get sore so sometimes I alternate even though it is a double pump. Alternating seems to get it going again sometimes. Unfortunately my ds is often in the same room when I pump. He talks non-stop, asks questions and is generally very noisy (though adorable)and I find it much more stressful than I do when I have peace and quiet. Today he told the postman I had just been expressing He also asks me how much I've "produced" and voices his disappointment if it's anything less than 50ml (which mostly it is)

Have you tried taking domperidone (Motillium)? That is what SCBU recommended to me. It s a travel sickness remedy with the side effect of increasing milk supply.

if your nipples are getting sore, could it be you need slightly bigger flutes so your nips don't rub against the side? it makes a difference to how much you'll get out too.

hand expressing after your letdown subsides with the pump also extracts more milk.

after your milk stops flowing, keep pumping to stimulate a second letdown or wait 10 - 15 mins and pump again - you can teach your body to produce another letdown straight after.

My eldest was in scbu and they had me pumping every 2 hours day and night.The pump I used was a hospital grade one and they told me to start of with a gentle suction and build it up.

Motillium is Domperidone is under a different name.

Flapjacks are good but am sick of the sight of them.

Blessed thistle or Mothers milk Tea might be an option to try.

Have you tried ringing the NCT,La Leche League or the Association Of Breastfeeding Mothers to see if they can advise.

I had the other problem of making more than child needed so the excess was cated off to the milk bank, is there a local one where they could get extra?

this link may have some good ideas in it.

have also sent you a CAT

Mollie - yes I am collecting a prescription for domperidone on tuesday. Last ditch attempt.

Pseudonym - thanks for the tip re resting for 10-15 mins and trying again. I will try that. My nipples are sore because the shields (aka flutes )at the NNU are too large so rub against my areola. I have personal fit ones at home but am at the hospital quite a bit and it is too much hassle to bring my pump there. I got my Avent hand held one from the loft today and noticed that it seemed to stimulate the let down more than the electric one does. I got the same amount but was thinking that if it stimulates the right bits, I might eventually get more milk.

babyicebean - I like flapjacks so that would not be a hardship for me. Am currently boiling some barley as was told it helps. Yes her milk is currently supplemented with milk bank breast milk (50 percent) but this will not be an option when she comes home.

Pseudonym - thanks for the CAT Some useful advice. Interesting about not needing to wash the pump each time. It is a hassle having to wash and sterilise it each time - particularly when I have only expressed 20 ml! I will put it in a bag in a fridge when I am expressing more frequently - ie during the day.

Lush, re the sterilising thing, there is a v long and old thread on MN about not needing to sterilise for prem babies. If you search this forum under the name 'RTKangamummy' you will find it. Her OP is worth a read.

Oh I see. Will have a look. Thanks

How are things going now ?

Domp worked wonders for me, i took fenugreek capsules too and scoffed flapjack.

If you can keep going till your DD can breastfeed directly that helps loads. pumping with no hormonal stimulation is realy tough.

How is your DD doing now ?

dd is doing well thanks. She is having a bottle now (mixture of my milk, bank milk and formula) - started yesterday. They think she might be home by next week I will try establishing bf when she is home but cannot do it whilst she is there because I have a 5yr old ds to look after as well and the NNU are not allowing children on the unit. The NNU gave me a letter for my G.P for maxolon rather than domperidone. I start it tonight. Will let you know

I am taking fenugreek as well but it's irritating my tummy and giving me terrible smelling wind

You could try holding a hot water bottle as you express too? Good luck and well done!

If you dont get on with the maxolon i've got 50 domperidone here i could post to you ? i dont need them any more. I read about the smellyness issues of fenugreek but i never noticed it myself, oddly i was kind of hoping it would make me smell im a bit weird like that

Glad to hear dd's doing well, she must be great if thee thinking of sending her home already !

check out the bliss message board, it moves a lot faster than this one and we've all the though the same thing, I'm worzselmummage over there

If you want the domp my email's [email protected]

Thanks for the offer of the domperidone. Might take you up on that. I'm getting some side effects from the maxolon which I can't cope with at the moment - fatigue and restless legs. I was worried I might fall asleep at the wheel when driving home from the hospital to collect ds from football. I didn't get a leaflet with the medication but according to stuff I read on the internet, about 10% of pts. suffer from fatigue, drowsiness and lassitude. I know I am tired anyway, but this was a different kind of tiredness where I could have slept for hours. In fact I did. Still woke up feeling tired as well. So expressing regime went to pot because I was so exhausted I had to go to bed.

So I'm not going to take any today. I need to be alert and don't want to be wiped out like I was yesterday.