The Case of the Dwindling Breastmilk

Miscellaneous and Personal Stuff I Must Share
21

First: Baby just nursed! Only one breast so far before he switched to gazing at me and giggling and grabbing my nose, but phew.

And thanks, all of you.

Again, I don’t necessarily doubt this, but I would really like to see cites for it. Or is this one of those things nursing women “just know” but has never been studied formally?

:eek::eek::eek: Gah! Soooo much there I didn’t want to know…

See the last bullet point in my OP. Need vomit smilie.

I will look into this locally.

I tried two or three cones when I started and am pretty sure I’m using the one that fits best – the thing is, I was pumping pretty successfully until a couple of weeks ago.

Aha! OK, I just did that. Crossing fingers.

I won’t. I will be seriously annoyed, though! Formula is freakin’ expensive, and it smells bad.

Thanks. This is my philosophy too.

:confused: Do I hire an assistant, or can I somehow stimulate growth of two or three extra hands? Seriously, I can nurse my son with only two hands if he’s cooperating, and I can pump with only two hands now that I’ve had lots of practice, but both at the same time?? I’ve seen those pump bustier things and laughed – are there women who can just hook up the pump and it works hands-free? I need to constantly apply/release all kinds of pressure and move the thing around to get any milk, and always have.

Ooh, I will. I’ve had my eye on one since pregnancy and even put it on our baby registry, where it was ignored… now I have an excuse to get it myself.

Hee hee. He can eat rats if he wants to and it keeps him full!

Oh! Me too! With cramps and all that crap, too. I had no idea there was a connection! :smack: Thank you!

Oh, I know from growth spurts, believe me. This kid loves skipping whole sizes of clothes in a few days. This is different from previous spurts, though I agree that may be part of it.

Now, for that I’d love a cite.

Again, I wasn’t having latch-on trouble until recently – but then and now, he’ll latch when he’s good and ready and not before, you know? And when he’s crying is never one of those times, sadly.

He sleeps about half the time in his co-sleeper and about half the time in bed with one of us (with all due safety considerations of course). I have never been able to nurse him in bed at night. He’ll nurse a little if we take a nap together in that same bed. He takes after me in sleeping soundly when he does sleep at night, I think (not that that stops him from fussing while half-asleep in the night, mind you).

I may try the herbs (even nasty fenugreek) but I’m pretty hesitant about the prescription drugs. I already take a handful of drugs and supplements every day for various medical conditions.

I’m hypersensitive to odors myself (it’s a migraine issue) and use unscented everything, and no new foods.

Does anyone know how this works with fenugreek, by the way? That crap puts me off my feed – I’m surprised babies put up with it.

Yeah, I’ve always had to do a lot of this to get any milk with pumping. I’ve never found pumping uncomfortable, fortunately – or nursing, for that matter. Once my son latches, he does it well; it’s getting him to consent to it in the first place that can be a struggle.

22

If you don’t already have one, get a My Brest Friend nursing pillow. They will allow you to easily nurse with one hand once he’s latched on, unlike the squishy, rolly Boppy. We never once used a Boppy while nursing–compared to the MBF, the Boppy is nigh-on useless as a nursing pillow.

23

Congrats, that’s what it takes. Just keep at it.

Nope, it’s pretty well established scientifically. Check out info on the hormone Prolactin

There are also numerous mental and physical triggers which influence breastfeeding, from the let-down trigger when a baby cries, to the oxytocin release when you watch your baby nurse. Yep, just looking at a nursing baby triggers the brain to release the chemical which helps support breastfeeding. This is one of the major differences between demand from an infant and demand from a pump. The brain isn’t stimulated by having a pump attached to a breast(your brain knows a pump isn’t a baby) and the release of oxytocin isn’t as strong, so let-down doesn’t occur as easily.

Nursing necklaces help encourage nursing to be fun time, as does more comfortable positions. We found that teasing one of our fussy nursers with the nipple and not letting them latch on for a few seconds at the start of each session was a great way to get them to rise to the challenge.

There are a large number of herbal formulas which support milk production. If fenugreek doesn’t appeal to you, feel free to try one of the wide variety of other natural galactagogues. The most effective are the prescription medications, but there are a large number you could probably find at the local health food store.

The best advice I have to offer is to drink like a fish. Never sit down to nurse without a glass of water and never get up before you finish it. If they’re drinking, you’re drinking. If you’re experiencing any constipation or irregularity at all that can be a sign of your body trying to split too low a fluid intake between demands.

Enjoy,
Steven

24

Cites for jaw development:

http://en.allexperts.com/q/Breastfeeding-1764/teeth-development.htm
askdoctorsears.com (#2 under ‘better teeth’)
http://www.notmilk.com/101.html (#77)

Your baby may also have nipple preference. Here’s an article about babies who prefer bottles and the reasons why:

http://www.lowmilksupply.org/bottles.shtml (scroll down to nipple preference)

Congrats on the nursing session!! :slight_smile:

25

Sounds like things may be improving - phew! Moon Unit went on a strike when she was 5ish months old and had been sick and we had a tense day or two before she got back to the breast.

If you can manage to nurse while lying down or otherwise very, very relaxed, try what I called “snack and snooze” at every chance. I’d get myself propped up on one side, lower arm out in front of me with baby’s head on that, baby latched on - and I’d drowse while baby alternately nursed and snoozed. I credit this - especially when Moon Unit was first learning to feed after 2+ weeks in the NICU - as really helping rebuild the supply.

26

In addition to what Mtgman cited regarding hormones, there is a protein known as Feedback Inhibitor of Lactation, which is in your milk. If milk sits in your breasts, this protein suppresses lactation:

So if you don’t remove milk from the breast regularly, milk production goes down. Babies are much better at removing milk and providing the stimulus at the nipple that triggers prolactin and oxytocin than a pump is. Many mothers produce plenty of milk nursing a baby, yet almost nothing when they pump.

Since pumps aren’t as good a stimulus as babies, the more formula a baby gets, the easier it is for mom to lose her milk supply. Same goes for sucking on a pacifier. The NUMBER ONE ADVICE given to mothers with supply problems is to nurse the baby as often as possible. All sucking is to be at the breast to provide maximum stimulation. It makes a lot of sense when you consider that our ancestors most likely had naked skin-to-skin contact with their babies 24 hours a day. I believe one study of a traditional culture found that infants nursed many times an hour - much different from our ideas about every 2-3 hours (which is just fine with the way our culture is set up, as long as your baby isn’t having nursing problems.)

In my experience, we as a society understand the benefits of breastfeeding (a/k/a the risks of formula feeding), but we’re still very much in a bottle-feeding state of mind. I’ve seen mothers come to LLL meetings and ask about low supply and slow weight gain in a weeks-old infant - and they didn’t have their babies with them! As they say, “Well, that’s your problem, right there.”

Hang out with your baby. Ditch artificial nipples as much as possible (of course first priority is the baby needs enough calories and nutrients). I think a hospital grade pump would help if you’re still having issues. Definitely check out LLL locally - sure there will be some fruit loops and nipple Nazis on occasion, but most of the Leaders are quite sane and very supportive - yes, even when you need to use formula.

I wish you both the best - your baby is very lucky to have such an invested mommy!

27

Oh, two other things:

If you’re using birth control pills, that is well known to suppress lactation.

Your baby may be impatient that he has to work for a let-down, versus milk flowing into his mouth immediately from a bottle. If you think this is the case, you can hand express or pump enough so there’s some milk on your nipple (or even to a let-down, if you can), then latch him on.

Other tried and true techniques are offering the breast when the baby is falling asleep or just waking up, nursing in the tub, or nursing while walking/swaying.

Nursing strikes are the pits, but they almost always end. Here’s hoping you guys are already seeing your way out of this one!

28

Just wanted to second this advice. I breastfed my first baby exclusively for a year, and my second I did a combo of formula/breast for about 9 months. I can really attest to the advice to nurse a lot if you want your supply to go up. I couldn’t get supply up at all with a pump, the pump was only beneficial to me to collect any excess in the mornings when I was extra full (especially as baby learns to sleep longer during the night…the first nights they slept through it was a mixed feeling of ‘hooray, baby slept through!’ and ‘dear lord my boobs are FULL’), or when I would skip or be away from baby for a feeding, I would pump for that feeding. But we would go through phases like you describe, where I seemed to be producing less, and then I would try to nurse more, and within a day or 2 it seemed to right itself again. I would agree with everyone advising not to give baby a bottle ‘in the meantime’ while you try to get your production up with a pump, I just don’t think a pump can maintain supply for most women. If you really feel like your baby is just so hungry you cannot satisfy him with your production, I would try spoon feeding him a little extra formula or breastmilk just to take the edge off his appetite and then go back to nursing.

The first day or 2 can seem frustrating/odd, because you are nursing a lot but the baby doesn’t seem to be getting anything since your production is low. But there is always a little something in there for him to eat, and with the stimulation and your body constantly getting the ‘breasts are empty’ signal, it can really up your production.

29

Yay!

A nice supportive pillow, football hold on one side with baby’s body tucked under your arm and your hand cupping his head, and on the other side hold the cone of the pump. It may not work for you, everyone is different, but I was working with my first nursling and because I needed the milk for the baby, almost I never nursed without pumping at the same time.

Also someone suggested upthread to nurse in the tub or while walking, I second this. If you can manage it sometimes a change of scene can help, and/or nursing when the baby is being relaxed.

Hang in there you are doing great.

30

I actually have one of each – bought the Brest Friend myself and got the Boppy as a gift – and concur with your assessment. I keep the Brest Friend downstairs where I use it all the dang time, and the Boppy upstairs where I use it at night at those times when I am too sleep-fuddled to negotiate the stairs (and my baby is too sleep-fuddled to remember he’s fussy).

You rock. Thank you for a cite!

You also rock… though I have to say I’m not entirely convinced on some of those. I looked at your first cite most carefully (hoping I can get to the others tomorrow or the next day) and it strikes me as one of those unsupported assertions that I’m now pretty suspicious about. I am very certain the doctors and others involved believe what they’re saying, and are saying it on the intertube-webs because they want to help other mothers – but I’m reminded of shoes. Specifically two things about shoe recommendations in the 20th century: first, runners since the 70s have been advised that they need supportive etc. running shoes, but as it turns out, such shoes may actually lead to no more or less runners’ injuries than minimal shoes. Second, the whole “babies need hard shoes when learning to walk, for proper foot development” thing, which we now know is a crock, but which the well-meaningest of well-meaning professionals espoused back in the day.

Does that make sense? I’m really craving scientific method and verifiable results right now.

You, especially, rock. This is quality info. I’m so glad you showed up! I was just telling my husband yesterday: “There’s this one Doper named ‘Unauthorized Cinnamon’ – no, I don’t know why she’s named that – she hasn’t posted to my thread yet, but I hope she will…”
[/QUOTE]

Do you know if the mini-pill does too? That’s what my GP,who is also my kid’s pediatrician, has me on, saying it shouldn’t be a problem. But I wonder if it’s possibly a problem for someone who is having a problem, if you know what I mean.

31

I understand your need for scientific data, I really do. I was the same way, and skeptical of anyone who provided me with anecdotes.
The trouble is, most moms who have gone through what you are going through don’t have scientific studies to back their experience. They only have their own stories.
I personally was on the mini pill while I breastfed both my babies. I think if I was really concerned with supply I would have gone off all pill/ hormonal birth control. The way I understand it, the pill works as birth control because it tricks your body into thinking it is already pregnant. And that will decrease your supply. Less than a full regular pill but it is still there ( as a side note, I know 3 women who have gotten pregnant while breastfeeding and on the mini pill, please make sure if you do not want to become pregnant that if you cut down from full on exclusive breastfeeding that you do not rely on the mini pill as birth control!
Any hormonal change could affect your milk. Statistics matter but you personal body response matters more. It is ultimately up to you whether going off the pill is worth a try.

32

I understand your need for independent scientific cites, too, but you have to realize that there are not a lot of breastfeeding studies done. The ones that are done are never done in the United States . Why? There’s no money to be made from them.

But I think even through observation you can see that there’s a difference between sucking from a bottle and suckling from a breast. Does your son get all hot and sweaty after drinking a bottle? What about after nursing? It’s a lot of work to get milk from a breast! I remember seeing an animation showing the difference but I can’t seem to find it. I’ll keep looking.

Here’s a powerpoint presentation from a dentist that shows examples of malocclusion caused by a variety of sucking issues:

33

Sorry, I should have written the studies are rarely done in the US! Not never.

34

Estrogen replacement therapy is also contraindicated during nursing; like the birth control pill, it suppresses lactation. Your minipill, while not in the same league, is playing the same sport, and might be making the difference – it won’t in most women, but “most” is not “all.”

35

Yay! I’m famous! I’m running out to the gym now, but later today I’ll look up the minipill in Thomas Hale’s Medications and Mother’s Milk. To the extent there are studies, he cites them, so it’s a great resource.

I’ll also explain my name if you like!

36

I’m the mother of four, and successfully nursed only 1 of the 4. Hindsight being 20/20 and all, here’s what I did right and wrong:

Baby #1 - I gave up too soon. My milk didn’t come in until the baby was a week old, and in the meantime he got used to the bottle, and I just decided I wasn’t EVER getting any milk in so I’d better give him the bottle. Imagine my shock a day or two later when my milk came in spades and the baby couldn’t have been less interested in it! Whoops! At 3 weeks old, he got colic, which lasted for months. He wasn’t sleeping through the night for nearly a year. Wonder why I got post-partum depression? :slight_smile:

Baby #2 - I got this one right. Nursed her right after delivery - all 4 of my kids were C-sections - so she was literally nursing in the operating room. :eek: I never allowed the hospital staff to give her a bottle or pacifier, and I kept her in bed with me constantly, nursing, getting my supply up. I didn’t feed her solids at the usual 4 months, instead waiting until she was about 6 months to start. At that point, when she started getting calories elsewhere, my supply started to go down slowly, until she was about 1 year old and then she switched over to cow milk out of a cup. Of all my kids, she is the only one that has no skin problems or allergies… she’s the least picky eater and the best sleeper and nap-taker. Yay, breastfeeding!

Baby #3 - born premature - I tried to duplicate my success with baby #2, but he was very little and had a weak suck reflex. Wouldn’t gain weight. So I started pumping and feeding him EBM in a bottle. It worked pretty well. But instead of being happy with pumping and feeding, I kept trying to pursue teaching him to nurse from the breast, and when he was about 6 weeks old, I stopped giving him the bottle and went to breast-only, which seemed to be going alright until his next visit to the Dr., when it was found that he was losing weight. So the doctor bitched me out, I no longer had access to the breast pump, so I had no choice but to put him on formula. He fattened right up and was fine, but only got about 6 weeks of breastmilk. Better than nothing, I guess.

Baby #4 - Another weak latch baby. He was never given a bottle (but did have a pacifier) but wasn’t gaining weight. He still wasn’t back to his birth weight at 2 weeks old, so the Dr. gave me another bitching out, and insisted I start giving him formula. My supply was gone in less than 2 weeks after I started “supplementing” with formula. I did continue nursing him anyway, even though my supply was 90% gone and he obviously prefers the bottle, so it’s more like he’s a bottle fed baby that’s supplemented with nursing than the other way around. Actually, this is more of an ideal situation than you might think.

Okay, so this is what I think:

If you’re doing the pump & feed, try looking at your baby while you’re pumping. If you can be nursing him on one side and pumping on the other, all the better. Even if you think the breast is empty, it’s really not, because it’ll keep producing (slowly) 24/7. The more suction, the bigger your milk glands will become in response, and voila! Lots of milk. Once the baby has nursed as much as he will on one side, then pump the empty breast.

The baby is a much better breast pump than your breast pump. Even if you’re not actually pumping out lots of ounces, the suction is still getting the job (making the milk glands bigger) done, and you shouldn’t give up on it, if you want to exclusively nurse. You might consider renting the industrial-strength milking machine for a month to see if it helps - it very well might.

Try waking up in the middle of the night and pumping an extra time. Never go more than 3 or 4 hours between pumping sessions while you’re trying to get your supply back up. Drink tons of water. Pump, pump, and pump some more until your supply is so grand and glorious that your baby can get a bottle’s worth during the first couple of let-downs. When nursing his fill becomes a viable alternative to the ease of having a bottle of formula or EBM, switch him over slowly, and make sure he’s weighed frequently to make sure he’s still gaining. I personally would put off starting him on solids, since once you’re started feeding him food, you’ve basically begun the process of weaning him from breastmilk AND formula. Why head down that road before you need to?

And most of all, do not make the error of equating success with nursing with success at parenting. They are NOT the same thing. There’s no shame in giving the baby formula if that’s what he needs. Four months of exclusive nursing is quite an achievement - you have ALREADY SUCCEEDED here as far giving your baby the best start you can give him. Natural immunities, avoiding colic, future allergies and all the other benefits of breast feeding have already been awarded, and the rest is just gravy. Don’t sweat it.

37

OK long day, but I’m back.

This is from the entry on oral contraceptives in Medications and Mother’s Milk, Fourteenth Ed. (2010)

(Also, don’t know if you’ve heard this, but my doctor told me if I wanted to use the minipill, I’d need to take it at the exact same time every day to avoid getting pregnant. Not relevant to the milk issue, but important info!)

(Oh, and my name comes from an episode of Deadwood, when Jewel put cinnamon on the peaches at a meeting, causing an allergic reaction in one of the men, and Dan chastisedher for putting out “unauthorized cinnamon.”)

38

Very very interesting, UC and others commenting on birth control. I started taking the minipill about 13-14 weeks postpartum. I *did *get the warning about taking it the same time every day, and the warning that we should probably keep using condoms too, but *not * “discontinue [the minipill] at first sign of low milk supply.” The timing correlates strongly with when my kid started being fussier at the breast and when I started having dramatically lower pumping yield.

Sigh. We were using condoms (only) when we conceived…

We have a well-child visit Monday – I’ll ask the doctor about this, and probably try going off the minipill. In the meantime I’m pumpingpumpingpumping and offering my baby the breast frequently (I’m usually getting the frustrated howl, arched back, and tense extremities when I do, but not every time).

THANK YOU, ALL!

39

I would be suspicious of the hormones if he suggests a Mirena instead, fyi, since you think you are being affected by the minipill. Consider a Paragard (copper) IUD - I’m on my third (before kids, between kids, and after kids), and I love them.