Re: low milk supply at 5 months

[Guest guest]

Dear Kathy:

These situations come up a lot. And while you'd certainly want to explore the

possibility of any unusual primary problem with milk-making (has she started

birth control pills? other medications? unusual health issues like thyroid

problems, vitamin deficiencies, blood sugar problems, etc?) it's more likely

that the supply has down-regulated because of reduced milk-removal. It's

helpful to convey that the body is so thrifty -- it doesn't want to waste

anything or make more milk than what's needed on a steady basis.

At five months out, she'd need to know that it would require a " campaign " to

increase milk production -- maintaining supply is less work than trying to

change what the thrifty body is making. (That's why the rapidly-increasing

early weeks require a crazy amount of milk removal, and then the routine starts

to settle down by 6-ish weeks, once the mother/baby team hit that plateau of

25-35 oz.)

It sounds like her life is very busy, rich and full, with three beautiful

children, so you'd need to talk with her about a plan that's manageable in the

realities of her day. She has to think about what may have de-railed their

breastfeeding in the first place

Her instincts are good that she can't battle this baby or make him breastfeed.

And a baby now getting 3 oz of supplement each feeding can't have supplements

dropped out " cold turkey. " The goal is to taper down as she rebuilds her

supply. Part of the equation is how much of the supplement is currently pumped

milk.

At this point the baby is frustrated with the breast, so the first step would be

getting them both enjoying breastfeeding again. One useful approach might be

giving a good portion of the supplement first, with a slow, paced bottle (make

that less of a free ride) followed by " dessert " at the breast, lots of

skin-to-skin and patting and chatting. This reinforces that the breast is where

the child ends up full and happy. If this seems to be working, the mother can

slowly reduce the amount that's given first. (This approach might also be more

time-efficient, since she doesn't waste time battling at the breast or wondering

how far to push the baby before giving the bottle. It just gets the bottle out

of their way first.)

The bottle-first approach is discussed under " supplementation " at

West/ Marasco's site:

http://www.lowmilksupply.org/

The site and the book might be useful to her. There is information about

galactogogues, herbal and prescription, (and maybe domperidone isn't the huge

hassle where you live?). But those aren't the first line of attack. Yes, it

does seem that they can sometimes give things a boost, but only in conjunction

with lots of effective milk removals -- that's always the first line of attack.

A baby who is doing a good job is better than a pump (plus it time-efficiently

gets milk out of the mother and into the baby in one happy step) so if she can

woo the baby into effective feeding, that would probably probably be the best

first step -- offering very freely. Not just as a " meal " but as a " cup of

coffee " or a snack any time it seems like the baby would be willing. A sling

might help.

But the pump can be a good tool in these situations, since the mother can

control it. Just leaving the pump set up and wedging in pumping sessions

wherever she can in the day and night. Anything she gets out, she'll give to

the baby, so she doesn't have to worry about timing the pumping around the

baby's efforts. If baby wants to feed, and she's just pumped, she can give him

an ounce or two she pumped and " dessert " at the breast. The amounts pumped will

be very up-and-down, so she can think of it as " placing the order. " It's

tempting to wait long periods to get a bigger pumping output. But it's better

in the big picture to get in more frequent sessions -- the factory picks up when

the product is flying out the door.

It might help to get the baby doing more with a cup -- a good skill at this age

-- to reduce the sucking satisfaction gained elsewhere. At this age, solids

should be making little, if any, contribution to the daily nutrition. (Don't

know what the official guidelines/cultural norm is in Greece.)

Pumping is a lot of work, so you can discuss ways to make it more feasible. If

someone is pumping for a healthy term baby in their own home, and the milk will

be used within the day, people don't always laboriously take apart the pump,

wash it and clean it each time. One routine is to just take the assembled kit

off the tubes, put a baggie over them and refrigerate them in between sessions

-- take them apart and wash them about every 6 hours, and try to get 2-3 pumps

in that time. (Other LCs may have other, more generous routines on this -- the

idea is that you want to make it easy to just grab the flanges and wedge in some

pumping.) A hands-free rig, either purchased or made out of an old bra with

slits in the cups, makes it easier to multi-task the pumping onto other

activities, massage while pumping and pull a big shirt over the whole set-up to

feel less self-conscious around the older children.

A campaign to build supply is not a life-style one wants to do forever. So it

helps to convey that once she's rebuilt supply, and the baby is feeding better,

she can drop out the pumping and see if the baby can run the show and maintain.

Mothers differ on how quickly or how much they can re-build a down-regulated

supply. So one can't promise anything. But generally if there's milk-making

tissue around, it can be pushed into higher productivity. And even if she

doesn't get back to complete breastfeeding, any amount of breastmilk and happy

breastfeeding are good things. So it doesn't have to be all or nothing,

particularly with solids coming on down the road.

Sometimes when a baby is sleeping a long stretch at night, it allows a hormonal

swing back toward menstrual cycles. If you do a little research, there's some

anecdotal ideas on calcium/magnesium supplements helping with the dip in milk

production some women seem to see with the return of cycles. Obviously

breastfeeding can go on for years after that, so it's certainly something that

can be overcome. But for some women that long stretch at night can be bad for

overall supply, particularly if the baby doesn't get a chance to make up for it

by cluster-feeding like crazy during the day. (This comes up with employed

mothers -- there's lots of insanity in the U.S. on " sleep-training, " yet mothers

and babies are apart much of the day, and don't get any chance to re-balance

things.)

My, this is a long e-mail, but it is a big topic. Good luck to you in your new

career.

Margaret Wills, land

>

> Hi , I am new to the field of IBCLC, glad to found this group. I am so into

learning from others and sharing experiences. This issue has come up and would

like to read some IBCLC responces.

> have a mom with low supply at 5 months and this has happened with the other 3

kids also. She is a stressed mom, baby tends to be fussy with breastfeeding,

cries after a few minutes of breastfeeding both breasts and after good

breastfeeding still takes 80 to 100 cc of supplement and has started solids

slowly. her question is would pumping and fenugreek and any other things that

can increase milk supply work at this time? she is currently taking fenugreek

with no change.

> thank you

> kathy dounouli

> Greece

>

[Guest guest]

Margaret,

THANK YOU so much for your lengthy and thorough reply. You have helped me so much, not only with this mother but with a way of thinking things through and seeing it now from a professional point of view, helping me up set up step by step care plans.

THANK YOU, again.

regards from Greece

Kathy Dounoulis

ps. just a note, I do have many moms tell me they see a drop in milk supply when menstruation begins and I will definitely look into your suggestions. That is something I didn’t know yet.

From: Margaret

Sent: Sunday, November 13, 2011 6:17 PM

To:

Subject: Re: low milk supply at 5 months

Dear Kathy:These situations come up a lot. And while you'd certainly want to explore the possibility of any unusual primary problem with milk-making (has she started birth control pills? other medications? unusual health issues like thyroid problems, vitamin deficiencies, blood sugar problems, etc?) it's more likely that the supply has down-regulated because of reduced milk-removal. It's helpful to convey that the body is so thrifty -- it doesn't want to waste anything or make more milk than what's needed on a steady basis.At five months out, she'd need to know that it would require a "campaign" to increase milk production -- maintaining supply is less work than trying to change what the thrifty body is making. (That's why the rapidly-increasing early weeks require a crazy amount of milk removal, and then the routine starts to settle down by 6-ish weeks, once the mother/baby team hit that plateau of 25-35 oz.) It sounds like her life is very busy, rich and full, with three beautiful children, so you'd need to talk with her about a plan that's manageable in the realities of her day. She has to think about what may have de-railed their breastfeeding in the first placeHer instincts are good that she can't battle this baby or make him breastfeed. And a baby now getting 3 oz of supplement each feeding can't have supplements dropped out "cold turkey." The goal is to taper down as she rebuilds her supply. Part of the equation is how much of the supplement is currently pumped milk.At this point the baby is frustrated with the breast, so the first step would be getting them both enjoying breastfeeding again. One useful approach might be giving a good portion of the supplement first, with a slow, paced bottle (make that less of a free ride) followed by "dessert" at the breast, lots of skin-to-skin and patting and chatting. This reinforces that the breast is where the child ends up full and happy. If this seems to be working, the mother can slowly reduce the amount that's given first. (This approach might also be more time-efficient, since she doesn't waste time battling at the breast or wondering how far to push the baby before giving the bottle. It just gets the bottle out of their way first.)The bottle-first approach is discussed under "supplementation" at West/ Marasco's site:http://www.lowmilksupply.org/ The site and the book might be useful to her. There is information about galactogogues, herbal and prescription, (and maybe domperidone isn't the huge hassle where you live?). But those aren't the first line of attack. Yes, it does seem that they can sometimes give things a boost, but only in conjunction with lots of effective milk removals -- that's always the first line of attack.A baby who is doing a good job is better than a pump (plus it time-efficiently gets milk out of the mother and into the baby in one happy step) so if she can woo the baby into effective feeding, that would probably probably be the best first step -- offering very freely. Not just as a "meal" but as a "cup of coffee" or a snack any time it seems like the baby would be willing. A sling might help.But the pump can be a good tool in these situations, since the mother can control it. Just leaving the pump set up and wedging in pumping sessions wherever she can in the day and night. Anything she gets out, she'll give to the baby, so she doesn't have to worry about timing the pumping around the baby's efforts. If baby wants to feed, and she's just pumped, she can give him an ounce or two she pumped and "dessert" at the breast. The amounts pumped will be very up-and-down, so she can think of it as "placing the order." It's tempting to wait long periods to get a bigger pumping output. But it's better in the big picture to get in more frequent sessions -- the factory picks up when the product is flying out the door.It might help to get the baby doing more with a cup -- a good skill at this age -- to reduce the sucking satisfaction gained elsewhere. At this age, solids should be making little, if any, contribution to the daily nutrition. (Don't know what the official guidelines/cultural norm is in Greece.)Pumping is a lot of work, so you can discuss ways to make it more feasible. If someone is pumping for a healthy term baby in their own home, and the milk will be used within the day, people don't always laboriously take apart the pump, wash it and clean it each time. One routine is to just take the assembled kit off the tubes, put a baggie over them and refrigerate them in between sessions -- take them apart and wash them about every 6 hours, and try to get 2-3 pumps in that time. (Other LCs may have other, more generous routines on this -- the idea is that you want to make it easy to just grab the flanges and wedge in some pumping.) A hands-free rig, either purchased or made out of an old bra with slits in the cups, makes it easier to multi-task the pumping onto other activities, massage while pumping and pull a big shirt over the whole set-up to feel less self-conscious around the older children.A campaign to build supply is not a life-style one wants to do forever. So it helps to convey that once she's rebuilt supply, and the baby is feeding better, she can drop out the pumping and see if the baby can run the show and maintain.Mothers differ on how quickly or how much they can re-build a down-regulated supply. So one can't promise anything. But generally if there's milk-making tissue around, it can be pushed into higher productivity. And even if she doesn't get back to complete breastfeeding, any amount of breastmilk and happy breastfeeding are good things. So it doesn't have to be all or nothing, particularly with solids coming on down the road. Sometimes when a baby is sleeping a long stretch at night, it allows a hormonal swing back toward menstrual cycles. If you do a little research, there's some anecdotal ideas on calcium/magnesium supplements helping with the dip in milk production some women seem to see with the return of cycles. Obviously breastfeeding can go on for years after that, so it's certainly something that can be overcome. But for some women that long stretch at night can be bad for overall supply, particularly if the baby doesn't get a chance to make up for it by cluster-feeding like crazy during the day. (This comes up with employed mothers -- there's lots of insanity in the U.S. on "sleep-training," yet mothers and babies are apart much of the day, and don't get any chance to re-balance things.)My, this is a long e-mail, but it is a big topic. Good luck to you in your new career.Margaret Wills, land>> Hi , I am new to the field of IBCLC, glad to found this group. I am so into learning from others and sharing experiences. This issue has come up and would like to read some IBCLC responces. > have a mom with low supply at 5 months and this has happened with the other 3 kids also. She is a stressed mom, baby tends to be fussy with breastfeeding, cries after a few minutes of breastfeeding both breasts and after good breastfeeding still takes 80 to 100 cc of supplement and has started solids slowly. her question is would pumping and fenugreek and any other things that can increase milk supply work at this time? she is currently taking fenugreek with no change.> thank you> kathy dounouli> Greece>

[Guest guest]

Hello, Kathy.

Galactogogues, including fenugreek, can only work when the breast is being drained well. If this mother is not pumping regularly, she is wasting her money on the fenugreek. A baby 4 mos or older (and sometimes a little younger) will not stay at a breast and nurse and nurse and nurse like a younger baby in a growth spurt. Instead, if the supply drops, they come off the breast when they can't get more and look at you with betrayal in their eyes, like "What did you do with the rest of it?", but they won't stay and nurse longer. Baby is coming off when he can't easily get more milk, and then mom is bottle-feeding. Fenugreek doesn't work for all mothers, no matter the baby's age, but it has worked for mothers of older babies, but they must be consistently draining the breast well.

I would suggest she be pumping for 10 minutes as close to the end of every feeding as possible (when baby is calm or sleeping--she won't let down milk well if he is crying). I feel strongly that pumping not only tells the body how much milk is wanted, but also *when* it is wanted.

Also, has an IBCLC who is *not* hospital-based ever watched this baby breastfeed? It is quite possible that he has never had the correct suck, so whenever her hormones down-shifted, he didn't have the right suck to maintain the milk supply. A lot of mothers had tender nipples all along, but wanted baby to have breastmilk so decided they could tolerate it for their baby. In other words, they were being a martyr for the baby because they wanted him to have breastmilk. But while there are many times to be a martyr for our children, breastfeeding is not one of them. I always tell mothers that they need to get it checked out whenever there is any discomfort to breastfeeding. "It's not too bad" IS too bad! It won't allow breastfeeding to continue long-term. And I swear there is a small percentage of women who simply don't have pain receptors in their nipples and areolas, or whose pain

receptors shut down after severe trauma in the early days of breastfeeding, so then they thought everything was okay. So whenever there is a milk supply problem, even if mother reports no discomfort, I always want to observe a feeding.

Dee KassingHi , I am new to the field of IBCLC, glad to found this group. I am so into learning from others and sharing experiences. This issue has come up and would like to read some IBCLC responces.

have a mom with low supply at 5 months and this has happened with the other 3 kids also. She is a stressed mom, baby tends to be fussy with breastfeeding, cries after a few minutes of breastfeeding both breasts and after good breastfeeding still takes 80 to 100 cc of supplement and has started solids slowly. her question is would pumping and fenugreek and any other things that can increase milk supply work at this time? she is currently taking fenugreek with no change.

thank you

kathy dounouli

Greece

[Guest guest]

THANK YOU Dee,

you have enriched my knowledge on this issue. No, she has never been observed by a LC, we do not have LC here in Greece in hospitals, yet, and those that do exist are either mostly in pp.

reagards,

Kathy Dounoulis

From: Dee Kassing

Sent: Monday, November 14, 2011 8:07 AM

To:

Subject: Re: low milk supply at 5 months

Hello, Kathy.

Galactogogues, including fenugreek, can only work when the breast is being drained well. If this mother is not pumping regularly, she is wasting her money on the fenugreek. A baby 4 mos or older (and sometimes a little younger) will not stay at a breast and nurse and nurse and nurse like a younger baby in a growth spurt. Instead, if the supply drops, they come off the breast when they can't get more and look at you with betrayal in their eyes, like "What did you do with the rest of it?", but they won't stay and nurse longer. Baby is coming off when he can't easily get more milk, and then mom is bottle-feeding. Fenugreek doesn't work for all mothers, no matter the baby's age, but it has worked for mothers of older babies, but they must be consistently draining the breast well.

I would suggest she be pumping for 10 minutes as close to the end of every feeding as possible (when baby is calm or sleeping--she won't let down milk well if he is crying). I feel strongly that pumping not only tells the body how much milk is wanted, but also *when* it is wanted.

Also, has an IBCLC who is *not* hospital-based ever watched this baby breastfeed? It is quite possible that he has never had the correct suck, so whenever her hormones down-shifted, he didn't have the right suck to maintain the milk supply. A lot of mothers had tender nipples all along, but wanted baby to have breastmilk so decided they could tolerate it for their baby. In other words, they were being a martyr for the baby because they wanted him to have breastmilk. But while there are many times to be a martyr for our children, breastfeeding is not one of them. I always tell mothers that they need to get it checked out whenever there is any discomfort to breastfeeding. "It's not too bad" IS too bad! It won't allow breastfeeding to continue long-term. And I swear there is a small percentage of women who simply don't have pain receptors in their nipples and areolas, or whose pain receptors shut down after severe trauma in the early days of breastfeeding, so then they thought everything was okay. So whenever there is a milk supply problem, even if mother reports no discomfort, I always want to observe a feeding.

Dee KassingHi , I am new to the field of IBCLC, glad to found this group. I am so into learning from others and sharing experiences. This issue has come up and would like to read some IBCLC responces.

have a mom with low supply at 5 months and this has happened with the other 3 kids also. She is a stressed mom, baby tends to be fussy with breastfeeding, cries after a few minutes of breastfeeding both breasts and after good breastfeeding still takes 80 to 100 cc of supplement and has started solids slowly. her question is would pumping and fenugreek and any other things that can increase milk supply work at this time? she is currently taking fenugreek with no change.

thank you

kathy dounouli

Greece

[Guest guest]

Private practice is better anyway, since so many hospital-based IBCLCs are not allowed to talk to mothers about symptoms which show that craniosacral therapy may be helpful. Some are not even allowed to talk about tongue-tie. Since so many hospital IBCLCs have their hands tied like that, this mother is much more likely to get better answers and assistance from a private practice IBCLC.

Dee KassingTHANK YOU Dee,

you have enriched my knowledge on this issue. No, she has never been observed by a LC, we do not have LC here in Greece in hospitals, yet, and those that do exist are either mostly in pp.

reagards,

Kathy Dounoulis

From: Dee Kassing

Hello, Kathy.

Galactogogues, including fenugreek, can only work when the breast is being drained well. If this mother is not pumping regularly, she is wasting her money on the fenugreek. A baby 4 mos or older (and sometimes a little younger) will not stay at a breast and nurse and nurse and nurse like a younger baby in a growth spurt. Instead, if the supply drops, they come off the breast when they can't get more and look at you with betrayal in their eyes, like "What did you do with the rest of it?", but they won't stay and nurse longer. Baby is coming off when he can't easily get more milk, and then mom is bottle-feeding. Fenugreek doesn't work for all mothers, no matter the baby's age, but it has worked for mothers of older babies, but they must be consistently draining the breast well.

I would suggest she be pumping for 10 minutes as close to the end of every feeding as possible (when baby is calm or sleeping--she won't let down milk well if he is crying). I feel strongly that pumping not only tells the body how much milk is wanted, but also *when* it is wanted.

Also, has an IBCLC who is *not* hospital-based ever watched this baby breastfeed? It is quite possible that he has never had the correct suck, so whenever her hormones down-shifted, he didn't have the right suck to maintain the milk supply. A lot of mothers had tender nipples all along, but wanted baby to have breastmilk so decided they could tolerate it for their baby. In other words, they were being a martyr for the baby because they wanted him to have breastmilk. But while there are many times to be a martyr for our children, breastfeeding is not one of them. I always tell mothers that they need to get it checked out whenever there is any discomfort to breastfeeding. "It's not too bad" IS too bad! It won't allow breastfeeding to continue long-term. And I swear there is a small percentage of women who simply don't have pain receptors in their nipples and areolas, or whose pain

receptors shut down after severe trauma in the early days of breastfeeding, so then they thought everything was okay. So whenever there is a milk supply problem, even if mother reports no discomfort, I always want to observe a feeding.

Dee Kassing

[Guest guest]

I think this may have been covered by some of the other posts -- but they were

quite lengthy --- so forgive me if I'm adding what others have said. The MOST

frequent reason I see for a drop in supply after 3months is a drop in the

frequency of feeding, especially with busy mothers of older babies. How many

times is this mother offering her breast? I usually couple the approach in this

manner refining any one of these techniques depending on the mom and the baby

1) breast switching -- up to four breasts if the baby is willing --- often older

babies will go a little while longer because it IS a switch

2) making sure the mother fits in 6 feeds at the breast in 24 hours; 5 at a

rock bottom minimum because the 4 feeds a day plan is a set up for childhood

obesity --- and if mom can only get the baby to feed 5 times a day I definitely

add a before bed pump for mom

3) pumping for every bottle given and sometimes + 1

a) usually after because the baby is calm then, and definitely if the baby

won't take the breast if its just been pumped

sometimes after for the babies that like to suck themselves to sleep

a) and are always dependent on in-depth discussion with the mom and

watching how the baby feeds

sburgernutr@...