Low Milk Supply

Adjusting the Dream of Breastfeeding

A few weeks ago, we sent out a call for Breastfeeding/Chestfeeding/Pumping memoirs.  Our desire was to flood the Internet with beautiful breast/chestfeeding and pumping stories of triumph, overcoming challenges and struggles, and positive outcomes, regardless of the total amount of milk a parent was producing.  We are thrilled to share these stories with you, our readers, and hope that they offer support and inspiration for you, wherever you are in your breast/chestfeeding or pumping journey. 

Thank you to all of the parents who submitted their stories!  If after you read these memoirs you are inspired to submit your story, feel free to send it to RobinKaplan@sdbfc.com.    


This memoir is from Becky.

We were in Cambodia. Part business, part travel. I was seven months pregnant with our first baby and loving every bit of what first time mamahood brings. The flutters, the kicks, the dreaming of what would be. 

We had fought for this baby — with years of infertility and trying and going through the system and finally attempting IVF, as our last effort — and there she was…a little heart beating on the first ultrasound. We did it. And we were ready for all she had for us. 

As we rode wide-eyed through the streets of Cambodia, I saw her. A mama, holding a toddler, nursing an infant…all while balancing on the back of the moped her husband was steering. 

That would be me someday. I was sure of it. It was all so natural and freeing. I was ready and excited to breastfeed.

January 2011, our baby came at rocket speed. We were in front of the hospital as she made her entrance into the world. It was freezing outside. She was tiny and shivering her ounces away. 

We were on cloud nine. First time parents. I was high on endorphins and oxytocin and the thrill of a fast labor. I was walking around hours later. Things could not be going better. (I had no idea these things were not normal).

She seemed to latch well. The nurse told me I had the perfect breasts for breastfeeding. I had read all the books. I was feeling confident. 

Too confident. 

The next day, they said she was losing weight too quickly. I couldn’t understand it. I almost didn’t believe it. They almost didn’t send us home, but we were resolute. We thought we just needed to get out of the hospital, to get home and comfortable.

What I didn’t know is how hard it could be. From everything I had heard, it would be natural, and it would just work. 

But it didn’t. Our sweet baby girl was not gaining weight. The pediatrician threatened to label her with ‘failure to thrive.’ 

In the post-baby haze, I didn’t capture the gravity and seriousness of it all. I was caught in the trap of first time motherhood that takes every input from every direction and confuses it with intuition. I was lost. There was no support. 

I cried myself to sleep clutching our new baby, nearly every night.

We have five kids now. And every single one of them has a breastfeeding story of their own. We always tried and it never went exactly as I wanted. Yet, every baby, every child ended up thriving.

With our first, I used a supplemental nursing system with formula until she could also use table food, at which point I nursed her until she was 14 months old and we were ready for our next embryo transfer.

With our second, he got off to an amazing start. I thought “ah, THIS is a different story.” He gained weight well in the first several weeks, and he began sleeping more. I couldn’t have been more thrilled. Then, at his 8 week appointment, he hardly gained an ounce…in FOUR weeks. It was like a punch to the gut. All the self-doubt and trauma returned. We supplemented with formula until we moved nearer to a dear friend who provided her breastmilk for him. At 9 months my supply was gone, and he plumped up on my friend’s luscious, gracious milk.


With our third, we were ready. We met with San Diego Breastfeeding Center while he was still in utero. I had a midwife and a doula and an acupuncturist and an LC, and I was ready. He was a spitfire from birth. He rarely slept easily but nursed well, I thought. At three weeks, I sobbed as I left SDBFC group meeting. He had hardly transferred any milk. He wasn’t thriving. All the terror and sadness returned…yet, somehow, with help, we pushed through. I pumped, and supplemented from the meager ounces I could squeeze out. It was trying. But he made it to self weaning at 11.5 months.


Our fourth, our only non-IVF baby, was born at home. We were getting more and more natural as time went on. Maybe, I thought, that would help with breastfeeding. And he did well. I held onto every encouraging word from my LC. I remembered the diligence my body required. I was exhausted, but it didn’t matter...he made it. My supply was JUST enough, so I didn’t pump, and I didn’t supplement. It felt like a breath of fresh air. He weaned himself at 11 months, much to my heart’s sadness…yet I had to also rejoice. We made it.

Our fifth and final baby was a champ. Born at home and co-sleeping, she was the best weight-gainer-sleeper of them all. It felt like smooth sailing. Then, suddenly when she was 7 months old, my hormones went haywire, I had a crazy migraine, my period returned and my supply tanked. Where she used to be gulping, there was nothing but air. Once again, my LC walked me through with encouragement and a solid, educated plan. We used donor milk, and soon she’ll be transitioning to 100% table food.

I still think about that nursing mama on the back of the moped in Cambodia. I’m glad that is her story. I’m glad that for many women in the world who chose to breastfeed, their babies thrive. 

But for those of us whose babies don’t thrive, whose dreams of breastfeeding are altered or jolted or completely shattered, we know that every ounce of effort is part of our souls. Every compromise is for the good of our babies’ health, and every bit of love we show by adjusting our dreams is what will set them on the thriving course to someday make their own dreams come true.

How Do I Wean from Supplementing my Breastfed Baby?

This is Part Two in our supplementation series.  Don’t miss Part One: I’m Told that my Breastfed Baby Needs to be Supplemented…. What Should I Do?

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One of the most challenging aspects of supplementing your breastfed baby is knowing when and how you can reduce or completely stop that supplementation.  You will want to work with your pediatrician and an IBCLC to help fine tune this process for you and your baby, but here are some general guidelines.

The reason you were supplementing may determine when you can stop

Early supplementation in the first few days after your baby was born may have been recommended to help resolve a temporary medical situation, such as jaundice, hypoglycemia, or excessive weight loss.  Typically, once your milk supply has fully ‘come in’ and baby is gaining well, supplementation can stop. Longer-term supplementation, such as for a premature baby, baby with feeding challenges, or a breastfeeding parent working to increase milk supply, will likely require a longer weaning process.  In both cases, though, watching the baby for signs of effective breastfeeding will be an important part of baby's care.  

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How do I know if my baby is breastfeeding well?

There are quite a few ways we can tell that a baby is breastfeeding well

  • Baby actively feeds for 20-40 minutes, seems satisfied after eating, and can go about 2-3 hours between most feedings

  • Breastfeeding is comfortable and your breasts feel softer after your baby has fed

  • Diaper count - Babies in the first few weeks to months should pee/poop at least 5 times a day.  As babies mature, so do their digestive systems. After the first few months, babies often continue to pee at least 5 times daily, but poop frequency may drop to 1-2 times daily

  • When you weigh your baby before and after a breastfeeding session (like with a gram-sensitive scale at a breastfeeding consultation or support group), your baby is taking in an appropriate amount for his/her age and weight.

  • Weight gain - Baby is gaining the appropriate amount of weight based on his/her age  

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What is the best way to wean from supplementing my breastfed baby?

As your baby begins to breastfeed more effectively and transfer more milk from you while breastfeeding, you might also notice that your baby begins to refuse supplements (or just takes less) after breastfeeding.  If your baby is gaining weight well, then you might consider offering less of a ‘top off’ after breastfeeding and see if your baby continues to gain weight well. If your baby is gaining more weight than expected for his/her age, this is also a reason to pull back on supplementation.

To wean from supplementing your baby, you will want to either reduce the amount of supplementation after each breastfeeding session or cut back on how often you supplement during the day.  Try this reduced supplement amount for a few days and see if your baby still seems satisfied after eating throughout the day and night, as well as check your baby’s weight to make sure he/she gained enough over that time period.  If weight gain is still more than needed/expected and your baby seems satisfied after eating, continue to pull back on the amount of supplement per day until you reach a point where you have either cut supplementing completely or dropped down to your baby’s sweet spot.

While reducing the supplementation amount, this also means that you might be able to cut back on the number of times you pump per day, which is what every parent wants to hear, right?  A lactation consultant can definitely guide you on this process so that your milk supply isn’t lowered with this decrease in pumping frequency.

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What if I am unable to wean from supplementing my baby?

There are some situations when a breastfeeding parent may not have a full milk supply and will need to supplement long term.  Working with a lactation consultant can be very valuable during this process to help maximize your milk supply potential, as well as discuss options for long-term supplementation.  

It is incredibly important for any parent needing to provide long-term supplementation to understand that EVERY drop of breastmilk you produce for your child is valuable.  You are creating a perfect food for your child, as well as providing amazing immunity-boosting benefits that only YOU can create. Your milk was meant for your baby and breastfeeding does not have to be all or nothing.  While it can feel absolutely heartbreaking to hear that exclusive breastfeeding may not be a possibility, I’d like to share a beautifully written breastfeeding memoir on our website.  The author, Aran, brilliantly coins a new term, ‘Inclusive breastfeeding’, which helps put all of this breastfeeding and supplementation into perspective.

 So, what additional questions do you have about weaning your breastfed baby from supplements?  Feel free to add a comment here and we will gladly offer advice!

And, if you need some guidance on how to navigate your supplementation journey, book an appointment with us, as we would love to help!

To book an appointment at the San Diego Breastfeeding Center, click here!

If you don’t live in San Diego and would like to book a virtual consultation, email Robin at robinkaplan@sdbfc.com

If you are looking for a lactation consultant in your area, click here for ILCA’s Find a Lactation Consultant Directory

I'm Told that my Breastfed Baby Needs to be Supplemented.... What Should I Do?

Being told that your breastfed baby needs to be supplemented can feel extremely overwhelming and can often feel like quite a blow to the self-esteem.  You might be concerned about your milk supply and if your baby will prefer the bottle to your breast. You may feel confused as to why your baby isn’t gaining the appropriate amount of weight while breastfeeding.  

So, let’s talk about the reasons why a baby might need to be supplemented and how to do this without sabotaging your milk supply and your breastfeeding relationship.

 

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What is a supplement?

A supplement is anything in addition to what your baby receives from your breast while breastfeeding.  Babies can be supplemented with: 

Mom’s own pumped milk (if baby is not removing her milk well enough)

Donor milk (from a milk bank or from another breastfeeding/pumping parent)

Formula

How do I know if my baby truly needs supplemental feedings?

Babies are expected to gain a certain amount of weight based on their age.  So, if a baby is NOT gaining that expected amount, additional supplementation is often recommended.  Here are the weight gain expectations for the first year of baby’s life:

Initial weight loss in the first few days of life - no more than 10% of baby’s birth weight

2 weeks - baby should be back to birth weight (or very close, if he/she lost more than 10% in the first 2 weeks

2 weeks - 4 months - baby should gain about 7 ounces per week

4 months - 6 months - baby should gain about 4-5 ounces per week

6 months - 1 year - baby should gain about 2-4 ounces per week

Why might a baby need to be supplemented?

There are many common reasons why a baby might need supplemental feedings.  

Some common medical issues that can arise shortly after birth that may lead to supplements are prematurity, low birth weight, poor feeding, low blood sugar levels (hypoglycemia), elevated bilirubin levels (jaundice), dehydration, excessive weight loss or poor weight gain.  After those first few weeks, some common reasons for supplementation are baby not removing milk well while breastfeeding (due to tongue tie, reflux, very long feeding sessions) and a low milk supply. In all of these cases, the first step is to ensure that baby is breastfeeding effectively.  Next we want to assess mom’s milk supply to make sure that she is producing enough milk for her baby. Sometimes all it takes are a few modifications to the baby’s feeding routine to help baby start to gain weight. Other times it requires a lactation consultation (done by an IBCLC) to assess baby’s feeding and mom’s milk supply for the cause for baby’s low weight gain.

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What if I can't express enough milk for my baby?

First you’ll want to make sure that you have everything you need to express your milk.  If using an electric pump, make sure the pump flanges fit correctly and that you are pumping for about 15 minutes after breastfeeding.  Some moms let down for the pump easily. Others find that they prefer a hand pump or hand expression. You will want to find what works best for you.

In those first few days after birth (when milk production has not quite yet surged), it can be a bit challenging to express a measurable amount of milk.  In this case, sometimes baby might need to be supplemented by donor milk or formula.

Once your mature milk is in (after those first few days), you might want to meet with an IBCLC to put together a breastfeeding/pumping plan to see if you are able to express enough milk for your baby, as well as increase your milk supply, if necessary.  If you are not yet able to express enough milk for your baby’s supplemental feedings, donor milk or formula would be recommended.  

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Do I have to use a bottle when giving my baby supplemental feedings?

Not at all!  There are several ways to supplement a baby.  Each way has its pros/cons and will be determined by what works best for you and your baby.

Cup feeding is great for older babies, as well as some younger babies who will not take a bottle

Finger feeding is great for the first few weeks of life, as the flow is slow and your finger can help organize your baby’s sucking rhythm.

Supplemental nursing systems (SNS) allow your baby to be supplemented at the breast so that he/she still thinks everything is coming from you!  The SNS has a tube that slips into your baby’s mouth, at the breast, to provide the supplement at the same time baby is breastfeeding. This works best when baby is latching/breastfeeding well and mom is trying to increase her milk supply.

Bottles are definitely an option, as well.  You will want to offer a bottle in a baby-led (paced) manner so that your baby doesn’t begin to prefer the ease and flow of the bottle, compared to your breast.

Will my baby ever be able to fully breastfeed after supplements?

Generally, the answer to this is YES!  Most reasons for supplementation are short-term problems that are resolved relatively quickly with good treatment.  Premature babies grow and get stronger, and typically get better at breastfeeding around their due dates or shortly after.  A baby who is having difficulty with breastfeeding immediately after birth will often be ready for breastfeeding within a few days after birth.  If breastfeeding challenges linger for more than a few days, an IBCLC can help identify the reasons and set you on a path for reducing and hopefully eliminating supplementation as soon as possible. In the meantime, expressing your milk in addition to breastfeeding will help maintain and build your milk supply as challenges resolve.  

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When can I stop supplementing?

Part 2 will discuss how you’ll know it's time to wean from supplements and helpful tips for doing so. 

For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned 

Low Milk Supply: Donor Milk, Milk Banks, and Formula

Partial Breastfeeding: When Supplements are Needed

Keeping Up Your Milk Supply During the Holiday Season

Since Winter Break has descended onto our homes, Ashley and I are taking the next few weeks off from blogging to spend some quality time with our families.  However, that doesn't mean that you'll be left without our breastfeeding support until the new year!  We have over 300 articles on the San Diego Breastfeeding Center blog, which means there is no reason for you to google 'sore nipples' at 3:30am.  Just check out our extensive article list and you will be well on your way!

Here are some of our favorite tips for keeping up your milk supply during the holidays

What about My Freezer Stash of Breastmilk During a Power Outage?

As many breastfeeding moms prepare for Hurricane Sandy and her aftermath, we wanted to share a fantastic article written by our friend, Katy Linda of Stylin’ Momma.  Here’s all you need to know about what to do with your frozen breastmilk during a Hurricane, or any power outage for that matter. 

Our thoughts are with all of you on the East Coast who are bracing for this monstrous storm and hope Sandy is much weaker than expected.

 

Weathering a Storm with a Freezer Stash of Breastmilk

Reposted with permission by Katy Linda, IBCLC of Stylin’ Momma

As Hurricane Sandy approaches the east coast of the US, many moms are wondering, ‘What about my freezer stash?‘.  And with good reason.  There is concern about what this storm will do and how long people may be without power.  Many moms have worked hard to have frozen milk on hand for their babies, and the thought of losing that liquid gold is just too much to bear.

Does traveling cause a dip in milk supply?

A close friend of mine was at a breastfeeding support group recently and was told that many moms see a dip in their milk supplies when traveling with their babies. My friend speculated that this may be a reaction to the stress of traveling with an infant. I told her I would look into this, since I couldn't fathom why traveling would make a mom's milk supply decrease. A mom's milk supply could surely decrease when traveling WITHOUT her infant, but why WITH her infant? After some internet and article searching, I couldn't find any scientific reasons that would cause this phenomenon. But, since a few moms have seen this happen, I thought I would offer some advice on how to make sure that this doesn't happen to you.