Monday, July 14, 2014

Breastfeeding: Low Milk Supply

I have had my share of breastfeeding challenges with Hunter. Mainly due to his reflux. (and an unfortunate bout of mastitis!)  But breastfeeding exclusively is so important to me and my husband that I resolved to stick with it no matter what. Once we found the right medication for Hunter's reflux, breastfeeding became simple and easy again. I just love it.

Unfortunately a brand new issue reared its ugly head this week: Low Milk Supply. 

It seemed I always had an abundant amount of milk for Hunter from the start. I was blessed! But Hunter started waking up early from his naps a couple of weeks ago. Right between 30-45 minutes into his naps he would awake. He started waking up and was content until his next feeding, just happy to be up and play. But a few days ago he started waking up and crying profusely. I thought he was having trouble in his sleep transition from light to deep sleep since the timing was almost spot on every nap. But I read in babywise, that more often than not the "45 minute intruder" or waking early from naps is due to a feeding issue. But this didn't make sense to me since he was eating well and seemed content after his feedings (although now looking back there were signs that said he was not fully satisfied: rooting after 45 minutes of nursing, sucking on his hand, fussing after feeding) but being a first time mom I would just burp him and after I got a burp out of him he seemed fine so I didn't think he was still hungry! Well he was!

We went to the doctor this week because I was concerned with his feeding. He started becoming really irritable during feedings. But this was not the same agitation he felt when he was having reflux issues. This time he would latch on, suck for 10-15 seconds, then pull away and come back to latch on. He would repeat this for a little while until either I switched breasts or changed nursing positions. I just thought he was distracted, since he was getting older and more aware of his surroundings. But now it makes sense that he was not getting the milk fast enough or as abundant enough. Another thing he did was started sobbing after a couple tries latching on. I mean out of the blue suck suck suck, pull off, sob. It was heartbreaking. 

So, to the doctor we went! 

He weighed Hunter, and sure enough he did not gain as much weight as he should have. He gained under a pound in a couple of weeks. The doctor wasn't SUPER alarmed but he did say we needed to make some changes. He mentioned supplementing and my guard went up immediately. I did NOT want to give my baby formula (now, if this was the ONLY option for Hunter then obviously we would do formula, anything that could help him.) I explained that to the doctor and he said that I could supplement with breast milk. He suggested pumping in between Hunter's 7 and a half hour sleeping stretch at night. So it was back to little sleep for this momma...but worth it if it helped me to be able to continue breastfeeding. 

The extra pumped milk was not only done to help boost my supply but to give to Hunter in a bottle; one to two extra ounces a day. I had not pumped nor given Hunter a bottle yet so I was a bit reluctant because I did not want him to refuse the breast having a bottle. But I kept telling myself that this is better than having to get formula. (which would have been given through a bottle anyway). 

So, 4 AM rolled around and I stumbled downstairs half asleep. I pumped for 15 minutes using an electric double breast pump. (Ameda Purely Yours pump found Here!)

I discovered that when I pumped the left side I only got 3/4 of an ounce after 15 minutes. The right 
pumped 2 ounces. According to the pediatrician Hunter should be eating between 4 nd 6 ounces per feeding. So,  if I fed him for 15 minutes he was only getting 3 ounces. No wonder he was fussy! (I know that breast-feeding is more efficient at emptying the breast so he could be getting more than this amount but it gave me a good idea to start with)

I give Hunter 1 ounce of pumped milk at his 5:00 feeding and 1 ounce at his 7:45 feeding. He took the bottle just fine and it didn't seem to create any nipple confusion at this point.

It is now day 4 of pumping and the quantity has increased a bit to 1 ounce on the left and 2.5 ounces on the right. 

Other tips found from Kellymom and LLLi to increase milk supply.

  • Make sure that baby is nursing efficiently. This is the “remove more milk” part of increasing milk 
  • production. If milk is not effectively removed from the breast, then mom’s milk supply decreases. If positioning and latch are “off” then baby is probably not transferring milk efficiently. 
  • Nurse frequently, and for as long as your baby is actively nursing. Remember – you want to remove more milk from the breasts and do this frequently. 
  • Take a nursing vacation. Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest!
  • Offer both sides at each feeding. Let baby finish the first side, then offer the second side.
  • Switch nurse. Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to “comfort” sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer.
  • Avoid pacifiers and bottles. All of baby’s sucking needs should be met at the breast if possible.
  • Only breastmilk for baby!  Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. 
  • Don't forget momma! Rest. Sleep when baby sleeps. Relax. Drink lots of liquids and eat a balanced diet. 
  • Adding pumping sessions after or between nursing sessions can be very helpful – pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops milk.
  • Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue.
Hunter has increased a majority of his naps from 30 minutes to about an hour. Now I know if he's waking early it most likely is a hunger issue.

I'll give an update on how my little guy's doing in a week or so! 

Props to all you mamas out there who are breast-feeding and have stuck with it. It's challenging I know but soooo worth it!!

Prayers for good milk! Xoxo-B