Sudden decreasing of milk supply?

[Yuliya]

Hi,

Already for over 6 days I have a significant decrease of my milk supply. My DD is a single side feeder. I tried pumping for 5-10 mins the breast I fed my baby before, but not the other one b/c I am afraid there will be nothing to feed her for her next feed. She is 14.5 WO and exclusively bf. I used to have decreasing of milk before but it would come back after 3 days (with the help of pumping + Fenugreek). I still take Fenugreek even more amount a day but it doesn't seem to help much.
Another problem is that she also started refusing to feed sometimes. I tried to feed her in a darkened room right after sleep but it makes the thing even worse - she falls asleep at the breast.
DD is on 3 hour EASY since she was 7 wo. I try to do the DF at 10:30 or 11pm, she wakes up at around 2:30am for feed and then at 4am but I give her a very small feed and put back to sleep otherwise she is not going to eat her first morning meal. She has never been a good eater so tanking up before bed time is out of the question.

- Is it normal that milk supply decreases suddenly not gradually? With me it always happens like this: I have enough milk for some time then one evening my breast just empty for DF and the following days i wake up in the morning with my breast not engourged and not enough milk for the rest of the day. And that for few days.
- Do you think I should pump for longer period and both breast? I forgot to mention that nothing comes out... well less than 1/4 oz. Sometimes not even that.
- Could it be something with the taste of the milk that causes its refusal?

Any advise is highly appreciated.
thanks,
Yuliya

[Samuel's mum]

This is probably going to sound a bit weird but are you just basing your concerns on how your breasts feel? What exactly is leading you to feel your supply is decreasing.
I only ask because the things you have mentioned could be explained by a growth spurt - which can hit at anytime. And the changes to your breasts are completely normal around this time. People stop feeling 'fuller' for a variety of reasons and it's a normal expected phase. The early sensation of 'fullness' is also about blood surrounding developing milk-producing cells and lymph fluid.

If you are only getting 1/4oz it sounds as though you just aren't getting a letdown. Which is also not unusual. What kind of pump are you using? You may need to work on relaxing and trying to get that letdown started by using a warm compress and some massage just prior to a pumping session and even during.

Make sure you are drinking plenty of fluids and eating well. Supply can decrease suddenly if a mother isn't drinking enough or is taking medication. Are you taking anything?

What form does her refusal take? Does she refuse to even latch on or just not wanting to feed once she is on?
The taste of milk thing is a possibility but it's not a likely one - it's more commonly something else. How much fenugreek are you taking?

I would suggest you focus on the pumping - see if you can get that letdown started. Remember it's all about supply and demand so the more 'demand' you ask of your breasts the better. If you want to pump to develop your supply the best way to do it is to pump directly after a feed (the equivalent of a baby drinking on an emptier breast which is what they do during a gorwht spurt to increase supply). Ideally it would be both sides which should be fine if it's directly after a feed. Make sure you are drinking enough.

Do you think she's hungry at that 4am feed? Have you tried to settle her in another way? Those are very specific wake-up times - are they really that fixed?

[KellyDMB]

Yuliya, I feel as though you wrote my experience.  I have been dealing with this same thing but the waking times are 1:30 and 4AM.  And, she never could do a dreamfeed or else she'd be up every 3 hours.  But, she was sleeping 9-10 hours before that.  This seemd to start at around 10 weeks.  And, oddly, my period returned at 8 weeks.  Sorry to hijack your post, but I am confused and maybe we have the same thing going on?   

[Samuel's mum]

Thanks for the reminder. When the first period returns it can have quite a knock on milk supply (as estrogen/ostrogen levels are raised and that can affect supply just as it does in early pregnancy or when taking the combined contraceptive pill). If your period returns when your LO is younger (your milk supply has really only just got established) and pre-solids it makes sense that the 'knock' is more noticeable.
Yuliya - has your period returned?

Usually though the effect of the period on supply is only felt for a few days although it may take a bit of catching up. And it can mean a change in the 'taste' of milk and sometimes milk refusal occurs (as in pregnancy too).

[KellyDMB]

Thanks Emma.  Also, the increased waking makes me think my DD is not getting enough, as she only wakes to eat and then is right back to sleep.  she is also not naping weel, I think for the same reason.  Do you think I could start solids? 

[Samuel's mum]

If a mother has any concerns about supply that's an extra reason to hold off on solids until the recommended 6 months.

I know not everyone makes it to 6 months but starting sooner can mean less demand at the breast and for a mother with supply concerns that could have some serious consequences i.e. a baby feeling 'fuller' sending less signals to the breasts to make milk and supply slips further.

There's some info about why it's worth holding off on solids here (and how the recommendations changed from 4 months to 6 months relatively recently):
 http://www.kellymom.com/nutrition/solids/delay-solids.html

How is her weight gain? If her weight gain is fine then you know she is getting enough. Wakings at very specific times usually are not an indication of hunger but of a bodyclock/ habitual waking issue. A hunger waking tends to occur in a much bigger window of time i.e. over a 2-3 hour span. If she's going back to sleep quickly that might also be because the breast is a prop that she needs to transition between the sleep cycles.

If you really suspect a supply issue is going on then first stop is getting breast feeding support - looking at latch, management of breastfeeds. Then consider using pumping to increase supply, taking galactalogues like fenugreek or a combination of herbs. Then if all that fails and it really is felt supply remains an issue then supplementing with formula would be a choice before solids at your LOs age (15 weeks?). But of course that also has a knock-on effect on supply for a breastfeeding mother so needs to be managed carefully.
But solids is WAY down on that list. Something like rice cereal (putting aside all the concerns about early solids and allergies etc) is relatively low in nutrients and calories and you may literally be filling your LO's teeny tummy with something that takes away her appetite for the vital milk she needs. Plus she may not even possess the enzymes and disgestive capabilities to extract the nutrients that are there anyway.

[KellyDMB]

Thank you Emma, I know you are right on all accounts and I appreciate the info.  I am just so influenced by family who are quick to point the the breast as a problem and they keep saying a well feed baby sleeps better.  Maybe my milk is fine and I am getting doubt from them.  I was just reading the FAQ page and some o the signs for switching to a 4-hour EASY seemed to fit, ie eating less at the 3 hour mark, waking erratically.  Maybe I'll look at that a bit and stop obsessing about supply.  Her weight gain has been good, will know better on Tues.  And, I will try pumping after a feed to be sure.  Thank you for your help!

[Samuel's mum]

No problem.

BTW a well-fed baby doesn't ALWAYS sleep better. A well-fed baby like any other can get overtired/ have props issues/ have developmental milestones. If only it was always as easy as just being about the feeding!
If her weight gain has been good that really says everything. That wouldn't be possible if your supply was a problem - end of story.

[KellyDMB]

True True!  Thanks for the reassurance!  als, I love all of you info in the FAQ!

[Yuliya]

Hi Ladies,

Thanks so much for the information and help.
Today she again was not eating well, I mean we have to spend around 35-40 mins at a breast (I make her to stay) so that she could eat something. She eats okay whatever comes from the first letdown and then as soon as it starts slowing down she looses interest and starts looking around and smiling and cooing. Like I have said it takes me a lot longer than before to make sure she had enough (or my breast feels empty). I do comression etc, pumping almost after all feeds mostly from the breast i fed her before for about 10 mins. I know you told me to pump both breasts but the fear that i won't accumulate enough milk for her next feed prevents me from really emptying the breast. I just pump it for 3-4 mins.
- I am using "The first years" brand pump. It's a small electric pump, used to work okay before with me.
- the refusal of the breast is mostly just not latching again, turning her head away. I know that she is not full after because she eats just for 3-4 mins. I just keep her at the breast and eventually she starts looking for a nipple again and keeps on eating
- I am not sure if my period is back because I have a IUD since my DD is 6 weeks old. It is a hormonal IUD (progestin not estrogen) and women that use it don't have periods. It's called "Mirena".
- I am not on any medications. I take Fenugreek about 8 capsules (500mg/ea) / day. Is it enough ?
- Not sure about my DD's weight gain, couple of days ago we weighted her at home she was 5.9kg. Her birth weight was 3 kg. We'll see the DR next Tue.\
- Last night she woke up at 8pm, 10:30pm and 2:15 am to feed. She cried at 4 am but somehow went back to sleep which didn't happen before.

Last night i was thinking what could cause the milk supply decrease. Couple of weeks ago i was working on DD's naps extension and was pretty stressed and tired. Could it be because of this?

thanks,
Yuliya

[Samuel's mum]

Her weight gain sounds really good. If she's not far off doubling her birth weight at only 3 months then it doesn't sound like fundamentally you have a supply problem to be honest - which may or may not be much reassurance.
When you take fenugreek the recommendation is 3 capsules 3x a day so you could try that. Obviously your fluids intake is pretty crucial and you need to be eating around 2000-2500 calories a day.
A Mirena IUD wouldn't affect your supply at all.

It's important to know that a baby with a good technique dealing with a fast letdown really can finish a feed in an extraordinarily short time - like significantly less than 10 minutes so some of your battling to get her to continue on the breast might be in vain if she has genuinely finished. It might not all be down to her not wanting to deal with a slower letdown. However you say she will return to the breast and feed some more so perhaps she just has this 'gourmet style'. Dr Jack Newman talks about babies having different feeding styles - some are guzzlers and some savour and pause and contemplate (like her).

At her age a couple of night feeds are very very normal - like a df and one other. It's really to be expected. BUT you do ideally want the intervals to be longer than daytime eating intervals. That 8pm feed was a version of a cluster feed I guess but it might be that you could try and settle her in another way if the previous feed really wasn't long ago.

Not everyone who starts single-sided feeding sticks with it by the way. In 'Secrets of a baby whisperer' (p.116) Tracy says that a lot of babies move to double-sided feeding after around the time they reach 12 pounds/ 5.5kg so it might be that if you were to move to double-sided feeding then she will be more satisfied. You could also consider moving from one side to the other so that she gets new letdowns on each side and gradually will reach the hindmilk on each side. This 'switch nursing' as they call it may sound a bit scary if you very accustomed to single-sided feeding but it's a very effective way of boosting supply (as both breasts get stimulation and 'make more milk' signals) and motivating a fussy baby and LCs usually recommend it if anyone needs some supply boosting.

TBH I don't think the naps extension thing would have been enough to deplete a milk supply if that is the problem. But I'm really not sure from what you are saying that it is - based on her weight gain, the fact she will feed, the fact that YOU are the one pushing the feed to continue. To put it simply if she was not getting enough SHE would be reluctant to finish feeding and would be showing hunger cues soon after a feed has finished.

The only other thing to mention is that although 3 hr EASY is really what you'd expect at her age there are always exceptions and if she really isn't that interested in eating then you could have a look on the EASY board to consider extending intervals between feeds although obviously A times and S times are part of the decision process.

[Yuliya]

Hello Emma,

thanks much for your reply. It's sure a reassurance that her weight is good for her age. As a matter of fact it's a huge relief for me.

I keep on pumping but I'm not sure how long i can take it. My breasts are starting to hurt a little bit. Also starting this morning I started taking 3 capsules of Fenugreek, hopefully it will help too.

Now when you have mentioned amount of calories I should be consuming i think I might also had been a little underfed lately. Spent too much time with my LO in her room when working on her naps extension.

Do you really think I should be switching to 3.5h EASY? I am not too sure how to start it and should it be 1.5 hrs of sleep vs 2 hrs of awake time or vise versa? I guess I should look at EASY board closely.

Thanks much,
Yuliya

[Samuel's mum]

I'm not saying that a longer EASY is your answer for sure but it's one more thing worth investigating just because if she's not motivated to feed at 3hrs it might be a factor. Just do a bit of a ponder - although my natural instincts are not usually to recommend extending feeding intervals. Yes - all the answers will be on the EASY board and EASY FAQs.

Diet can be important - especially if there has been quite a sudden decrease in calories. Not drinking enough can make the biggest and fastest difference.

I wouldn't want pumping to hurt. That won't help with your letdown or the general situation. You could experiment with hand expression for a bit of variety or consider borrowing another pump so your breasts get different stimulation.

[Yuliya]

Hello Emma,

I just noticed you are ready to pop any time now. Can't wait when you announce a big news.

I think I on my side have some good news. For the past couple of days my milk supply increased a little bit. I seriously suspect that decrease in calories and fluid intake had impacted my milk supply. As soon as I started eating better and drinking more water as well as resting more and pumping few times a day it got much better, although it took me a while to get it back. So I guess I'd better stick to it in order to keep milk going.
I stopped pumping for now to give my breasts a break.

I still have one question though. Here in Canada it's recommended to drink mostly water or juice to maintain and keep the milk supply while in country where i am from (Kazakhstan) they say to drink mostly milk or tea with cream for the same purpose (my relatives and friends say something like "you can't get calories and nutrition from water". What do you think is better to take?

thank you so much for your help and time. you really helped me.

Yuliya

[Samuel's mum]

Thank you for sharing your good news. That's great.

On the fluids question - I think it's whatever you are comfortable with.
In the UK and US they also don't place an emphasis on milk or tea with cream but rather whatever you won't mind drinking approximately 2 litres of.
Tea which is obviously a source of caffeine is something you probably want to be consuming in moderation but milk as a source of calcium is not a bad idea. The fluids intake isn't really FOR calories but I know what they mean. If are someone who struggles to eat enough, milk is probably a good choice.
I'd go for a mixture of all of it!