Low supply - when to give up and offer formula?

[Britterbug84]

I have been having an off and on problem with low milk supply. It started when AF came back and every month since. It used to just dip for the few days of my period and then come back, but this past month it never came back. I feel like my whole day revolves around pumping and nursing, taking TONS of Fenugreek, drinking almost a gallon of water every day, eating a minimum of 2000 calories a day, and I just made a batch of lactation cookies. I had a really good milk day yesterday and thought things were looking up, but today it is gone again.

I am not able to leave her with anyone for any length of time because I have to be there to feed her. What I do pump is barely enough for her DF at night (5-7oz). Tonight I didn't have enough even for a full DF.

So far, my DD has had enough to eat, but I think it is starting to effect her naps. She has been having a rough month of short naps, and nothing I did with her routine was really helping. Then yesterday, when I felt like I had a lot of milk, she slept wonderfully! I don't know if it was just a coincidence, but it seemed like the first day in a while that she took in really good nursing feeds. Today she seems to want to eat more but it just isn't there!


My question is, when do I give up/give in and offer her formula? If I have to switch over how do I go about that? And last of all, does anyone have any other suggestions for upping my supply?

[First Time Mom]

Hi Brittany, I think that only you can make the decision of switching to formula. It does sound like you are doing everything possible to increase your milk supply. Are you sure you actually have low supply? Your lo is 7 months, at this age they are very efficient at nursing and we don't get that overfull engorged feeling as our bodies are efficient at making what is needed. We basically replenish what is taken out. How much is you lo eating in terms of solids? If a lo is taking a large volume of solids or if it's too close before a bf then they won't want as much milk and we won't make as much.

I understand how you feel about not being able to leave her, I bf my dd until she was 18 months and up until 12 months I couldn't leave her as for some reason I was able to bf but I was not able to pump a drop! That's right, not a drop for a single bottle! My body just seized up whenever a pump came near me and I wasn't able to produce. Luckily with ds it's quite different and I can pump (though he won't take a bottle but that's another issue ).

Do some thinking about it before you decide to stop bfing and make the switch and make sure you are ready and wanting to do so because once you do you can't go back. Know that you did a great job bfing for as long as you did and you gave your darling the best gift in her life so far .

[Britterbug84]

I am pretty sure it is a supply problem. DD never seems satisfied after a feed. She will nurse for about 5 minutes (with me compressing my breast like crazy) and then start bobbing on and off, and getting really frustrated. If I offer the other side she will calm back down and nurse for another 5 or so minutes. Then she gets frustrated again. If I sit her up to let her be done she will whine and cry a little like she is not satisfied. If I then put her back on (either side) she sucks a couple times and then bobs off and starts to fuss and cry. When I compress my breast to try to get more out I can feel that it is really empty. I don't feel my milk let down every time I feed her anymore either, and I have always been able to feel the let down.

I have been having to compress my breast while she is eating just to get her enough to keep her happy for an hour or so. Then I keep her happy, sometimes, with her pacifier, rice crackers, oatmeal cereal, or some solids for another hour until her nap. Last week I tried feeding her every 1.5-2 hours and didn't see any increase in my supply.

Today I have been NEEDING to feed her every 2 hours because she starts crying from hunger. She still doesn't seem satisfied.

She isn't eating much solids yet. Just some oatmeal, rice crackers, and a couple purees. I didn't want to rush her with the solids, and don't want to start now. I would only be supplementing her with the formula, at least until my milk dries up completely. I am really afraid that when AF comes this month it may be over whether I like it or not...I just can't imagine trying to feed her with even less than I am getting now.

[~ Vik ~]

Hi Brittany, and (((hugs)))

I agree with Marian, it does sound like you're doing what you can to increase your supply!  The only thing I would caution you on is drinking TOO much water - a gallon is 128oz!  I know that we recommend drinking plenty, but too much can actually decrease your supply.  Here's some information from Angela White, J.D., breastfeeding counselor (as quoted on http://www.blisstree.com/breastfeeding123/how-much-water-does-a-breastfeeding-mother-need-to-drink/):
"What’s the rule about drinking water when you’re breastfeeding? It’s the same rule for everyone, breastfeeding or not: drink enough to satisfy thirst. Drinking any more than that can actually decrease your milk supply! One study showed that consuming 25 percent more fluids than the “drink to thirst” recommendation led to a decrease in milk supply. I also learned from lactation consultant Linda Wieser at the LLL area conference that drinking more than 80 ounces of water per day can reduce a woman’s potassium levels and have a negative impact on milk supply."
(The study that she quoted for that information is Dusdieker, L. et al. Effect of supplemental fluids on human milk production. J Pediatr 1985; 106(2): 207-11.)

Really, like Marian said, only you can make the decision to give formula.  No matter what you decide, you should be proud of the length of time that you've been bfing!  And I know you've overcome a bunch of obstacles to get where you are (I've tried to help on a few of your posts before! ) and you've given your DD a wonderful gift.  And keep in mind too that breastfeeding is not an 'all or nothing' activity - you have loads of options.  You can supplement, you can continue to bf morning and bedtime but offer formula for other feeds, you can breastfeed during the day but offer a formula dreamfeed, etc.  If you decide to offer formula and need some help getting her to accept it, I can share the gradual way that we got Dylan to take soy milk for his day feeds.  And no matter what you decide we are here for support, hugs and advice! 

[Britterbug84]

I had to put her to bed hungry because I didn't have any more milk   I feel like an awful mommy. I just sat and cried after she finally fell asleep.

I counted exactly how much water I drank today and it was 3 1/2 34oz bottles of water.....so that is 119 oz. Maybe that is too much? I really have been drinking until I absolutely detest water by the end of the day, plus I am in the bathroom more than when I was pregnant.

DD has had a sensitivity to dairy in my diet, so I had some hypoallergenic formula on hand so I offered it to her. She spit it out immediately. So I went to the store and bought both soy and regular formula. She wouldn't drink either, and would bury her face in my shoulder and start to cry when I offered the bottle to her. Vikki, I would LOVE to hear how you got your LO to eat formula. I am still going to fight tooth and nail to keep BFing as long as I can, but I just can't let her go hungry so I need to be able to supplement.

I am on my own this week as DH is out of town on business. I am so glad I have you ladies here for me in case I am going to be dealing with a hungry baby all week.

[~ Vik ~]

(((hugs)))

I think that may be too much water (at least from the studies that I have read).  And if you're hating it and it's making you uncomfortable too then I would cut it back some.  Try maxing out at 80oz - that is still plenty of fluids but is below what seems to be the benchmark from what I have read.  Hopefully cutting back some will help your milk supply.

Ok, onto the formula.  I'm assuming that she takes a bottle ok since you mentioned you did a bottle dreamfeed, and it's the formula that she's rejecting.  When I was trying to get Dylan onto soy milk (he was 16mo so we were beyond formula) for his day feeds he rejected it straight off so we had to do it gradually.  We did:
week 1:  4oz ebm + 1oz soy
week 2:  3oz ebm + 2oz soy
week 3:  2.5oz ebm + 2.5oz soy
week 4:  2oz ebm + 3oz soy
week 5: 1oz ebm + 4oz soy
week 6: all soy

We had no problems with him rejecting anything along the way, probably because we did it so gradually, and I still bf morning and night.  You could go more gradually if you want (say, in 1/2oz increments instead of 1oz) and you can vary the timing (we did 1 week and made the change every Sunday, but you could increase by 1/2oz every few days if you wanted it to go more quickly). 

TBH, hypoallergenic formula tastes VILE so I'm not surprised that she's rejected it.  If she's got a dairy sensitivity I would try soy first - it's better tasting and you'll be less likely to deal with rejection.  Approximately 40% of babies with MPI are also intolerant to soy, so keep your eye out for symptoms.  Keep in mind though that some changes (like poops) are normal as her body is getting used to something new, but watch for diarrhea, increased fussiness, and other symptoms that you noticed when you still had dairy in your diet.

(((hugs))) and good luck.  Remember that this doesn't have to be the beginning of the end for breastfeeding - plenty of moms have mixed fed successfully so you can keep bfing too if that's what you want

[Britterbug84]

Today was pretty rough, but I managed to pump enough for her night bottle (6oz) and topped it off with almost an oz of soy formula. She drank it without a problem and got to go to bed on a full tummy. That is usually the only bottle she gets, and I don't know how to deal with the middle of the day hunger problems. I guess I could pump rather than feed her, and add formula to it, but I think that would decrease my supply even more.

I really want to continue BFing as much as possible, but if supplementing with formula is what I have to do, I will.

Have you ever heard that sleeping on your front can cause supply problems? I was told that when my problem first started and have been trying to only sleep on my sides or back, but I have always been a tummy sleeper and sleep best that way. Any thoughts?

[~ Vik ~]

Only have a second to post as I'm on my iPod and heading out the door to work, but will check later tonight too.

You can pump during the day and add the formula if you want. Pumps are less efficient than babies so what I've done in the past is pump during nap, bf on waking (there will still be an oz or so in each breast even if you just finished pumping), then offer the mixed bottle after bfing.

I am a tummy sleeper and have not noticed any problems - could just be lucky though

Good luck today

[~ Vik ~]

How did everything go today?  Been thinking of you and your DD

[Britterbug84]

Things have been a bit better. I still can't get any extra, but DD seems to be more satisfied. I am still going to transition her to drinking formula so that she will be able to have it in an emergency.

Thank you SO much for all the advice and support. Hopefully things stay good for a while here.

[lpperry]

Have you tried More Milk Plus?  They have it in liquid form and pills.  I go to a a breastfeeding group at a store owned by lactation consultants.  They sell the More Milk Plus, but I am sure you could get it online.

I had an incredible struggle breastfeeding until my LO was 3.5 months. It turned out he had a posterior tongue tie and was not able to get an efficient suck.  Therefore, my supply dropped to almost nonexistent because there was such little stimulation.  When we got his tongue clipped at 3.5 months, it solved all of our breastfeeding problems, but prior to that I had to pump to get my baby something since he wasn't growing and was unable to get any milk.  Since my supply had dropped so much, I didn't have anything to pump. I took More Milk Plus and my milk was back in just a few days.

They are not super cheap, but $20 or so wouldn't be a bad for you to try so you don't have to give up breastfeeding without trying everything. 

I just went in to my store last night to bet More Milk II.  My supply is dropping again because I am newly pregnant, but still breastfeeding my 11 month old.  You can't use More Milk Plus while breastfeeding, but you can use More Milk II.  I hope it works as well!