Critical Factors in Milk Production
It is very important for all women to understand the basics of lactation whether she is breastfeeding or pumping; and perhaps more important for women who are pumping. What follows are some of the keys aspects of milk production that are critical to understand when exclusively pumping. Understanding how lactation is initiated and regulated can help you establish a strong milk supply and maintain that supply with a breast pump.
Stages of lactation Lactogenesis I begins during pregnancy. The mammary glands change from inactive to active preparing for lactation. About half-way through pregnancy, the breasts will begin to produce colostrum. You may or may not experience leaking at this time. Breasts usually enlarge, veins become darker, the areolas enlarge and darken, and the nipples become more erect. Lactogenesis II begins following the detachment of the placenta. This stage of lactation is triggered by the sharp decline in progesterone following the delivery of the placenta. Any retained placenta can greatly impact a mother’s ability to establish a full milk supply. Colostrum is present at birth and is all a baby requires until milk production increases. Colostrum is high in antibodies and protein, has a laxative effect assisting baby in removing meconium from her system, and coats the gut providing protection from potential pathogens. Formula provided during this time (even just once) changes the normal flora of the gut and it takes days for it to return to normal. Milk production slowly increases over the first few days post-partum. It usually takes 2-5 days for milk volumes to increase, but it can take longer depending on certain factors. First time mothers will see an increase later than mothers with previous children. Milk will slowly transition from colostrum to mature milk. Mature milk will usually have a bluish colour but can vary in colour due to mother’s diet. Breast milk is usually quite thin and watery and will separate if expressed and left to sit. It is important to realize that lactogenesis II will happen regardless of whether a woman is choosing to nurse her baby or not since it is a result of hormonal factors. Hormones Involved (oxytocin and prolactin) Prolactin Prolactin is the hormone responsible for triggering milk production. It is also referred to as a “mothering hormone” because it creates mothering responses. Prolactin levels rise sharply following delivery and falls substantially over the first 24-36 hours post-partum. Prolactin is produced by the anterior pituitary gland and causes a decrease in estrogen levels. Levels of this hormone vary throughout the day with highest levels at night; hence the reason why it is so important to pump around the clock and during the night. Once lactation is established prolactin takes on only a permissive role and opposed to a regulatory role meaning that it no longer drives production but its presence simply allows milk production to continue. Oxytocin Oxytocin is vital during both the birthing process (contractions) and lactation (milk ejection reflex). It is also a “loving hormone” assisting in creating affection and social bonds with others.Oxytocin can help to create a relaxed, calm, and euphoric feeling which both the mother and baby experience. Oxytocin is important to the bonding of mother and baby and in the presence of prolactin helps to create a strong bond between mom and baby. Oxytocin levels in the brain soar immediately after delivery- one reason why immediate and uninterrupted one-on-one time following a baby’s birth is so important. Endocrine and Autocrine Control Endocrine control refers to the hormonally driven stage of lactation- Lactogenesis II- which will happen regardless of whether a baby is nursing or not. During this time, lactation is established and supply is set. Production will vary depending on stimulation and frequency (i.e different for singleton baby than for twins). And for this reason, it is vitally important whether pumping or breastfeeding that pumping or breastfeeding happens frequently.
Autocrine (local) control is also referred to as lactogenesis III and is the maintenance stage of lactation. This is the process of supply and demand. Milk synthesis is controlled at the breast.
Milk removal is the primary control mechanism for milk supply. It is important to understand current knowledge of milk synthesis. Important aspects of milk production follow: Milk production slows as the breast fills! There are two reasons for this:
- 1. Protein in breast milk called Feedback Inhibitor of Lactation (FIL). Therefore as the breast fills, more FIL is present, and production slows. Think of a grocery conveyor belt. As you put groceries onto the belt, you have less and less room to add more and eventually you must stop adding anything because you have run out of room. In order to allow more groceries to be added- or breast milk produced- you must remove some of the groceries- or milk.
- 2. When the alveoli (small sacs that contain milk producing cells) are full of milk, their walls expand and the shape of the prolactin receptors change. This does not allow prolactin to enter at these sites and, as a result, slows milk production. As the alveoli empty, the receptors return to their normal shape allowing prolactin to enter and milk production to increase.
The Prolactin Receptor Theory is also an important concept in lactation and has important implications for the exclusively pumping mom. The basic idea of the prolactin receptor theory is that milk production is “set” during the first few days/weeks post-partum. Frequent stimulation increases the number of prolactin receptors in the breast allowing the body to utilize prolactin in the body more effectively. This sets the milk production for the rest of lactation period. Babies naturally feed for short periods but very frequently. This encourages the increase of prolactin receptors and the establishment of a strong milk supply. For mothers who are using a breast pump to initiate their milk supply, it is vitally important to understand this concept of the Prolactin Receptor Theory and ensure a pumping schedule that is provide frequent stimulation and removal of milk. Storage Capacity and Milk Production Storage capacity is the amount of milk the breast can hold between nursing or pumping sessions. Storage capacity is not directly related to the size of the breast and can differ between breasts. Storage capacity of the breast impacts the rate of milk production. A large storage capacity will allow milk production to continue on before slowing since the receptors will not “stretch” until full. This has a direct impact on pumping schedules and explains why some women are able to pump relatively infrequently while maintaining a strong supply and yet others must continue to pump frequently throughout their time exclusively pumping in order to maintain a basic level of production. Your storage capacity will directly impact a baby’s feeding pattern if the baby is directly nursing, but as a mother who is pumping, you need to understand how your own storage capacity will affect your pumping schedule. Think of this concept as a cup- you can drink a large amount of water throughout the day using any size of cup. If you use a small cup you will simply have to refill more often. This is not an indication that a woman with a larger storage capacity can produce more milk, only that a woman with a smaller storage capacity will need to pump more frequently. Fat Content The concept of foremilk and hindmilk is a rather outdated concept. Research has shown that fat is released into milk as the breast empties. A baby fed from a full breast will have an increasing amount of fat as the breast empties and a baby fed from a less full breast will have a more consistent level of fat throughout feed. Likewise, milk that is pumped from a full breast will have an increasing amount of fat as the breast empties. You will notice the milk that is first expressed is thinner and waterier. And milk that is expressed from a breast that is not exceedingly full will have a fairly consistent level of fat throughout the pumping session. A baby’s intake and not the amount of fat in breast milk is the ONLY thing that has been connected to infant growth. As long as you are pumping frequently and emptying the breasts as fully as possible during each pumping session, you really do not need to be worrying about fat content of your breast milk.
September 29th, 2009 at 7:51 am
Initially I used the breast pump 6/7 times a day when I used to exclusively breast pump. However, now since I am trying to direct breastfeed my baby, it appears that I am using the breast pump may be 5 times a day or even less than this.
Mostly my son sucks for 10/15 minutes, than fall asleep. However, within 30/50 minutes he starts crying since his hunger wasn’t met if I don’t bottle-feed him afterwards. Also, I feel that my breast is not empty as it should if I use the pump. The reason that why I don’t use the pump every time after I direct breast feed him is I want to ensure adequate milk flow when my baby sucks, therefore, I can’t use the pump as scheduled (every 3 hrs). Does this have any effect on milk flow?
It appears that it needs 2hrs to ensure adequate milk flow after I use the pump. (My assumption)
Assume, my baby sucks for 10/15 mins 3 times a day, I pump 4/5 times a day, does it adequate?
At around 6pm , I fed him with bottle. At around 4, I used the pump. So as per schedule, I should have use the pump at 7. However, I didn’t because I am waiting for him so that next time I can direct breastfeed. Will use the pump if necessary afterwards. Similar type of situation occurs very often. As I said that’s why I am unable to pump 8 times a day. So what is your point of view in this regard.
October 1st, 2009 at 3:42 pm
Hello Mahzabin,
There are a couple issues that important here:
1. The let-down response is largely a conditioned response and it will take time for your body to start responding to your baby as it has to a breast pump. Pumping for just a couple minutes before you start to nurse your son may help to initiate a let-down and provide a better flow of milk for your son.
2. It sounds as though your son is having a difficult time getting enough milk. You do not mention why you were pumping and now transitioning to direct breastfeeding. You may want to consider getting a consultation with a Lactation Consultant to ensure that your son’s latch is effective and he is efficiently transferring milk.
3. Breasts are continuously producing milk. It is true, however, that flow will be faster if the breasts are quite full. However, if you are pumping immediately after your baby nurses, there should be no concern of time.
4. Do not be too overly concerned about scheduling while you are trying to transition back to breastfeeding. The overall number of pumping/nursing sessions per day are much more important than pumping on an equally divided time schedule. I don’t believe you mentioned how old your son is, but generally, you do not want to go much longer than 5 or 6 hours between sessions at an absolute maximum.
5. You may consider a day or two where you only nurse and see how your son does. Switching from pumping to breastfeeding can be very challenging. In the end though, it is all about how your baby does. Ensure that your son is nursing effectively and allow him to nurse freely without concerning yourself about pumping schedules. You should be able to get a good indication of whether or not he is removing enough milk for his needs. In the end, lactation is all about supply and demand. If your baby is removing sufficient amounts of milk for his needs, your body will continue to produce that amount.
Hope that answers your questions.
Best wishes,
Stephanie
October 6th, 2009 at 3:35 pm
I have been EPing since my son was born. He was born with a cleft palate and put in the NICU soon after he was born. The hospital was so concerned with how much food he was eating that I pumped instead of nursed (I wish I wouldn’t have done that now). Once I was able to take him home he wouldn’t take to the breast (as he had gotten used to the nipple of a bottle). I tried breastfeeding classes a few times but nothing was successful. I have been EPing now for 4 1/2 months and I am so frustrated because I have never been able to produce enough to feed him with only breast milk- he has always had both breast milk and formula. When I first started pumping they told me not to worry about doing it at night so I could get some much needed rest. Once I had my baby home he took so long to eat (usually an hour at the beginning) and he needed held so much that it was difficult for me to get in pumping and attending to his needs. Now that he can be laid down for much longer periods of time I am working hard to get my supply up. Currently I pump 4-6 times a day and I am lucky if that makes one meal for him (which is about 8 oz). I drink lots of water and have recently started taking Fenugreek to help, but I still am only able to get 1-2 oz max per pumping. Do you have any suggestions on how I can produce more milk. He is scheduled to have his cleft surgery in Nov., so I want to be able to feed him my milk to make him as strong as possible.
Thanks,
Jessica
October 9th, 2009 at 3:15 pm
Hi Jessica,
First off, congratulations on the birth of your son and your dedication to provide him breast milk. Don’t beat yourself up over the poor information you received at the hospital. You have done what you could with what you assumed was accurate information. The education and support for pumping moms is sadly lacking.
I won’t lie to you; your supply is very low and given that it sounds like you have never had an ample supply, it may be difficult to increase it to the point where you are able to meet this needs. There are certainly strategies you can use, however, to increase it as much as possible.
At this point in time, supply is largely controlled by supply and demand, so if you want to increase your supply you much place more demand. There is no way around this and no herbal supplement or dietary changes will change this fact. If possible, I would encourage you to continue the fenugreek. Ensure you are taking enough. The usual dosage is 3 capsules 3 times a day. You should start to smell like maple syrup if you are taking enough. Drink to thirst. You do not need to drink excessive amounts of water. Ensure your diet is good and get as much sleep as possible. Use the best pump you can afford. Rent a hospital grade pump (such as the Ameda Elite or the Medela Symphony) if you can. Increase your pumping to 8 times a day if you are able to. Pump during the night at least once between 1 and 5 a.m. to benefit from higher prolactin levels. Use warm compresses prior to pumping (or take a warm shower) and use breast compressions and massage throughout your pumping session. You may benefit from pumping for about 10 minutes and then stopping for about 5 and then pumping for another 10 minutes. This may help to remove more milk. You need to ensure you are removing as much milk as possible and then continuing to pump for a few minutes after you have emptied.
The number of pumping sessions is much more important than having them spaced out in any specific way- especially since your supply is low. It really is best to go right back to the schedule you should have started with upon the birth of your son: 8+ times a day for about 12-15 minutes/session including at least one session during the night.
You may benefit from power pumping as well which is pumping extremely frequently around the clock for a short period of time. You can do this even in the evenings or on the weekend. Pump very frequently- every 1 ½ to 2 hours- for as long as possible. Don’t fall into the mistake of thinking because you are not removing milk you are not seeing any benefit. The benefit will come but you must be dedicated and patient (and it seems as though you are both!).
The other thing you may consider is taking a prescription medication. Domperidone or Reglan are both used to help with milk supply. These both work by increasing serum prolactin levels which is the hormone that regulates milk production. You do need to get a prescription for these so you would want to speak to your doctor. Reglan does have depression as a possible side effect so do not take it if you are prone to depression or have suffered post-partum depression. Domperidone does not have this side effect but you may have difficulty getting it if you are in the U.S.A. although I believe it can be compounded at some pharmacies.
I hope this answers your question. I hope your son’s surgery goes well next month.
Best wishes,
Stephanie
November 4th, 2009 at 6:00 am
I am exclusively pumping and getting out about 13 to 14.5oz a day. I would like to try and get more. I was pumping 4 times a day and getting 17 to 18oz a day. I haven’t really ever pumped more than that. Then I went to 3 times a day and pumping out almost the same amount. However the last week and a half, my production has lower to the 13 to 14 (my cycle just started as well). My baby does get formula with breastmilk but my goal is always give her more in breast milk than formula. Since my production has decreased she is getting a little more formula than breastmilk.
I am heading back to work as a teacher and will not be able to pump too much. I pump at 5:30am, 2:45 (which will be right after students leave), and at 8:30pm for about 25 to 30 minute sessions. I massage my breasts as I am pumping.
I did take fenugreek a long time ago but it gave me alot of gas and was upsetting my babies tummy.
I would like to get my production up at least to 18 to 20 so that I can give her more. What can I do to help it??
November 4th, 2009 at 7:29 am
Hi Marie,
Congratulations on your new baby! You do not mention how old your baby is nor if you have been EPing from birth or if you began with breastfeeding. What type of pump are you using? The situation that required you to pump? This information would be helpful to me in order to give you the most useful advice. I can give you some general information, but if you would like more specific info, providing a little more information would be helpful.
If you began pumping when your babe was only days or a couple weeks old, and have only pumped at max 4 times per day, you may very well not be able to see full milk production. Early and frequent stimulation to the nipples and breasts helps to set the milk supply for months down the road. Infrequent stimulation in the early days can, unfortunately, have a lasting impact.
Anytime you drop to a low number of sessions/day, you must expect a corresponding drop in milk supply. I would suggest that most women when they drop below 5 or 6 sessions per day will see a drop in supply, and when you drop below 4 it can be difficult to maintain supply and instead a slow decline is usual. This may not be true for women that have very large storage capacity, but I wouldn’t say that these women are in the minority.
To help counter the effects of a returned menstrual cycle, you can try taking calcium and magnesium supplements. Here’s a link that will provide info: http://www.kellymom.com/herbal/natural-treatments.html#calcium
Unfortunately, the only way to increase milk supply is to increase the demand. You must pump more frequently. Sessions, however, do not need to be spaced out equally, so if you are unable to pump through the day at work, you can pump very frequently while and home and through the night- as well as on weekends- which will help increase/maintain your supply. Try power pumping on the weekends which some find boost supply just enough through the week and then they power pump again on the weekend. Power pumping is basically pumping with extreme frequency around the clock for a period of a day or two. Pumping every one to two hours will mimic a growth spurt and can help to boost supply.
Fenugreek does unfortunately have the side-effect that you mention. You may want to try other herbal galactagogues such as blessed thistle. Here’s a link to info: http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html
There are a couple of prescription meds that can help with milk supply: domperidone and raglan. However, I would hesitate to recommend them unless you are able to significantly increase your pumping regime. In and of themselves, they cannot boost supply but must be used in conjunction with increased pumping/breastfeeding.
I hope that helps.
Best wishes,
Stephanie
November 4th, 2009 at 8:40 am
My daughter is 2 1/2 months old and recently I started EP. She breastfed like a champ for about a month and a half.
At three weeks of age she suddenly got extremely congested and that was the beginning of a long battle with trying to feed her. She would get very upset sometimes she tried to BF because she couldn’t breath well, we tried everything the doctor’s office suggested (drops, suctioning, elevating, humidifier) and we still use all of these methods, but she has remained an extremely congested baby.
On top of that she has reflux (she is taking Prevacid) and developed colic about 4 weeks of age (maybe it’s just because of the congestion, inability to eat, and resulting hunger???). She would wake up screaming for food and be so distraught that she wouldn’t recognize that I was offering her the breast. Standing with her and slowly bouncing up and down while offering her the breast was practically the only way to get her attention and get her to latch on.
Well, this difficulty persisted and then at about 9 weeks of age she became extremely social and active. The result on our breastfeeding relationship is that she cannot stand to just eat and not look around. She gets extremely mad when she is latched on and realizes that she can’t look around. This means that she went a few weeks of only eating half meals and every meal being an absolute battle between us (because of ALL of the problems mentioned above).
She is almost 12 weeks now and to save our relationship and to get her to eat enough so that she can gain weight I decided to primarily pump and offer her the breast only a couple of times a day. She has been eating a ton more and seems to be happier during the day because she’s not hungry all of the time.
Sorry for the long story but here is my problem–Since I have been pumping I have pumped about every 3-4 hours. I can get 3 1/2-4 ounces out of one breast every time but the other breast will only give me 2-3 ounces, sometimes less. I have always had more milk in my left breast, but I am wondering if there is anyway to boost the production in my right breast? I have had to supplement with formula about once a day because I can’t pump quite enough to feed her as she is eating 3-4 1/2 ounces every 2 1/2-3 hours.
Also, I can get letdown but I think only once or twice during a pumping session. So I will pump for a few minutes, then get let down and get most of the milk that I am going to get all at once (in a couple of minutes), then pump for 10 more minutes and only get a few drops. However if I massage my breast more will come out in streams. After massaging I will turn the pump back on and get milk for about 10 seconds then no more, and back to massaging more. Any advice for getting additional letdowns so that I can fully empty my breasts?
My nipples have also become pretty sore and it is for sure not because my flanges are too small. I have the Ameda Purely Yours Ultra and the standard size flange pulls half of my areola into it so I think that is even too big? I am waiting for the “Flexishield Areola Stimulator” to be shipped to me so hopefully that will help?? I am also trying to do less suction but if you have any suggestions please let me know!
Thanks so much and sorry this is a mile long!!!
Lindsey
November 5th, 2009 at 5:05 pm
Hi Lindsey,
Congratulations on the birth of your daughter. Sounds as though you have been going through some challenges. Before answering your questions regarding pumping, I’m just wondering if you have tried any type of elimination diet to see if your daughter is reacting to something that you are eating? Reactions to dairy products in the mother’s diet for example can happen. I’m sure you are trying everything and likely have already thought of this, but thought I’d mention it. Also, have you had a consultation with a lactation consultant (IBCLC)?
On to your specific question… it is very common for one breast to produce more than the other. This, in itself, is not a problem. More specifically, what you are wanting to do is increase your supply. The only way to do this is to increase the frequency of your pumping. You mention that you are pumping every 3-4 hours. This likely translates to about 6 times a day? If possible, try increasing your pumping sessions and add an additional one, or better yet, two sessions. Don’t worry so much about spacing them out evenly through the day, but fit them in where you can.
As for letdowns, your strategy is a good one. Can you massage and do breast compressions while pumping? Perhaps you are already doing this, but if not, it can be very helpful. The initial letdown will release the most milk and any following letdowns will release smaller amounts of milk. The length of session is important though not just to remove milk but to maintain the stimulation and “demand” on your body.
When you pump, ensure that you are using high cycling speed and low suction to start until you begin a letdown and then switch to a slower cycling speed and higher suction. When flow slows, switch back to high cycling and lower suction. Continue this pattern as you pump.
You may find the flexishields are helpful in eliciting letdowns as well and hopefully they will help with comfort. Are you using any type of lubricant when pumping? Try using lanolin or olive oil. Some find the lanoline too sticky and prefer the olive oil.
It sounds as though you are on the right path. Hang in there. If I haven’t fully answered your questions, feel free to contact me again.
Best wishes,
Stephanie
November 11th, 2009 at 7:27 pm
Stephanie,
Thanks so much for your reply! Yes, I have gone off of all traces of milk for three weeks and added all traces of soy for the last two weeks of that. There was no change whatsoever unfortunately. She even fits most of the symptoms to a T but it seems that it is just a coincidence?
I have not tried eliminating any other foods from my diet, but I was considering trying gluten? I can’t find much literature on what the symptoms are in infants to a gluten allergy.
I have not worked with a lactation consultant since she was first born, but at this point I think it’s probably too late since she has refused to latch on for about 5 days now. She doesn’t eat very well from a bottle either so I think the bigger problem with her is just getting her to eat period. In the end most feedings end with me standing and bouncing her while she stares out the window because when we sit down she can’t see anything interesting and will fuss. Haha, she is just so curious!
Unfortunately my milk supply has been slowly dwindling since giving up breastfeeding. I have added more pumping session but since they are closer together I get hardly anything–like maybe a total of three ounces.
What is the longest possible and shortest possible stretches between sessions that you would recommend?
I have been getting up in the middle of the night to pump to make sure I don’t go more than about 5-6 hours between pumping sessions and during those pumping sessions I will get a lot more milk, but even during those I am producing less than I used to. For instance last week I could get about 5 ounces from one side and 3 1/2 from the other in the middle of the night and first thing in the morning but now I’m down to 3 1/2 and 2 1/2 roughly. It’s so frustrating to be losing my supply when I’m trying so hard to maintain it!
One thing I’ve noticed is that I can’t always get enough hind milk out which has resulted in green diapers in the last couple of days. I am working harder doing the massage and compressions while pumping and that is helping a little but not really. I find that I can’t do it too well while pumping because it breaks the suction. I am still waiting for my flexishields to get here (should FINALLY be here by tomorrow) so I am really really hoping those help!
Anyway, I appreciate your advice. Thank you for your wonderful website! I just saw that you have a book so I’m going to order that too!
Lindsey
November 12th, 2009 at 1:26 pm
Wow, Lindsey,
I feel like I’m ready my own story here!! My son breastfed just fine for 6 weeks, then during the 7th week, began to do all of the things you described, and we reached our breaking point during that week and started EP’ng. The nipple soreness went away after a week or so, and I too produce MUCH more milk out of my left breast than my right. I added the middle of the night pumping session for about a week, and I get so much milk, that it makes up for the times later in the day (afternoon) that I don’t have to worry if I produce a little less. After a week of the nighttime pumping, I worked it back slowly until I now can go until about 6:30am. It’s a bummer, b/c I’d love that extra hour of sleep, but I get 8oz during that pumping session out of my left breast alone, and about 3-5 out of the right!! BTW, I did have to eliminate dairy and soy from my diet and it made a HUGE difference. My son is also on prevacid, which helped, but I think the biggest difference was the elimination diet and bottle feeding with Dr. Brown’s along with the meds. Good Luck! HTH
December 8th, 2009 at 1:53 pm
I am exclusively pumping and am only able to get about 2-3 oz. each time. My daughter is 7 weeks old now. I have tried fenugreek but it caused horrible gas in us both that I had to discontinue it. I pump every 2 to 2-1/2 hours during the day and once at night. How can I increase my milk supply? I feel like I have tried everything.
Thanks.
December 15th, 2009 at 11:53 am
Hi Brooke,
Congratulations on the birth of your daughter. It is hard for me to give you clear direction without knowing more about your situation. If you can provide some more detail, it would help me understand what may be happening.
Did you have any difficulties or interventions during labour/delivery?
Did you begin breastfeeding? If so, how soon after delivery; how frequently; how did your daughter nurse?
If you began pumping immediately, how soon after delivery did you begin? How often were you pumping? How long were you pumping per session?
What type of pump are you using?
Did you experience normal breast development during pregnancy? And did you experience changes after delivery- fullness, engorgement, etc.?
You mention you are pumping every 2-2 ½ hours through the day and once in the night. This should be a good schedule. Does this equal out to around 8 sessions/24 hours? How much milk are you pumping/24 hours? It is much better to look at pumping within a 24 hour period as there are always normal fluctuations of volume throughout the day.
I am happy to give any ideas I can think of if you can provide a little more info.
Best wishes,
Stephanie
Brooke provided more info and the following was my advice:
Hi Brooke,
A slow start to nursing/pumping can sometimes impact supply down the road. A c-section along with all the IV fluids that are pumped into a mother can also sometimes delay production. It sounds as though your little one had a hard time getting an effective latch which likely interfered with her ability to remove milk which may affect milk supply. However, I wouldn’t say that any of these things are insurmountable. Sometimes it is impossible to pinpoint exactly what is going on. Some women do not respond to a pump very well. The key is to have frequent stimulation and milk removal and remove as much milk as possible each pumping session.
You are certainly pumping frequently enough, so my guess would be that you need to improve the milk flow and work at ensuring you are removing as much milk as possible. Certainly using warm compresses and massage prior to pumping, and using compressions and massage during pumping will be helpful for this. Other ideas are to pump until the first let-down slows, then stop pumping for a short period (maybe 5 minutes or so) and then continue pumping to elicit another let-down or even two. You should be getting at least 2 let-downs per pumping session.
You could try doing some power pumping in the evenings or anytime you have some help with the baby. Power pumping is the idea of pumping very frequently over a period of time. So for example if you have a 3 or 4 hour window at night when you are not too busy (other than caring for a young baby ) you would pump every hour for example. This mimics the idea of a baby going through a growth spurt, places an increased demand on your body, and will hopefully boost production.
When you are working to increase your supply, you must always look at the pump. Ensure that all components of the pump are in good condition, especially the white valves. Even a tiny tear in those will impact the efficiency of the pump. Make sure you are always using the power cord and not batteries. Take off the faceplate and clean behind. I assume the pump is new to you. When EPing, I would never recommend using a previously used pump. If you feel the pump may not be working up to standards, consider taking it to a lactation consultant and asking her to test the suction. They often will have an instrument that they can use for this.
You may consider trying a different pump. Different pumps- especially from different manufactures- do work differently and some women will respond better to one than the other. If you can afford it, you may consider renting a hospital grade pump. I really liked the Ameda Purely Yours and the Medela Symphony has always been reviewed well. I would avoid the Medela Classic if those are still around.
You have already tried fenugreek, but there are other options for herbal galactogogues. Blessed thistle and alfalfa are two other common ones. Here’s a link to info on kellymom.com which may be helpful: http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html Oatmeal is often recommended for increasing supply. No research has been done on it to my knowledge but anecdotally, many women find it helpful and it can’t hurt.
There are drugs that can also sometimes help with milk supply: domperidone and raglan are the most common. You would need to see your doctor about these.
I hope this gives you some place to start. Regardless of whether you do manage to increase your supply or not, do consider what you are able to give your daughter right now. It is very meaningful and valuable! You are doing a great job. Please don’t hesitate to contact me again if I can be of further help.
Best wishes,
Stephanie
December 25th, 2009 at 1:02 am
Hi Stephanie,
I’ve just this week (since Monday) started to EP. My son is 8 weeks old and we were having a difficult time breastfeeding. He seemed to always be getting enough from breast alone after the first 1-2 weeks (during which time he was getting breastmilk from the breast plus supplement from previous pumping session and formula if needed); however I was experiencing extremely sore and damaged nipples due to poor latch/tongue tie that wasn’t released until about age 3 weeks, and then presumably bad habits picked up from having been on the bottle and/or just not used to extending his tongue out. I finally decided to EP since I was in so much pain and discomfort during feedings. I also was on domperidone for nearly 7 weeks and was reducing my intake due to being engorged. I finally stopped the domperidone completely last Saturday and am not sure if it is all “out of my system” yet, so I am not sure if the yields I am seeing from pumping are my system’s “regular yields” or if there is still an elevated level of PRL from taking the domperidone that is affecting my yields. In short, I am not sure if the yield I am getting will stay for the months ahead.
I have been pumping for 10-15 minutes (both breasts at the same time) and getting on average 2 oz. per breast. This has been more than enough for what my son needs. I pump once every 4 hours (8, 12, 4, etc.) What I am wondering is if I would be able to cut out the 4am pumping (so pump at 12 midnight and again at 8am) without much affect to my supply? It would be great to get more than 4 hours of sleep a night!
My son is still waking to feed at night– on average once every 3.5 to 4 hours. As a result I thought I should mimic his eating patterns. Should I wait until he starts to sleep “through” the night (or maybe 5-6 hour stretch) before I drop the 4am pumping session? Or could I drop it now, and just try to squeeze an extra session in during my waking hours?
Thanks in advance for any help you can give!
Julie
December 26th, 2009 at 12:05 pm
Hi Julie,
If I am reading your email correctly, you are currently pumping 6 times a day for 10-15 minutes/session and yielding about 4 oz/session for a daily total of 24 ounces. Is this correct?
I personally would not recommend dropping a session given your current yield and schedule. The fact that you have been on domperidone would suggest to me that you have also been having supply concerns and I would recommend moving slowly as you make any changes to your pumping schedule.
However, this isn’t to say that you should not get more than 4 hours sleep at a time! It is important to realize that your sessions need not be spaced exactly the same amount of time apart. There is no reason you cannot sleep for 6-7 hours and fit the same number of sessions into the remaining time in the day. Depending on how your day is spent, you may also be able to fit in an extra session.
Pumping in the early hours of the morning is always a boost to supply as this is when your prolactin levels are at their highest, but this also doesn’t mean that it has to be at exactly 2 am or 4 am. You may choose to do a final session early at 10pm and then sleep until 5:30 and pump and then continue your schedule as usual. There is quite a bit of flexibility, but the key is that frequent and effective milk removal is necessary to maintain supply.
At 8 weeks of age, your son should not be sleeping through the night. You could choose to mimic his feeding schedule with your own, but practicality and exhaustion often dictate otherwise when you are EPing! It is important to figure out a schedule that will work for you while doing what is necessary to maintain your supply. I woke up in the night until my son was about 9 months old although he started sleeping through the night around 3 months of age, but I preferred this as it gave me a little more freedom during the day. Also, you may have one of those wonderful children like my daughter who doesn’t decide to sleep through the night until they are 2 years old!
I would also recommend you increasing your pumping time slightly. Pumping 15-20 minutes per session will likely be helpful in the long run.
Hope this is helpful.
Best wishes,
Stephanie
December 28th, 2009 at 8:43 pm
Hello,
my name is Stephanie and I have been nursing and primarily pumping for nearly 8 months. My daughter was born completely naturally via vbac with no drugs, but she was a very heavy sleeper. Because she was a terrible nurser and rarely woke I certified Lactation consultant has me pumping every 2hrs and nursing. Then, at about 9 weeks we got severe thrush and the consultant had me take a break from nursing which drove my child to the bottle Since then I have been trying to get her back to nurse but she is reluctant and only does it for a small period of time at night. unfortunately. because of circumstances beyond my control I am no longer a stay at home mom and do not have the time to exclusively work with her at nursing, but pump a lot so she is exclusively fed pumped milk and no formula. is there any way i can get her to breastfeed better when we do have our moments at night?
December 29th, 2009 at 9:52 am
Hi Stephanie,
Kudos to you for being so dedicated! I usually get questions about pumping and supply and such, so it is nice to hear from someone who is not having concerns with this and who is successfully providing milk.
I’m sure you are doing all the things I can recommend with regards to breastfeeding your daughter. At her age, there really is no quick fix to returning her to breast. Key is to keep the experience pleasant for both of you. Lots of close, skin to skin contact can help. Allowing her to go at her own pace. You may find that using compressions while she is latched will help to increase the milk flow to her and allow her to get more milk during the session. It may also help to keep her latched longer since she is getting what she is wanting. One of the problems with bottlefeeding is the milk flows easily and quickly with very little effort from the baby. Switching then to breastfeeding forces babies to work more for their milk and often they are not easily convinced of this
I wish you and your daughter all the best.
Sincerely,
Stephanie
December 29th, 2009 at 7:49 pm
I am 5 months pregnant and already worried about my supply. I work 12 hours shifts, 3 days per week, and I am concerned about being able to leave my patients to go pump. I have an older Medela that worked fine with my last baby, but I am considering a newer model. Last baby, I pumped every 3 hours at work and got 6-8 oz per breast every 3 hours. My plan is to pump at 6am, 9am, 12 pm, and then hopefully once in the afternoon. THEN, I will pump right before going home at 7pm so that is 5 times during my shift. So I guess I will then pump at 9pm and try to feed during the night, but my last baby always slept all night long so I had to get up and pump instead. If this baby sleeps all night, I plan to pump at 1am and 4am. Do you think this will be enough. On days that I don’t work, I will be happy to pump every two hours around the clock. What do you think?
December 31st, 2009 at 9:30 pm
My son is 3 weeks old and I started exclusively breastpumping 3 days ago due to an infection on my nipple, and breastfeeding was excruciatingly painful because he constantly bites down and would get very frustrated trying to latch (sometimes taking up to 15-20 minutes). The lactation consultant said that he had a good latch, but the infection has led me to the breast pump. However, ever since I started breastpumping and giving him the milk in a bottle, he has been extremely fussy post-feed. Is this because he is eating too fast? Too much? Not enough? I’m getting about 2-3 ounces each time, and I pump every 3 hours. Any advice would be much appreciated…
January 1st, 2010 at 4:14 pm
Hi, Stephanie.
After having a preterm baby 3 years ago who was unable to suckle and I was never able to establish a strong milk supply, I am GRATEFUL to have an 11-week old who has a very STRONG desire to suckle. I have had NO problems with establishing a supply, but have had to REDUCE my supply more than once due to its abundance and force. So, I feel very blessed and lucky this time around.
However, my new baby is very inconsistent. One day, he’ll cluster feed and is on and off the breast every hour (or more). The next day, he’ll sleep for 4-5 hour stretches and I’ll get painfully engorged. I will pump during these times so my flow isn’t too much when he wakes up. I will also pump once during the night if I need to have a bottle ready for dad or a sitter should I need to be away for a few hours. My little man has reflux (I’ve eliminated almost everything from my diet, sadly, and he’s on zantac) and we have a complex process for upright nursing that still has him choking, gasping for air and hopping on and off the breast A LOT during feedings. It takes about an hour or more to nurse, then he needs to be held upright for 30 minutes afterward and THEN he can be placed back in bed or in a seat. I’ve worked with a lactation consultant and researched positions and latch techniques endlessly. I’ve even taken him to the chiropractor in case some of this was an alignment issue. No amount of time or adjustment helps his nursing style.
The problem is I work from home with my 2 babies at my side. I really don’t have the time to continue these often 2-hour sessions AND tend to my other responsibilities. Baby has also become VERY dependent on nursing to sleep, screaming if I don’t give him the breast when I know he’s already full to the point of spitting up. He just wants to latch on and shut his eyes. I really need to streamline feedings, not stretch them out, so this isn’t a desired habit.
I’ve noticed during his few bottle feedings that he takes the bottle MUCH easier, sucking the milk down without all the choking and gasping. That trims about 45 minutes off the process so I’m considering switching to exclusive bottle feeding (except maybe at night when I have more time but still fear reinforcing the need for the breast to fall asleep). I am SO worried about losing the supply I’m so grateful for. With my daughter, no amount of pumping and herbs provided enough milk to meet her nourishment needs beyond 6-8 weeks. It was heartbreaking to watch my milk dwindle each day and my cycle to return at 10 weeks, causing my supply to drop even more.
I HOPE pumping every 3-4 hours will give me consistency to regulate my supply (maybe skipping one session at night to get a LITTLE more sleep than the 4 hours I’m getting) as well as help with nipple soreness (he STILL has latch issues) AND reduce the vast amount of time spent on feeding and holding each day.
I’m turning to you for reassurance and advice on maintaining my supply (maybe even having a little extra for bottles as I will soon need to be out of the house at least one afternoon per week). Again, baby is 11 weeks old and is pretty inconsistent with his feedings but is PROBABLY taking about 4 ounces about 5 or 6 times a day (give or take an ounce or two, and give or take a feeding or two). Just to give you an idea of where I’m at TODAY, when I pump after one of his long snoozes, I easily get 6-8 ounces. I usually get 4-6 ounces at the 4-hour mark. So, I estimate I’ll likely pump about 24 ounces per day if I do so every 3-4 hours. Is that enough as he grows? I can’t remember what babies require as they get older.
In conclusion, I want to make sure pumping instead of nursing won’t hurt my precious supply and that I am producing enough to meet his needs (and then some) as he grows. I appreciate your advice.
Best,
Stephanie
January 2nd, 2010 at 12:40 pm
Hi Yvonne,
Congratulations on the birth of your son! Sorry to hear you’ve had a difficult start to breastfeeding. Hang in there!
You do not mention what type of infection you have. Is it possible that you have yeast/thrush that may also be affecting your son? This might be something to ask your lactation consultant about. When a mother gets thrush she may or may not pass it along to her baby. Yeast is always present in our bodies, but a yeast overgrowth can happen given the right circumstances. Sometimes the circumstances are right in the mom and not the baby or vice vera. Yeast in the mouth can cause soreness and discomfort for the baby. Look to see if you can see any white patches that cannot be wiped off.
You mention a few possibilities as to why your son may be fussy after feeding: eating too fast, too much, or not enough. Any of these are possible. Other possibilities are that he needs to suck more or perhaps needs to burp. Babies are born with a need to suck. Nature has filled this need through breastfeeding and as long as a baby is not limited in their access to the breast, they will meet this need and eventually it will subside. Babies who are bottlefed often are not able to fulfill their need to suck only when feeding. Bottles have constant flow and, unlike when breastfeeding, a baby cannot moderate the flow of milk from a bottle. It may be that your son is wanting to suck longer. Using a soother when bottlefeeding can help alleviate this problem. If you use the bottle as the sole means to meet the sucking need, a baby can easily overeat.
The flow of milk from a bottle is often much faster than at the breast. There is also much more air that enters the milk from a bottle- there is very little air that is swallowed by a breastfed babe. Your son may be reacting to the excess air in his tummy and a need to burp.
Try using paced bottlefeeding. Here’s a link with information: http://www.kellymom.com/bf/pumping/bottle-feeding.html Paced bottlefeeding will help ensure he is not eating too fast or too much.
Finally, your son is just hitting that wonderful period that most babies go through where they suddenly “wake-up” and become fussier. This is usually a reaction to their increasing ability to stay awake longer and be more alert and yet their immature ability to change states- from wake to sleep and sleep to wake. I highly recommend The Happiest Baby on the Block by Harvey Karp as a technique that will work to help calm babies.
It’s impossible for me to determine through email exactly why your son is fussy after feeding. Trust your mom instinct! Realize as well that many babies do become more fussy around his age and generally it will pass by 12 weeks or so of age.
Hope that helps.
Best wishes,
Stephanie
January 2nd, 2010 at 12:41 pm
Hi Ginny,
I think that your plan sounds very good. How you initiate your supply will make a big difference. It sounds as though you will primarily be breastfeeding and will only be pumping while at work. Is this correct? Ensure that you begin breastfeeding as soon as possible after your baby is born- within the first hour is optimal. Room in with your baby at the hospital and offer the breast whenever your baby shows an interest- which for a newborn is whenever they are awake. Frequent stimulation in the early hours and days are crucial and “set” supply for down the road. Ensure you are not scheduling feeds in any way and nurse your babe whenever they indicate an interest or even just need the closeness and calming.
Let-down is largely conditioned, so you will need to begin pumping prior to your return to work in order to condition let-downs with the pump.
Also, remember that you do not need to pump at exact increments. If you need to take a couple longer periods between pumping sessions, make it up by pumping more frequently in the remaining time.
Hope that helps.
Best wishes,
Stephanie
January 2nd, 2010 at 12:42 pm
Hi Stephanie,
Sounds like you have done many things to try and ease your son’s troubles when nursing. It sounds as though you have a very strong let-down and perhaps a bit of oversupply which are likely contributing to his choking while nursing and easier time when bottlefeeding. You may find that as he gets a bit older things get easier on that front- perhaps not.
As to the crux of your question- will you be able to maintain your supply and produce enough milk if pumping? I would guess that you are likely producing more than 24 oz/day. Milk supply hits a peak around 4 weeks post-partum and stays relatively consistent until around 6 months or so at which point babies often begin eating small amounts of solids and begin replacing the breast milk with other calories. Unlike formula, breast milk changes as the baby ages, so it is the composition of milk that will change and not the volume. Average intake of breast milk varies widely from around 24oz./day to around 36oz/day. I usually suggest that if a woman has the ability to increase her supply past this amount (if EPing) it is a good idea to do so. This extra cushion allows for unexpected dips in supply or the ability to freeze excess.
You sound as though you are responding to the pump very well. This can sometimes be an issue for women who switch from breastfeeding to pumping. I would recommend that if you are planning on switching to primarily pumping, you start by pumping every 2-3 hours instead of 3-4. Take a longer stretch during the night, but never longer than 6 hours. Ensure you are pumping for about 120 minutes per day and always emptying your breasts as much as possible. This will give you a good idea of where your supply is at. At this point, if you find that your supply is very strong, you will be able to slowly cut back on sessions- one at a time- while increasing the time of the remaining sessions so that you continue to pump for the same total amount each day.
The other key element is the pump you are using. I don’t believe you mention what kind you have. It is important if EPing to use at least a double electric pump such as a Ameda Purely Yours or a Medela Pump in Style or a similar to better pump.
I can’t guarantee what will happen with your supply. But following guidelines will help.
Best wishes,
Stephanie
January 3rd, 2010 at 1:33 pm
Hello,
I gave birth via C-section to quadruplets on Dec 9 at only 27 weeks gestation. (One baby only lived 10 days but the others are doing well right now) They are still too young to nurse so I have been pumping since the day after surgery. It took awhile to get the real milk but wasn’t concerned. My concern now is that I am not getting even close to enough milk. I have a hospital grade pump and I pump at least 8 times a day, one being in the middle of the night. I only get 1 ounce on each side during the day and maybe 1.5 each side during the night pump. It seems like my supply has decreased slightly from even a week ago. 4-5 days ago I started fenugreek but haven’t noticed any increase yet. Do I just need to give that herb more time? I would love to be able to have enough milk by the time the three are ready to get all of their nutrition from milk so I don’t have to use formula but at this rate that won’t happen. I feel like I have pretty good nutrition (maybe breakfast is the only meal that isn’t truly balanced). I don’t know what else could be the problem! Please help!
Martha
January 5th, 2010 at 9:24 am
Hi, Stephanie.
My son is 5 months old. I tried breastfeeding him but he would not latch properly. After visiting several lactation consultants, we decided he simply liked the quick flow of milk to the bottle nipple vs. the work needed at the breast.
Even when I infrequently got him to latch in the beginning, he wouldn’t suck well and he just fell asleep.
After a couple weeks of trying, I decided to exclusively pump. I wanted him to have the benefits of breastmilk.
I have a Medela Pump in Style. I pump 6 times a day every 3 or so hours. I do not pump from 10 p.m. to 5 a.m. I yield 7 oz at the 5 a.m. pumping and only 3 or so for all other pumpings.
I only now learned about fenugreek and domperidone. I’m a bit hesitant to take either as I had gastric bypass 8 years ago.
My son was getting pure milk for about the first 3 months. Since then, we’ve been mixing formula with milk. He’s gone from 1/2 and 1/2 bottles to now 2 oz milk and 4 oz formula per bottle. We’re trying to keep a small supply so he can continue on it longer but also to help him get used to more formula than milk.
I’ve been thinking about trying to make it to the 6 month mark (Jan. 24) and then stopping. Exclusively pumping is very difficult and I wonder how much benefit my son is getting now.
I don’t know if it’s worth trying to increase my supply at this point (if it even will) and to keep going or stop. I don’t know how much benefit he’s getting from the amount of milk he receives.
Help.
January 5th, 2010 at 10:47 am
Hi Martha,
Congratulations on the arrival of your babies. My condolences on your loss. A very difficult time for you on all fronts, I’m sure.
It sounds as though you are doing things right: hospital grade pump, pumping 8 times a day, pumping during the night. Frequency is key at this stage, so continue pumping as frequently as possible until your supply increases. It is common for moms of preemies to have difficulties initiating a strong supply. Your body wasn’t quite ready to have these babies and it can sometimes take a while for it to “catch up”. Many moms of preemies do see a gradual increase in supply over the first couple of months; some never develop a strong supply, but it is important to recognize the value of any amount of breast milk for a baby- especially preemies.
Always use all the best practices such as massage and compressions while pumping, adjusting the cycling and suction to initiate let-downs, using some type of lubrication (lanolin or olive oil) when pumping, ensuring that your flanges fit you correctly, etc. Also ensure your pump is working efficiently and regularly change out any wearable part.
Having a premature baby is very stressful. Having a difficult pregnancy and delivery will make it more so. Having four babies will add even more to the stress. Do be sure to take care of yourself. Accept any offer of help. Search out opportunities to connect with other women in your situation. Ask for a lactation consultant to see you in the NICU and have them continue to follow you until your babies are released home- and beyond if that is possible. Get as much rest as you can and eat as well as possible. I know how difficult this can be when you are spending so much time in a hospital, but it is important.
You may also be able to speak to your doctor about getting a prescription for domperidone or reglan. Both can help boost milk supply by increasing the level of serum prolactin in your body. Reglan does have depression as a possible side effect, so it may be advisable to avoid it if you have a history or are experiencing post-partum depression.
I hope this helps some. Best wishes to you and your babies.
Stephanie
January 5th, 2010 at 10:47 am
Hi Jamie,
Congratulations on making it this far! You are right that it is very hard to exclusively pump. It takes a lot of time and dedication and you are doing great!
I don’t believe I am in any position to tell you whether or not you should continue or whether or not it is worth it to try and increase your supply. Ultimately it is your decision. However, what I can share is what I’ve learned about breastfeeding and breast milk over the past 7 years. What I know is that breast milk is the biologically normal method of feeding our babies. Every single component of breast milk is vital to the health and development of our children and they work in combination and ways we don’t even understand to create the nutrition necessary for babies to grow and development to their ultimate potential.
However, having said that, it is fact that not all babies will be able to receive breast milk and some, like your babe, will need to be supplemented with infant formula. This is necessary. Formula is a life-saving measure that we are fortunate to have for when it is needed. Still, any amount of breast milk that a baby receives provides the baby with the living components that formula does not have. Immune properties not present in formula will help to prevent illness and strengthen the baby’s own immune response. Anti-bacterial, anti-viral, and anti-protozoan elements in breast milk will help protect the baby’s maturing digestive system and protect the baby from the many things in his environment that may cause harm. The growth factors and fats in breast milk will ensure optimal grow and brain development. And the benefits continue…
Although your son is also receiving formula, the benefits of the breast milk are still present. Obviously more breast milk is better, but do not discount the benefits of even a small amount of breast milk. Here is an article that you may find interesting and helpful: http://www.breastfeedingresources.net/article.htm
Ultimately the decision is yours and I don’t think the benefits alone are ever the sole reason we EPers decide to continue or to wean; it is only one element of our decision making process.
If you feel you would like to try to boost your supply, my advice would be to increase the number of sessions you are doing through the day and reduce the length of time during the night when you are not pumping. Adding an extra session, or preferably two, during the day and decreasing your sleep by even an hour, should yield some benefits. I understand your hesitation to try fenugreek or domperidone and this is likely a wise decision. You can try other supply boosters though such as adding oatmeal regularly to your diet. Also try boosting your intake of good fats which will pass into your breast milk and provide an extra dose of good fat for your baby.
Whatever your decision, give yourself credit for the work and dedication you have shown and the love you have passed along to your baby. These past five months of breast milk will benefit your babe throughout his life.
Best wishes,
Stephanie
January 22nd, 2010 at 6:55 pm
I have a few questions. First of all this website has been VERY helpful. My son is 10 weeks old and my goal was to exclusively nurse him but we were not able to due to jaundice and loss of weight in the hospital and needed to supplement.
When we came home from the hospital I would sit in a quiet room and try to nurse and it would take over 45 minutes to get him to latch ( and I would have to entice him by using formula in a syringe and squirt it as he would try to latch-NOT FUN!!) and he would cry and get frustrated and in turn I would do the same and cry. So I would literally only have 20 minutes to myself in between feedings. I did this for about 5 days and was told by the hospital to pump after each feeding to establish good milk supply. All in all I was miserable and he was also by the whole breast feeding experience in the beginning.
So I began to exclusively pump. In the beginning I pumped every 2-3 hrs and was so exhausted that I began to sleep through the night and pump when I got up and now I pump about 4 times a day. So some of my questions are when I pump I get 5 oz or more out of my right breast but only 2-3oz out of my left breast why is this? I know that there is a difference but I didn’t think that big. So in the past 2-3 weeks I have been nursing again about 2-3 times a day and he will only take the left breast as it has a quicker flow than the right is there anything I can do for this? When pumping my left breast empties in about 20 minutes and my left takes a lot longer and when I pump I have to massage also. I would like him to take the right as well since when I pump I get about 5 oz. So if he only nurses on one side it won’t help with the milk production to the other breast correct? Also when he nurses he falls asleep almost immediately but doesn’t do it with the bottles. Why is this? He will continue to nurse but is asleep. I like the closeness of nursing but I never know how much he gets and he will be fussy after sometimes so I give a bottle and sometimes overfeed him.
I do use supplements with fenugreek and have been able to obtain a supply of frozen breast milk but I would like to nurse him more but its just easier to pump since he won’t take the right breast. Any suggestions would be awesome.
January 24th, 2010 at 2:48 pm
Hi Meaghan,
Congratulations on the birth of your son! I’m sorry to hear of your difficulties with breastfeeding so far, but it does sound as though you are persevering and have a baby that is still happy to latch and nurse to some extent which is great and will give you many more options.
Your questions bring up a number of different issues. The first place I’ll start is with one of your last comments about not knowing how much your son is getting when you breastfeed. This is a very common concern and one I’m afraid has been encouraged by our bottlefeeding culture. We have lost the faith in our bodies to produce enough milk and the faith in our babies to tell us what they need. There is really no need to know how much a baby is fed. The measures that we need to use as breastfeeding mothers are very basic: is your babe having the appropriate number of wet and dirty diapers per day and is your baby gaining appropriate weight for a breastfed baby (approximately .5-1 oz./day for the first four months or so)?
You ask why your son falls asleep when nursing but not when drinking from a bottle. The breast is a place of comfort and security for a baby. It’s where they feel the most comfortable and relaxed. Your son is likely enjoying the experience. Also remember that babies are born with an intrinsic need to suck. When at the breast, they can meet this need and moderate the milk flow so they are not getting too much. When meeting this need with a bottle, they have no choice but to get formula/milk from the bottle too. If your son is growing well and his diaper output is within normal range, I would allow him to nurse if you are okay with that and let him meet his needs that way. His fussiness after nursing may very well have more to do with simply wanting that closeness with you and not a need for more food. You may want to consider using a baby carrier such as a sling or a wrap so that he can have the closeness he is wanting.
The other area of question is the variation of production between sides and the fact that your son doesn’t like to latch on the right side. Production variations between breasts are for the most part normal. Variation may happen simply because one breast has more milk ducts than the other or you may at some point in your life had an injury to that breast that damaged the structure. If this variation is has just recently happened, it could be that you have blocked ducts in the one breast. If you have any hard or hot spots in the breast, this is likely the case and you need to treat for that.
Pumping only 4 times a day at 10 weeks is not a lot (although I’m assuming you must be nursing in addition to this?). If you are having long stretches of time between pumping/nursing sessions this may very well be reducing your supply. It may be that the one side is maintaining supply better than the other. If your son is latching and nursing well, I would encourage you to nurse him as frequently as possible. You could try pumping the right breast just for a couple minutes until the flow increases and then trying to latch your son on that side. It may help him if he doesn’t have to work as hard to initiate let-down. Also, while you are nursing on the right side, use breast compressions to help increase the flow and again reduce your son’s efforts. You may also try warm compresses prior to pumping/nursing to help with milk removal. You can also try increasing the frequency of pumping on the right side only to help boost supply.
If he isn’t latching at all on the right side, there may be other reasons than the flow. Carefully check your positioning or have someone else watch. (Is it possible to get a consult with a lactation consultant?) Often, just due to our dominant hand, we will inadvertently position our baby differently on one side than the other. Also, watch your son closely. Does he seem to have a preference for one side? Did you have a difficult or long delivery? Where there any interventions such as suctioning used? Sometimes babies will get misaligned or injured during delivery making it difficult for them to latch comfortably on one side.
My best advice would be to keep persevering. Let your son nurse from the one side and keep offering the right breast while seeking out a lactation consult and considering other possible reasons for him not latching on that side. Keep pumping the right side as much as necessary to protect the milk supply on that side and see what happens over the next few weeks. I understand your frustration with your son not latching on the right side, but you are (literally) half way there
If it is any consolation, I know a woman who nursed two children from only one breast. One breast will produce enough for your son if you are allowing him to nurse as frequently as he wishes and not limiting his time at the breast. Enjoy the closeness of nursing him. As long as he is gaining weight adequately, don’t worry about how much he is getting. If he’s hungry nurse him and trust him to manage your supply.
I hope that helps in some way. Feel free to email back if I have missed something or if I haven’t explained something well.
Best wishes,
Stephanie
January 31st, 2010 at 9:15 am
I am a first time mother and my son is exactly a month old today. I am breastfeeding him through pumping the reason is he was little early baby(born at first day of my 37th week and he was only 5lb and 10oz). Due to his weight the hospital gave him formula the minute he was born and I am having trouble latching him after.I am trying to increase my milk supply but only producing 2-3oz every 2-3hr pumping and I do max 6-7 times per day. I do pump at night at least twice at night. My main concern is that can I increase my milk production at this point or is my milk supply set by now.If I leave 4-5hrs gap in pumping I produce 3-4oz and I think this is not the right thing to do.We also give my son formula at night(directed by pediatric) but I want to give him breast milk for all his feed. I take fenugreek 3 times per day. I usually find my right side producing less than my left side. Does this happen or is my pump having deffect( I am using electric pump medela symphony)?. Do I have a chance to increase my supply at 4 weeks after my delivery?.
January 31st, 2010 at 6:17 pm
Dear Sugitha,
Your instinct to not lengthen the time between sessions is a good one. In order to increase supply, frequent pumping is necessary. Always look at your supply in terms of 24 hour production as opposed to individual sessions as your supply will naturally vary throughout the day. Best advice is to increase the number of sessions per day. Pump every 2 hours with at least one pumping session during the night and pump for approximately 120 minutes/day divided among your sessions.
If you wait longer to pump you will initially see an increase in the amount you are pumping, but this will be very short lived. Your breasts continue to produce milk and will store it for a certain period, however, milk stored in the breasts signals production to slow and eventually stop. So longer periods between pumping sessions will in the end begin a decline in production.
It is normal for one breast to produce more than the other. You may find that this sometimes will switch as well throughout your time pumping. It’s not a concern at all unless it is a very recent development or the difference is extreme. Blocked ducts in one breast can cause a decrease in supply in one breast.
So the short answer is, yes, you can likely increase supply, but it will require you to increase your pumping schedule. Look through the FAQ section of the website and you will also see information regarding power pumping and cluster pumping which you may also consider trying to boost your supply.
Best wishes,
Stephanie
February 3rd, 2010 at 7:33 am
Stephanie,
I have one more question for you. When I breast feed my son he sometimes will nurse for over an hour. How long is too long? And when should I take him off? He does continue to nurse but not as quick as in the beginning so I don’t know if I should let him continue or stop him?
February 3rd, 2010 at 6:37 pm
Hi Meaghan,
There are a couple issues here. First, is he nursing this long because he is not nursing effectively and needing to nurse this long in order to transfer enough milk or attempt to transfer enough milk? If this is the case, then you need to get a consultation with a lactation consultant to see if you can help your son become more efficient at nursing. Hour long nursing sessions that are a result of poor milk transfer are not normal and should be investigated. Often there are reasons for the extended feeding time and solutions can often be found. Look for signs of milk transfer including swallowing sounds, deep jaw excursions that indicate swallowing, frequent bursts of sucking/swallowing when nursing, adequate weight gain, adequate wet and dirty diapers. A content baby is not necessarily a sign of a baby who is getting enough milk.
If your son is breastfeeding well, transferring sufficient quantities of milk, and gaining weight well, then extended periods of latching are not necessarily a problem unless you feel they are a problem. Some babies have an greater need for oral stimulation and they will meet this need by nursing- nothing wrong with this and it can be very good for your milk supply. Some babies just like the closeness of being right next to mom; it’s where they are most content, safe, and happy. Again, there is nothing wrong with this. However, it can be frustrating to have a baby that requires so much time at the breast and it can seem as though you never get time to do what you need to do. If this is the case, you may consider wearing your baby in a carrier such as a sling or wrap. This can meet the baby’s need for closeness while at the same time provide you with the use of your hands and give you mobility.
Baby’s under 3 or 4 months of age can also go through an increased period of fussiness and may soothe themselves at the breast. Early evenings are a particularly common time for babies to stay at the breast for extended periods. There are a few theories as to why this is, but the key point is that it is normal and common. In the end, if all is going well with breastfeeding, a baby who likes to “hang out” at the breast is doing what is normal and natural for them. Try to meet his needs while also meeting your own.
I hope this answers your question.
Best wishes,
Stephanie
February 8th, 2010 at 7:31 am
Hello. I had my son on the 12th of Jan. and i have been exclusively pumping since i have been home. My breast were so engorged the first week i had no choice because he wouldn;t stay latched on because it wasnt coming out fast enough from plugged ducts. My question is that I have two older children one 7 and one 1 1/2. I am very busy and found that with my 1 1/2 yr old my milk seem to stop because i couldnt keep up with the schedule i set for myself. I am afraid the same thing will happen with my son. How can I avoid this and keep up with a daily routine?
February 8th, 2010 at 9:20 am
Hi Brice,
Congratulations on your new baby! EPing with older children at home certainly does create new problems. Unfortunately, there are no easy answers to your question. If your baby will latch and nurse, and you are amiable to the idea of breastfeeding, this would likely be the easiest solution. At only one month of age, your son could likely still switch to breastfeeding with little effort. Even a combination of nursing and pumping can be helpful. EPing really is the work of both breastfeeding and formula feeding and there is no easy way to reduce the amount of time required for it.
There is no easy way around the work necessary to initiate and maintain a strong milk supply when EPing. The first thing that is important is to initiate a strong supply early on. This means that you must pump frequently- at least 8X a day- for the first few weeks and starting as early as possible after delivery. The frequency of stimulation early on will help set your supply months down the road.
The second thing I would recommend would be to establish as strong a supply as you can right now. Producing more than your son needs at the moment will allow you to build a sizable freezer stash and give you a cushion in case of supply dips down the road.
Remember that you do not need to pump on exact intervals. It is important to pump approximately 120 minutes/day (this can vary for individuals) regardless of how often you are pumping. Early on, when you are pumping more frequently, it is okay to pump every couple of hours for most sessions but extend others to 3 or 4 hours if necessary. Work around your needs, but pumping must be priority and must be frequent in the early weeks.
When you do start to drop sessions in the coming months, always add time to your remaining sessions. You should continue to pump for approximately the same amount of time per day.
Pumping at night can help to free up time through the day (at your stage, you should be pumping during the night anyhow). It deprives you of sleep, but it’s all a balancing act! Pumping at night also makes the most of your higher prolactin levels at night.
Using a very good quality breast pump is also important and maintaining if regularly is key.
Ultimately, EPing requires a great time commitment and dedication. There is no way to maintain a strong supply without the time put in- unfortunately. Every woman is different and some women will have to pump more often throughout in order to maintain a good supply while others can pump quite infrequently (only 3-4 times per day) and maintain a very strong supply. This has a lot to do with a woman’s storage capacity and there is really nothing you can do to change it.
When you have older children in the house, you need to be able to find a balance that will work for you. Determine your priorities. Ask for help. Let some things slide. If pumping is placed low on the priority list, then you have to expect your supply will suffer.
I hope this helps some. There is really no easy answer to this question. Find the place that you can live, then set your goals and make those your priority.
Best wishes,
Stephanie
February 9th, 2010 at 1:32 pm
Thanks for the information and suggestions. Thanks again. Brice
March 3rd, 2010 at 1:05 pm
Hi. I had my daughter on November 25th. She was an unexpected c-section. She latched on as soon as I was out of recovery. The next day in hospital she was having some difficulty latching, and by a week, she wasn’t nursing well at all. I was supplementing formula because she had to eat. I worked with a lactation consultant and I tried nipple shields, which seemed to work for awhile, but eventually she was doing the same as without. Pulling away, fussing and not seeming full after a feed. So, I decided to buy a pump and see how much milk I could express following a feed. 4-5oz was the amount. I assumed she wasn’t getting very much with breast feeding, so I decided to EP after that. She was much happier, and full! It has been a couple of months now, and going well, but getting very exhausting. I have a set schedule of pumping four times a day. 0600, 1130, 1630, & 2200. I am taking herbs to help with my milk supply. I usually get around 20-24oz per day. My two issues are that by 2200, i’m so tired and just feel like giving up alltogether on the pumping, just so I can get extra, much needed sleep, and the other issue is that I feel like a hermit crab. I don’t get out hardly at all anymore because of two schedules: baby sleep schedule and pumping. I am not a social butterfly to begin with, but it’s nice to be able to have some “freedom” to keep away the blues. Maybe I just need reassurance and extra support. I know there will come a time when I will have to wean, but when that is….I am not sure. Is there a “recommended” length of time to feed breastmilk as opposed to formula?
March 4th, 2010 at 1:30 pm
Hi Wendy,
Congratulations on the arrival of your baby girl. You have obviously done a lot to provide your baby with the best possible and you should be very proud of yourself!
To answer your specific question, the recommended length of time to breastfeed or provide breast milk is 6 months of exclusive breast milk- meaning only breast milk for the first six months of life- and then continued breastfeeding along with appropriate complementary foods up to 2 years of age or beyond.
Everything you are experiencing is shared by most women who are EPing. You are certainly not alone! EPing is hard work. Being a mother is hard work. It’s tiring and taxing and often leaves very little for ourselves. You may find that if you add an extra pumping session somewhere in your day, you could perhaps pump for the last time at 9pm without any affect on your supply. You may want to play around with your schedule a bit and see what happens. Adding an extra session should also help boost your supply if you would like to increase it.
As for being a hermit, I know I felt this way as well. It was frustrating always having to live your life around your pumping sessions and electrical outlet availability! But I did it. In the end, I don’t regret doing it. There are many women who are very mobile with their pumps and will pump wherever they happen to be. For others, this isn’t something they are comfortable with. You need to figure out what you are comfortable with and make it work for you.
I think it is important to recognize the very small period of your life that this is affecting. In the big picture that is your life and your daughter’s life, a few months of not having complete freedom is a very small amount of time. You need to weigh the benefits of what you are doing against that big picture and decide for yourself if it is something you want to continue.
Finally, it is important to realize that some of what you are feeling is just the normal adjustment to motherhood. You have added a new being into your life and it takes time to find a new balance. You are also going through hormonal fluctuations which affect your emotions. If you are feeling really down, or having a hard time with the adjustments to motherhood, do seek out help from your doctor or a new mother support group. If you are not already part of a new mom group, I highly recommend them as a way of connecting with others who are going through the same things you are.
Hang in there! Things will get better and you’ll start to figure out a pattern to daily life. Don’t put too many expectations on yourself. Just focus on the things that are most important to you and take the time at home to enjoy your baby. From personal experience, I can tell you they grow up far too quickly!
Best wishes,
Stephanie
March 6th, 2010 at 9:44 pm
Hi, I had my son 3 weeks ago. He was 12 weeks early. My water broke and they were able to slow the contractions, with various medications. I was on IV clindamyacin & erythromycin to fight infection. I developed a fever and went into full blown labor 4 days later. I did get the 2 doses of steriods to improve lung development. I had an emergency c-section. He is in the nicu and I have been EP since. I have been getting only 3/4oz from 1 side and only 1/1.5oz from the other side. I double pump every 3 hrs for 12-15 minutes. I did become engorged and was told by the lactation consultant to use cold cabbage leaves & ice.
I thought by now I would be producing much more milk. What is a “normal” amount for my situation? Was my milk affected by the medications they used to try to stop labor? Should I be doing something different? He needed surgery the day after he was born on his ruptured intestions. He has an ileostomy bag. He has been tolerating feedings well (through feeding tube) Due to his intestional issues I really want him to have only breastmilk. I only drink water (about 32oz daily) I have had some difficulty sleeping (Incision opened & became infected, scared about his health & have a 3 yr old confused why she can’t see her brother) Thanks for your help.
March 7th, 2010 at 9:42 am
Hi Lori,
Congratulations on the birth of your son! How are you doing? Having a premature baby is very traumatic and stressful. Be sure to take care of yourself at this time.
To my knowledge, the antibiotics should not negatively affect your milk production. I do not know about the other medications they may have used and how they might impact lactation; however, being on IV fluids can delay production and you most likely would have received substantial fluids during your experience. At this point, frequency and consistency are very important. I would encourage you to start pumping every 2 hours if that is possible. Perhaps just start pumping with more frequency when you are at home and able to pump a little more often. Ensure that you are also pumping in the night at least once.
You need to remember that your body was not ready to begin lactation. The hormones of a pregnant woman at 6 months are different than a woman at 9 months. This does not mean that you will not be able to produce more milk, but just that it might take some extra time. The milk you are producing right now is particularly designed for your baby who was born prematurely. Please understand how vital any amount of your milk will be to your baby.
Going through the stress of a long premature labour may also take its toll on your body. Again, give it time. Take care of yourself. Be consistent with your pumping schedule.
Cabbage leaves can certainly help with engorgement, but the best course of action for engorgement is milk removal. You get engorged because of a backup of milk that hasn’t been removed. Instead of trying to stave off engorgement, pump! Use warm compresses prior to pumping and lots of compression and massage while pumping to help remove the milk. If you are feeling full, pump. When milk is left sitting in the breast, production will slow. You do not want this. Also, if you are choosing to use cabbage leaves, be careful not to leave them on too long. If left too long, they can actually have a negative impact on supply.
You don’t mention what kind of pump you are using. I strongly encourage moms of preemies to use a hospital grade pump. If you are experiencing any type of pain or discomfort when pumping, solve it. If you feel the pump is not efficiently removing milk, try another type of pump.
It is hard to say what is “normal” in your situation. Some literature suggests a mom of a preemie should try to get a supply of around 700ml/24 hours (24oz) by a couple weeks post-partum. Every situation will be different though and I think it is best to focus on your particular experience and doing what you can do to improve your supply.
Having had a premature baby who was born 9 weeks early, I understand many of the challenges you are going through right now. Ask for help when you need it. Recognize your limits. Don’t feel as though you always have to “keep it together”. Enjoy your new baby. If it is possible, spend time with him skin-to-skin (kangaroo care). This will also help your milk supply.
I hope that helps.
Best wishes to you and your family,
Stephanie
March 14th, 2010 at 12:42 am
This is a great site! I wish I knew it was here when I started on this journey of exclusively pumping on my own. Here’s a couple of tips that help me (not sure if they are really all that recommended but they have worked for me): I try to pump for at least 1/2 hour (this is my first child so it’s a luxury I know). I also massage my breasts toward the end of the pump- I notice this kicks up a second letdown most times- I massage until my breasts are empty. I am now pumping 3-4 times a day with 12-16 ozs a pump.
March 17th, 2010 at 5:10 pm
Hi, I must admit that I had never heard of EPing before I found myself doing it. Come to find out, a girlfriend with a premie EPed for a year, and I didn’t even know it until now! Hopefully word will get out and this won’t be such a foreign concept to people.
I had my son via emergency c-section 12 weeks ago. He was 12 days late and 9 pounds 14 oz. He was taken immediately to NICU and given a bottle for low blood sugar. We were together after a two hour separation and he seemed to latch and do well. We shared a blissful first hour together. Unfortunately, our problems began soon after. In the hospital, and for the first month of his life he was ALWAYS hungry. There never seemed to be an hour that I wasn’t nursing. Yet he didn’t gain weight. He lost 14 oz. in the hospital and our pediatrician recommended forumula supplementation. For the next month, I nursed around the clock, adding up to 3-4 oz. of formula via SNS.
At four weeks old, a lactation consultant that I had been seeing noticed he had a shortened frenulum. The next week we had it clipped, and I started pumping 3-4 x/ day to build my supply, which never seemed to be enough. He hadn’t been gaining. It took 5 weeks to regain birth weight, including a 12 day spell where he didn’t gain an oz. This was a hazy and depressing period. With the added pumping, I was spending every moment of my day addressing feeding my child. I would nurse, supplement, then pump. To add in some break, I started supplementing via bottle versus SNS. Although this freed up some time in my day, it made it easier to give him more and more formula (by my self and now by my husband.) On the upside, he was gaining weight & happy.
By 7 weeks, I was supplementing 12-13 oz now formula and expressed breastmilk, which seemed so ironic to me. I sought out a second lactation consultant for another poind of view. She recommended renting a madela symphony pump (I had been using an ameda pump) and increasing pumping to 8-10/day and take the baby off the bottle (back to SNS, but this time finger feeding). So for several weeks, I did this and went nearly insane. My son stopped taking pleasure from nursing — where as before, even if he didn’t get much milk he would just fall asleep, now he was rejecting the breast. I felt like I was in a hamster wheel. I rarely ever left the house, and felt like a complete failure for not being able to breastfeed or provide enough daily milk.
Sorry for the long complicated backstory. My current situation is that with a 12 week old baby, I’m pumping 8-10 x/ day for a whopping 18-20 oz. He’s consuming about 32 oz. day, which means alot of formula. I also nurse him for short periods in the morning, late afternoon, and evening to help him fall asleep (I know we’re not supposed to be human pacifiers, but it pacifies me, too).
I’ve been on domperidone for about 3 weeks, as well as fenugreek. I would really like to transition back to breastfeeding, but don’t think I can handle another failed attempt. Short of this ideal, I would love to increase my supply. Is it too late to get my supply up to cover his daily needs? What else can I do? I feel like I’ve tried everything and need to establish some normalcy to my life that doesn’t revolve around my failed breastfeeding. Thanks for your help!
March 19th, 2010 at 1:32 pm
Hi Becky,
Congratulations on the birth of your son. I’m sorry to hear you have had such a difficult time starting out. You are an amazing mommy! Your son is very lucky.
Hard to determine exactly why your supply is low. I would think perhaps your difficult start breastfeeding likely is the main culprit. There are other things that can often limit supply such as a history of PCOS, birth control pills, retained placenta- but I would assume the lactation consultant you saw would have ruled those out. While lactation is initially hormonally driven, it is still very important that milk is removed in order to continue production. It may be that due to your son’s difficulty with milk removal, your supply has suffered. Given that you are already pumping 8-10 times a day and taking domperidone and fenugreek, you are doing likely all you can do to boost your supply. Doing whatever you can do to increase milk removal is your best bet at this point. You may actually find that by easing up a little bit, you reduce some stress and that may have a positive impact.
I do like to provide some ideas and strategies, but it is difficult in this case given your current pumping schedule. You have seen lactation consultants and are already using a quality, hospital-grade pump. Sometimes, it is important to recognize all that you have done and grieve the loss of what you had hoped for. Set the terms of your own success. You are most definitely successful- just not in the way you expected!
You mention that you would like to return to breastfeeding your son. I think this is a wonderful goal. It is important to realize that you may never be able to produce enough for him and you may very well need to continue supplementing his intake with formula, but breastfeeding is, for many, about much more than simply providing nutrition. If your son is willingly latching, nurse him. If he needs formula to supplement your production, provide it. But do so knowing that you have done everything possible and are still meeting his many needs by nursing him.
Hang in there!
Best wishes,
Stephanie
P.S. I don’t think there is anything wrong will allowing a baby to comfort nurse- or use you as a pacifier. Babies need to suck- it’s instinctive. Nursing is far more “natural and normal” than the use of a pacifier! You don’t have to feel as though there is a problem with it. And you’re right about it pacifying you; sometimes when breastfeeding is difficult, it can really soothe the pain to be able to nurse your baby to some extent.
March 23rd, 2010 at 3:05 pm
Hello Stephanie -
I was so excited when I first read your story of exclusively pumping. For a large number of reasons - I was unable to nurse my son (his blood sugar wouldn’t hold steady while he was in NICU). Now he is about 7 weeks old and I’ve been exclusively pumping since he was about 4 days old.
Currently I am using a Medela Pump in Style (I used a hospital-grade pump at the hospital to get my supply started). At first I was getting about 750 ml a day while pumping about 8 times a day (10-15 minutes per session). Now I’m down to pumping 5 times a day (30 minutes per session) and I’m starting to get upwards of 1,000 ml a day.
Everywhere I’m reading that I really need a hospital grade pump. Since my supply seems well established is that really the case? Everyone I know keeps telling me that I’ll dry up if I don’t rent a better pump quick. From my understanding of breast milk production, as long as there is adequate nipple stimulation (and my health is good) I won’t dry up. Is that true?
I do understand that the pump might not hold up. If I do need to acquire a pump because this one gives out it would still be cheaper (and better for my baby) than formula.
March 26th, 2010 at 3:33 pm
Hello. Glad to have found this site! I’m a first time mother who has been pumping 6 times a day for 6 months and have felt quite alone in my decision-until now. My son got stuck in my womb and was diagnosed with pneumonia at birth so my dreams of breast-feeding right away were strained. It was traumatic and for many days he was feed through an IV so I began pumping around the clock (every 2-3 hours because I wanted establish my supply). After he was well we worked with several lactation consultants trying to get him to latch properly, however, it was a struggle and I experience several clogged ducts and emotional distress from him screaming at the breast! (he will nurse when he’s half asleep, but only then). Although, we tried for several months to breast-feed time at my breast became a battle. Some suggested to not offer a bottle and force him at the breast, but I was afraid to cut him off from my pumped milk because the pump helped ease discomfort when my breasts were sore from not being emptied. When he turned 4 months old I realized the nursing and pumping were taking every bit of energy I had and decided to pump only. It was freeing. At times he will nurse (once a night) but he is inconsistent and his latch is not great. Recently, I realized that the bottom line is that he likes my milk, and he happens to prefer a bottle to my breast. I felt horrible about that, but after reading all these posts, I’m feeling much better! I stay at home so people assume I should be able to breast-feed, but my son, Soren and I are happier with the bottle.
So, my question? I was wondering how much my 6 month old needs per 24 hours. I pump about 24oz a day (every 2-3 hours with an 8 hour break at night) Should I be pumping more? He now eats rice cereal and a few veggies, but it’s more about the texture and play than sustanance. He’s a big boy (22 lbs)!
April 13th, 2010 at 8:33 am
Hi Cari,
Thanks for your comment and congratulations on the birth of your son!
You have a good supply which is great to hear. You ask whether it is necessary to use a hospital grade pump. While for many mothers- especially moms of preemies- a hospital grade pump is recommended early on, there are many women who have had great success exclusively pumping with a personal double electric pump such as the Pump in Style or Purely Yours. There are a number of other personal double electric pumps that are newer on the market and these also seem to be of decent quality.
The key to maintaining supply at your stage is to remove milk. So if you are responding well to the pump and removing milk effectively, I don’t see any real problem. I do always recommend that you maintain a very good record of your pumping output so that you can quickly see any negative trends and move to correct them. With these single user pumps, as you point out, the big concern is that they are not intended for the frequent use that an EPing mom requires. It is more likely that you will have problems with them compared to hospital grade pumps. But, having said that, if you are closely monitoring your output and doing everything you can to ensure effective milk removal, you should be fine. It is also important to perform regular maintenance on the pump and swap out wearable parts on a regular basis.
Hope that helps.
Best wishes,
Stephanie
April 13th, 2010 at 8:33 am
Hi Heidi,
Glad you found the site! Sounds like you had a rough start to things. Please remember that your son isn’t choosing the bottle over you. With such a rocky start to breastfeeding, your son’s innate reflexes and responses that are there to drive him to breastfeed were interfered with to such an extent that breastfeeding was no longer the natural process it should have been. It’s not your fault and it’s not his choice- sometimes things just happen. You definitely showed a lot of courage and dedication to provide breast milk for your son!
With regards to the amount of milk your son needs, there really is no single answer. The best answer is to feed him what he wants; just ensure that it is milk he is wanting and not comfort or to meet his need to suck. My son never took more than 24oz/day but some babies fed breast milk will take significantly more. Recent research has shown that a breastfeeding mother’s milk production stays relatively stable from around 4 weeks post-partum to around 6 months post-partum, so likely what he is taking now will suffice until he slowly transitions to solids. Remember too that breast milk changes as the baby ages so, unlike formula which much constantly be increased to meet the baby’s needs, the volumes of breast milk needed do not significantly change.
Hope that answers your question.
Best wishes,
Stephanie
April 21st, 2010 at 5:18 pm
Hi there,
I was directed to this site by the lactation consultant I have been working with for the past 5 weeks. My son is 2 months, 2 weeks old. And we have been struggling with breast feeding for I would say the past 6 weeks. I have tried everything imaginable (and am exhausted to say the least) to keep nursing him but I am frustrated beyong belief and am starting to accept that I might have to pump and feed him.
My son was very fussy around 3 weeks, we took him to our homeopathic doctor, she said he was colicy so we started him on a remedy. Didn’t work. In the meantime his poops were GREEN, almost like a salad in his diaper. And when we went back to see my midwife (I had a natural, home birth) she weighted him and we found that he had lost some weight. So we came to the conclusion that it was a formilk/hindmilk inbalance. The LC she hooked me up with said that I had an oversupply and that perhaps he was getting full on formilk, and that formilk has so much lactose and perhaps that is why he was so fussy. So she got me started on a 2 hour block feeding schedule. (up until then I was doing 1/2 an hour block feedings to ensure he got enough hindmilk). So we started the 2 hr block feedings and his poops turned yellow and he started gaining weight. During all this we would give him a bottle at night (my husband gets home at 10pm, he’s a Chef, so that would be my “break”).
Then we slowly started struggling with a low supply, some nursing strikes,a tongue tie which we had clipped, we went to a craniosacral therapist, I rented a hospital grade pump for two weeks, tried going back to exclusive nursing to see if maybe he was “spoiled by the paci and bottle”, I tried to go back to a nipple shield thinking maybe that would help, and quite frankly, there has been SOOO much going on I can’t remember the right order to how it all happened. I can tell you where we are at now.
I think I have to EP. He nurses for 2-3 mins on each side and then starts freaking out. I have tried everything but nothing is working.
So, I pump 10 times in 24 hours. During the day I can get 2 oz at the most from both. At night I can get 4-5 oz from both.
I have been pumping like that for the past god knows how many weeks and still I can’t get more than 2-3 oz during the day and every single day I am on pins and needles thinking I am going to run out of milk. I will do anything to keep him on Breastmilk but I can’t see how I will be able to keep up once he starts drinking more and more. I can’t pump any more than I do now, I mean 10 times in 24 hours is a lot, isn’t it?
I’m on Fenugreek, and More Milk Plus, I drink a Guiness every day (don’t know if thats a myth or not but it keeps me sane).
Please help!
Ozzie
April 30th, 2010 at 11:00 pm
My Success Story (So far…..)
My son was born on 3/17/10 I was induced due to PIH. He was 4.5 weeks early, but a very healthy 7lbs, 9oz.
My labor was very long and very hard. They started the induction on the evening of March 15th with cervadil. In the morning the doctor checked me and I was only 1 cm, but she broke my water anyway and then started pitocin. My blood pressure maintained at about 145/90 during the labor so an emergency c-section wasn’t necessary.
15 hours later I was still stuck at 5cm. Since my blood pressure was still fine and his heart rate was still good, I insisted on putting off a c-section for a while longer. We discovered that his head was Sunny Side up and stuck in the birth canal. For 4 hours the nurses manhandled me into uncomfortable positions to get him to rotate and get me to dilate. at about 1 a.m. on the 17th I was finally ready to push. 2 hours later and still nothing. Apparently he hadn’t completely turned and now his head was stuck sideways in a position which made it so the Dr couldn’t use a vacuum to assist. She had to do a double episiotomy for his head to fit and I still tore badly. He also had a very large noggin, especially for being 4 weeks early. It was 14.5 inches! He was born 30 mins later and was doing fine for the first few minutes. His Apgar was 8/9. His breathing became irregular and labored so they took him away for 2 hours and put him on a C-Pap machine.
He also had a severe case of Jaundice and lost 13 oz in the first day and a half, so the hospital insisted on supplementing with formula. As soon as he had that first bottle, he never wanted to latch well again. We spent many frustrated hours trying to nurse the first few days and I became painfully engorged (my milk came in at full force at 72 hours). I also regularly have very large breast (DD) and engorged they were very hard to manage and made it impossible for him to latch.
We were both able to go home after 4 days. His biliruben levels were still at 12-14 so we had to have him on the biliruben lights at home for at least 20 hours a day. This ruined almost all efforts for breastfeeding. By the time he got latched (45+ mins) He would have to be given a bottle so that he would eat quickly and go back under the lights. He was on the biliruben lights for almost 2 weeks.
I started pumping as soon as I got home from the hospital (4 days) to help relieve the engorgement and get milk to feed him from the bottle so that I didnt have to use all formula. I had received a Lansinoh Double Electric Breastpump at my baby shower. It never had enough suction to run both pumps. I had to use it as a single pump. This made it so it took about an hour every pumping to empty both breasts (30mins/side) And then I still had to feed the baby with the bottle or attempt nursing very shortly after pumping sessions. I was getting no sleep and completely exhausted.
I finally decided that I needed a double pump that worked. I read reviews for days and finally decided to get the Medela Pump In Style. We couldn’t really afford a hospital grade pump, and really didn’t want to spend that much in the event that I could eventually breastfeed. The suction on this pump is amazing! I also discovered that they have hands-free pumping bras. This was a life saver. Now my time was cut in half and I was able to still use my hands.
The new pump also increased my milk supply excessively. With the Lansinoh I was only getting about 1 ounces per side every 2 hours. With the Medela I now get between 3-4 ounces/side every 2 hours. I have between 20-30 surplus ounces per day which we have frozen (now about 650 ounces in a deep freezer) I wish that I had known how much of a difference the right pump could make. I wouldn’t have wasted the 1st week and a half using a single pump. I did however have to purchase the large flanges because my nipples were too large for the medium ones that come standard with pumps.
I kept my schedule very strict for the first 4 weeks. I pumped every 2 hours. If my husband was driving, I could pump in the car with a blanket over me. I can use the car adaptor or battery pack which is very nice, and the wall outlet with an extension cord at home. With the hands free bra and a little bit of practice I am now able to pump and feed my son at the same time. He just has to be next to me before I start the pump and then I can simply pick him up from next to me, place him carefully and drape the pump tubes over his belly. He really doesn’t mind the tubes and enjoys his mommy time. Not to mention this saves an enormous amount of time and stresses me out way less. I also find that my let down seems to be faster when I hold him. now pumping only takes a total of 15-30 mins total at a time. The let down does still vary quite a bit and so does the amount of milk depending on time of day. It is never less that 2 ounces per side, but can go as much as 6 ounces per side. I get the larger amount between 9 pm and 2am usually.
The last 2 weeks I have been experimenting with my schedule a little more so that I can sleep more in the night and not be bound to as strict of a routine. During the day I try to pump every 2 hours still. I make sure never to go more that 3 hours if I have things to do. I always pump at 1 am and try to get to 6 am before pumping again so that I can get a full 5 hours of sleep. But if the baby wakes up in that time, I pump anyway. So I am still pumping between 5-8 times/day. Cutting out a session here and there has not changed my supply so far.
He is now 6 weeks old, (although my due date was only 2 weeks ago) and a very healthy 11 pounds. In the last 6 weeks I have managed to lose 40 pounds and weigh 10 pounds less than before pregnancy and feel great. I did not increase the number of calories in my diet. I eat the same as pre-pregnancy, or about 1800-2000 calories. I don’t know that my weight loss would have been as drastic if I were breastfeeding from the breast. This was with NO exercise besides walking. I just got approval from my Dr. last week to begin an exercise plan again after the rough delivery.
Although I found it very depressing for a couple of weeks that my son had no interest in my breast after being introduced to a bottle, I am now very happy with my decision to exclusively pump. This allows us more flexibility with feedings (daddy can feed him too) and actually saves time if you can manage multitasking. I also know how much he is eating which is comforting because I never wonder if he is getting enough.
I do NOT take any herbs or supplements and really haven’t changes anything. I think it all has to do with the pump and the consistent pumpings.
Good luck everyone and don’t give up!
May 1st, 2010 at 5:39 pm
Hi Ozzie,
Well, the good news is that if you are pumping 35 oz./day, then your supply is quite good. Most babies take between 24-34 oz/day of expressed breast milk. Unlike with formula, breastfed babies do not significantly increase their intake of breast milk as they get older. Recent research has shown that a nursing mothers’ milk supply is fairly consistent between 4 weeks post partum and 6 months or until complementary foods are added. Most important is to ensure a bottlefed baby isn’t overfeeding by using the bottle to meet their sucking needs. Milk flows from bottles very quickly and unlike at the breast where a baby can control the flow and simply nurse for comfort, with a bottle a baby is always getting milk. If you google “paced bottlefeeding” you will find information on a bottlefeeding technique that helps to minimize overfeeding.
Many women EP with a Pump in Style. In your case however there is no way of knowing indeed how new it is. It’s always best to run it from an A/C outlet and not batteries and ensure you are maintaining and changing out all wearable parts on a regular basis- especially the white valves in the flanges. Also clean behind the faceplate on a regular basis.
You might consider using the larger flanges on a trial basis and see what happens.
I think you could likely drop a couple sessions without concern. Try going to 8 times a day and pump for around 120/day divided among those sessions. I’m assuming you are pumping during the night now and I would continue doing so until you see what happens with your supply.
Keep accurate records of each session and your daily totals. Again, looking at daily totals is a better way of gauging your supply since there are normal fluctuations during the day.
With regards to how you are responding to the pump, you should get more than one letdown per pumping session. You will get most of the milk during the first letdown, but will get still quite a bit from a second or even third let-down. Things that will assist with eliciting a letdown include using warm compresses prior to pumping, using massage and compressions while pumping, starting with low suction and higher cycling until you get a letdown and then switch to lower cycling and higher suction (this does not mean the highest suction) and then when your milk flow slows switch back and go through the process again. You can also try pumping until the flow slows and then stopping and taking a break for 5-10 minutes and then finishing your session. This will take longer to complete a session, but some find it helpful in removing more milk.
To increase supply it really is about increasing the demand and removing the milk. At 10 sessions a day, you’ve got the demand part down, so I’d focus on methods to remove as much milk as possible.
Hope that helps. Let me know how it’s going.
Best wishes,
Stephanie
May 24th, 2010 at 8:20 pm
Hello Stephanie. I was very excited to find this website and will probably buy the book after I go back to work. I have had a hard time finding information on pumping and what I do find is all the same. I only started pumping a few days ago. I had thought about exclusively pumping at some point anyway. Right now I’m using a Medela hand pump. I’ll be getting a double electric pump from a friend of mine soon, which I’m hoping will help. My son is just over three weeks old. He is my first child. However, I have a step son who is nearly four. The first two and a half weeks of breast feeding went spectacular, except one night of cluster feeding that seemed never ending. My son would feed about every two hours during the day and usually sleep one four hour stretch at night. He was a very content baby. However, after two and a half weeks I spent four days with my son attached to my breast with one or two, two hours stretches of sleep. Gabriel would nap for about fifteen minutes after I laid him down and then wake up crying. Even when burped and with a dry diaper, he would only be happy when feeding. He also started becoming congested, I believe. A few days ago I had to have a sitter for the night, so he was fed formula. This is when I started using my hand pump to pump while I was away from him. However, I am so pleased with his reaction to recieving the milk from a bottle that I want to continue EP. He is back to feeding and sleeping how he was during the first two weeks and I am much mores stress free and can devote more time to my family and household as a whole.
I am, however, having to supplement about one bottle a day of formula which displeases me. When I pump I only get about two, sometimes three, ounces total. In the morning I get about four. I saw a mention of overfeeding when children are given bottles and would like to know how to prevent that. I am pumping about every two hours. However, today I have been power pumping. I have not went more than two hours without pumping and even pumped every hour a few times today. I do have concerns about whether my suction cup (sorry I don’t know the correct terminology) is too small. I do think I may have large nipples. How can I tell if this is true? I want to know how long I should pump for before I stop and the best way to get the most milk possible. I have tried massaging during pumping, but with a manual pump it’s nearly impossible.
I will be going back to work soon and I want to know that my supply is established before then and that I can successfully EP. I do not want to have to supplement formula. Thanks for any help/advice.
May 25th, 2010 at 4:45 pm
I just wanted to post again and say that I received the electric pump today. It’s made by Medela and is a double electric pump. I love it! I’m now getting around two ounces from each breast.
May 27th, 2010 at 7:01 am
Hi, Stephanie. Thank you for maintaining this extremely helpful site. I’ve worked with a number of excellent lactation consultants over the last three months, but there is more really specific pumping info here than they’ve been able to give me. I’m hoping you could answer a few questions I have about my current situation.
I’m a first-time 39-year-old mother who had twin girls by c-section on 2/20. Each weighed 6.5 pounds. Neither would latch on, so I began pumping exclusively, using a Medela Symphony. At first I continued to try to get the girls to feed directly, but the lack of success with it was so frustrating that I gave up when they were about two weeks old.
I pumped frequently at first (at least 8/day), including once in the middle of the night, and soon had a very good supply: generally 1100-1250 ml/day. This production was adequate until the girls were 7.5 weeks old, when I began having to add a little formula, generally 2 to 3 oz/day per baby. That didn’t bother me too much, but as the weeks have passed, I’ve found myself getting in only 4 pumps/day very consistently, and my production diminished to around 900-1000 ml/day. I’ve found it impossible to pump more b/c I can’t really do any child care while pumping, and each pump takes a very long time (at least 45 minutes … I have very large breasts and don’t get much in the way of let down, so the milk comes out relatively slowly, even though there may be 15 oz of the stuff in there). So the girls, who eat 18-26 oz each per day, were getting more and more formula.
At about 12 weeks, I decided to try direct breast feeding again, figuring it would be the only way to build supply back up … and, amazingly, the girls both latched on well. So now I’m trying to transition to doing mostly direct feeding, with some pumping so that other care-takers can give bottles.
I just started taking fenugreek.
My questions:
- Will I be able to increase supply at this point, having allowed it to decrease as much as it has? I figure I need about 1500 ml/day to feed the twins breast milk exclusively, which would be wonderful (but certainly not essential). I’m currently feeding each baby at the breast about every 1.5-2 hrs and pumping at least twice (once after the morning nursing b/c there’s way more in my breasts at that time than the babies can remove, and once before I go to bed … I also pump before leaving the house if I’m going to run errands for a few hours).
- How important is it at this point to pump in the middle of the night (the babies are approaching 14 weeks)? The girls generally sleep until 4:30 or 5:30 in the morning, and I don’t really want to get up to pump before that. I generally pump right before bed, starting at about 8:00 or 9:00 p.m. I haven’t pumped in the middle of the night in ages.
- One of my babies is willing to stay on the breast just about interminably, flutter-sucking. Is being a human pacifier a good way to stimulate my breasts, or should I remove her?
- The babies don’t seem to be as efficient as the pump at removing milk, at least for now (maybe they’re still learning). Will that hurt my supply? Pumping after after each nursing, even briefly, doesn’t sound doable.
Any other advice you can think of would be greatly appreciated!
May 30th, 2010 at 6:55 am
Hi Alex,
Congratulations on the safe arrival of your girls! Happy to answer your questions.
You ask: “Will I be able to increase supply at this point, having allowed it to decrease as much as it has? I figure I need about 1500 ml/day to feed the twins breast milk exclusively, which would be wonderful (but certainly not essential). I’m currently feeding each baby at the breast about every 1.5-2 hrs and pumping at least twice (once after the morning nursing b/c there’s way more in my breasts at that time than the babies can remove, and once before I go to bed … I also pump before leaving the house if I’m going to run errands for a few hours).”
You definitely can increase your supply, especially given that you had a very good supply initially that has recently decreased. As always, the key to increasing supply is to increase demand. You have the benefit of having two ways to go about that: (1) breastfeed, and (2) pump. You don’t mention in your email whether the girls are exclusively breastfeeding at this point or whether you are still having to supplement with formula. I’m assuming since you are asking about increasing supply, that you are still feeding formula. While it may be taxing with two babies, I would recommend you organize a nursing holiday where you focus solely on breastfeeding your babes for a two or three day period. During this time, allow them access to nurse whenever they wish. This may end up being a lot! But having them increase the demand will stimulate your breasts to increase the supply. You can of course do this with a pump, but since you’ve got willing babies and have to care for them anyway, might as well do it all at the same time.
Watch your daughters for signs of adequate intake: wet and dirty diapers, weight gain (although this is a little more difficult at their age since growth is slowly), and swallowing during feeding, etc.
- How important is it at this point to pump in the middle of the night (the babies are approaching 14 weeks)? The girls generally sleep until 4:30 or 5:30 in the morning, and I don’t really want to get up to pump before that. I generally pump right before bed, starting at about 8:00 or 9:00 p.m. I haven’t pumped in the middle of the night in ages.
Well, that’s a big question that isn’t as easy to answer as one might expect. Initially, pumping during the night is important because frequent stimulation is vital to establishing a strong supply. At this stage though, pumping during the night is more a matter of lactation management. Milk left sitting in the breast slows production and can eventually reduce supply. As well, prolactin levels (the hormone that initiates and allows lactation) is highest during the early morning hours. So, if you are trying to build supply, pumping during the night is never a bad move. I can’t tell someone they must get up to pump though since I remember all too well how precious sleep is. You need to weigh the cost/benefit and see if it is something that can work for you.
- One of my babies is willing to stay on the breast just about interminably, flutter-sucking. Is being a human pacifier a good way to stimulate my breasts, or should I remove her?
To a large extent, I think this is a parenting decision. I personally, allowed my daughter to comfort nurse when she wanted unless I had to get up to do something. The stimulation will help to some extent, but it won’t make the difference between having a low supply and a ample supply. In my experience, babies comfort nurse because they find it comforting. Plain and simple. They tend to reduce the amount of comfort nursing as they get older and learn their own methods of soothing, yet breastfed babes will always find it comforting to be at their mom’s breast. This is one of the beautiful things about breastfeeding- just your closeness makes things better.
- The babies don’t seem to be as efficient as the pump at removing milk, at least for now (maybe they’re still learning). Will that hurt my supply? Pumping after after each nursing, even briefly, doesn’t sound doable.
If you still have contact with the lactation consultants, a quick consult to assess your babies’ latches might be a good idea. There may be a simple change that could help them with transfer. As I mentioned above, simply allowing them to breastfeed as often as they need will help boost supply. Limit or remove any supplementation, watch their “output” carefully. You will feel like they are going through a big growth spurt, but it should help a great deal to boost your supply. Pump when you can. And if they are nursing quite well, pumping even for a few minutes 4 or 5 times a day will really help to increase supply. You won’t have to do it forever, just until the supply is up where your girls need it and they are removing it themselves. Hopefully that day will come soon!
You are such a wonderful momma! Your girls will be very proud of you one day when they learn how dedicated you were to nurturing them in this way. Hang in there! The fact that they are both latching is fabulous and may very well mean an end is in sight to your pumping days. Do get their latch checked to ensure they are transferring milk well. If they are, I think it really is just a matter of them increasing your supply and then they’ll take off!
Read through the site when you get the chance (or of course you could order my book
). There is lots of information there with regards to boosting supply, power pumping, helping to elicit let-downs, etc.
Hope that fully answers your questions.
Best wishes,
Stephanie
May 30th, 2010 at 6:56 am
Hi Amanda,
Congratulations on the birth of your son! How wonderful that breastfeeding got off to a great start. I don’t hear that too often It is very common for babies to enter a period of increased fussiness and crying around 2 weeks of age. This can last, for some babies, until around 3 or 4 months of age. If you have not already done so, I would recommend reading Dr. Harvey Karp’s book The Happiest Baby on the Block. In it, he suggests that babies at this age are having a difficult time transitioning between states- wakefulness/sleep- and it is this inability to easy transition that causes this upset in many babies (often called colic). Babies at this age are awake longer, but they get overwhelmed easily and have difficulty shutting out the many stresses and stimulations around them. They have difficulty falling to sleep easily. This is very likely what your son is starting to experience.
With regards to your milk supply, my honest advice is to continue breastfeeding as much as possible if your son is latching well and transferring milk well. When you go back to work, breastfeed as much as you can when you are with your son and do not limit his access or intake. If you decide to EP, then it is important to get a quality double electric pump- while possible to maintain supply with a manual hand pump, it will be difficult. Either way, pumping now to build your supply and help your body start responding to the pump is a good step.
Every 2 hours- 8X a day- for about 120 minutes/day divided among sessions is a good place to start. Milk ejection response is largely a conditioned response and it will take time for your body to begin letting down for a pump as it does for your son. You may because of this see a decrease in supply, at least initially. Consistency and frequency are key. Warm compresses prior to pumping and massage and compressions during pumping can help.
You can find information on the site regarding flange sizing here: http://www.exclusivelypumping.com/2009/04/29/correctly-fitting-breast-shields / and for information regarding paced bottlefeeding to reduce the risk of overfeeding see here: http://www.exclusivelypumping.com/2010/05/16/bottlefeeding-and-obesity-reduce-the-risks/ there is a link to paced bottlefeeding in the article.
As for nipple size, there have been comparisons made to coins: diameter of a dime is small, a nickel is about average, a quarter large. Really, it’s a matter of how you fit the flange you are using.
Hope that helps.
Best wishes,
Stephanie
May 31st, 2010 at 9:26 pm
I am so glad I found this website. It’s a wonderful resource for many mothers out there. My son was born full term at the end of April. He is almost 5 wk old. I tried breast feeding from the beginning. He was able to latch, however, my milk didn’t come in until the 6th day. Even after it did come in, there was very little. Because of his low blood sugar, we started formula on the 3rd day, and I started pumping right away trying to establish a good supply. Now, a month later, he is taking about 30oz a day, 6-7 oz of breast milk, rest is formula. I also try to nurse him, but it is hard know how much he is really getting. He only likes to nurse on the left side, and refuses the right side. We tried different positions which made no difference. I have been pumping 5-8x a day + some nursing, also taking fenugreek and blessed thistle. I have not noticed any significant increase in supply. My questions:
1) Is there anything else I can do (except for taking reglan) to improve milk supply?
2) A lactation consultant told me that even 1 oz of breast milk a day will have some benefit. Is that true?
3) I have to go back to work in 6 weeks, I am concerned that I will probably only be able to pump 4x a day. Should I start freezing some now, which will decrease even more how much he takes in now?
Thanks so much for your help!!!
June 4th, 2010 at 8:53 pm
Hello again! Thank you for your encouraging words. I have been EPing for over a week now. I’m much happier and my son seems much happier, as well. Up until a few days ago, I was producing about 24 to 28 ounces a day and I usually had enough to freeze a bag or two for later use. However, in the past few days I’ve only been producing just over 21 ounces. I either barely skim by with enough milk for my son or I have to supplement one or two bottles of formula. I’m not really sure of why it’s suddenly changed.
I was originally pumping nine to ten times a day, about every two hours. I would occasionally do a four hour stretch without pumping, in order to get a little sleep. I was pumping 20+ minutes over the 160 recommended minutes. I got really busy for a day or two and didn’t record those days, but I don’t remember pumping less.
So, I’ve tried to put myself on a rough schedule to try and increase my supply back up to an average of 25 ounces or so. I wanted to know your opinion of my schedule and ways I can improve, if possible.
I plan to pump at roughly 12:15am, 2:30am, 6:30am, 10:30am, 12:30pm, 2:45pm, 5:00pm, 7:00pm, and 8:30pm every day. I always pump for at least fifteen minutes and sometimes pump for 25 to 30, when I lose track of time or just don’t mind sitting and pumping for that long. If I don’t end up sleeping between 8:30pm and 12:15am, I usually pump another time because my breasts become rather full. I’m wondering if I need to work that 10th pumping session into my schedule or not or if leaving it as a “maybe” is okay.
Is my schedule a likely to maintain my supply? How long should I wait to see if my supply goes back up before adding additional sessions into my routine? Will I always have to do those additional sessions in order to maintain supply? Thank you for all your help! I know it’s possible that this is just a dip in supply that will pass, but I want your advice, just in case.
June 9th, 2010 at 3:50 pm
Hi my daughter is now 4 months old. and i have been EPing since she was born practically. She has very bad jaundice and we had to moniter how much she was drinking. I tried to nurse her when she got better but she would only nurse with a nipple sheild and after about a month wouldn’t even do that. i was pumping fine for the first 2 months and she barely had to use any formula. I pumped after every feeding which was about 8 times a day. At 3 months tho she increase to eating 4-5 ounces a feeding and my milk was still only pumping about 3. I have tried pumping every 2 hours and when she would wake up at night and i simply just pumped less at each session. I get engorged easily if i go any longer than 6 hours at night without pumping so sometimes i even have to get up before she does to just pump. I am gradually getting less and less milk everytime. In the past 2 weeks i am lucky to get one ounce every two hours. I am just looking for any advice or methods you know of that i can try. I am desperate to continue giving my daughter breastmilk because i know it is the best thing for her.
August 16th, 2010 at 12:02 pm
Hi,
I have an almost 3 month old son who was born/induced 5 weeks early due to a possible PDA closure. Turns out his heart is fine, but he did have respiratory distress/possible pneumonia and had to stay in the NICU for 1 1/2 weeks. During this time I exclusively pumped, since at breastfeeding sessions he seemed to intake nothing. Since I would be going back to work and have an 18 month old daughter I decided to exlusivley pump.
Everything was going well while I was on maternity leave. I pretty much pumped on demand. However, now that I have gone back to work the milk supply I make seems to be inadequate.
I still produce 2-3 oz. every pumping session. I pump a minimum of 3x while at work for 10-15min. I try and pump 8x a day.
However, my son seemed to be not happy with merely 3-3.5 oz. and so my caretaker asked if we could increase the amount to 4oz. I have done so and he seems to be much happier. However, I am having trouble getting that much and I never have enough milk to start out Monday’s at work. He has to have formula bottles. I’ve tried pumping every two hours on the weekends, but never seem to come out ahead. I just pump smaller amounts, but the total seems to be the same. I think rest seems to be a key element I am missing, but I still feel the need to wake up in the middle of the night and pump at least once if not twice. I take fenugreek, but usually I can only remember to take two capsules at night.
Is there anything else I can due to meet my son’s requirements?
December 5th, 2010 at 5:01 am
Hi,
I am an EP mom and get a number of plugged ducts. My main issue is with getting a proper let down sometimes. I recently got one that was so bad, that my left breast was literally like a stone for 2 days. It was so painful and hard to sleep, sit, stand etc. Any suggestions to avoid this? I try my best to empty my breasts. I use the hospital grade medela symphony at home and MPIS at work. I keep warm pads before i pump. I massgae some while pumping too. What else can i do. As soon as i feel a block what can i do to get it cleared. Any suggestions will be very helpful. My daughter is 5 months. I want to BF (bottle feed BM) for atleast 1 year but am losing it with so many blocks
Can anyone help?
Thanks
Archie
December 10th, 2010 at 10:52 pm
Hello there,
I am so glad that there is a website decided to EPing and someone to give me sound advice. My little girl was born 5 weeks premature. She is now 2.5 months and she has been receiving breast milk from me via the pump almost since the day she was born because she couldn’t latch on properly. I tried and tried to breastfeed her but she would always be fall asleep at the breast and I got severely engorged breasts because she wasn’t emptying them properly. Needless to say, EPing has been a lifesaver!
I do not have any supply issues. In fact, I make way more mmilk than my little one needs. I pump every 3-3.5 hours for 20 mins and this cycle of constant pumping and then feeding her the bottle has left me exhausted! On top of that, I often get clogged milk ducts. I’ve read elsewhere that the more frequently I pump, the less clogged milk ducts I should get but this doesn’t seem to be helping. I’ve tried massaging my breasts before and after pumping, as well as drinking more water so try to stop this from happening.
My question to you is whether or not EPing is causing me to have more clogged milk ducts than if I were breastfeeding. I know that pumping isn’t as efficient with draining the breasts as a baby is but that is why I pump so frequently. Still, I get clogged milk ducts and they are so painfu. Is there any way I can pump and avoid clogged milk ducts. Please help!
Thank you so much!
February 4th, 2011 at 10:11 am
This website has made me feel so much better about my decision to EP! I tried a frustrating 4 months to breastfeed my baby. From the very beginning, my son was an eager eater but would only eat for about 5 minutes total. At about 3 months old, he started eating for 10-15 minutes total, but then got sick with a cold and it all went downhill from there. With flow issues, plugged ducts, and an easily distracted baby, every time I was preparing to breastfeed it became so stressful as I would never know if it would be a “good” feeding or a “bad” one. When our pediatrician told us our little one’s weight had fallen from the 30th to the 10th percentile at his four month check-up, I made the decision to start bottle feeding more. Since then, the faster and more steady flow and ability for my son to look out at the world while eating, has helped me make the decision to EP.
Since starting EPing, I’ve been able to increase the amount I can pump out with my Medela Pump in Style. Initially I had a plugged duct and was only pumping 18oz/day. In the last two weeks with the help of Fenugreek and pumping about every 3.5 hours during the day (6:40, 10:15a, 1:45p, 5:30p), and about every 4.5 hours during the night (9:30p, 2a) (total 6 times a day), I’m finally up to pumping about 28oz and the increased supply has seemed to level off. However, to get that 28oz, during about 4 of these 6 pumps I am having to power pump for 20 minutes, off 10, on for another 10, off for another 10, then on for another 10, for about 60 minutes in order to get more oz out. Sometimes when I pump just “straight pumping” for 20-30 minutes I can only get about 3 oz, as opposed to when I power pump I get 4.5-5.5oz. I know you say to aim for pumping 120 minutes a day, but I’m pumping more like 200-230 minutes a day, and I’m still only pumping almost exactly what my son is eating right now. I’m also eating oatmeal 2x/day along with oatmeal “lactation cookies”, Mother’s Milk Tea 2x/day, along with the Fenugreek 3/3x a day. I would like to increase my supply to make sure I have enough supply if he starts needing more as he gets bigger, and also to replenish my frozen stash(I went through it during plugged duct phase).
Do you have any suggestions on how I can cut down on power pumping and still get the number of oz I need to feed my son every day? (He’s drinking about 27-29 oz a day at 20 weeks old). Would it help if I rented a hospital grade pump instead of using my personal Medela Pump-in-Style?
February 4th, 2011 at 11:45 am
I forgot to also ask — is it possible to EP starting from 4 months on? Or is that too late to develop a good enough supply with only the pump?
March 1st, 2011 at 7:09 am
Hello,
Thank you for this wonderful website. I had a preemie and he is doing great. He would not latch on and I found that electric mendela pumps really helped me established EP.
I have been EP for three months but my supply has been decreasing. I am wondering if I have to supplement, would I need to stop adding Vitamin D to my breast milk?
May 15th, 2011 at 3:34 am
My son is turning 1 month old today, and throughout the past month I have tried breastfeeding with a very discouraging outcome. First of all, I am a red head with very fair skin and was told(by a lactation consultant that my husband and I attended a BF class with) that due to the lack of pigmentation in my skin I would have a very difficult time BF due to sensitivity. The nurses at the hospital assisted me with latching my son on and from the beginning he got a bad latch and damaged my nipples. I have struggled the past month through the pain to try to correct his latch, hiring a lactation consultant to assist me through numerous feedings, however was unsuccessful. From birth we mistakenly introduced a pacifier, and now recently, out of desperation for relief, we introduced a bottle. His latch is of course very much directly for my ipple and the thought of putting him back to my breast terrifies me. I want to feed him breast milk for a year without supplementing formula. I have been reading the information on your website and would appreciate any guidance you could offer me. From what I understand I need to pump every 2 hours during the day… is this 2hours from the end of the pumping session? So if I pump at 2pm, one breast at a time for 15 minutes each, totaling in a 30min session that ends at 2:30pm, do I then pump again at 4:30 and not 4pm.
I seem to get much more milk from my left breast than right. For example I slept 4 hours and then pumped 7oz from the left and 4oz from the right, is this normal?
Also I pumped a bottle that looked like strawberry milk from blood mixed in. Should I dump that bottle or can I still give it to my son?
Thank you so much for your time and much needed help.
May 22nd, 2011 at 12:42 pm
Hi,
I have 3 and 1/2 week old twin boys both born healthy via c-section and able to come home with upon discharge. I’ve been breastfeeding them both and supplementing occassionally with pumped milk or formula if/when needed. One is a weaker nurser than the other which is making nursing challenging. They’re also starting to wake hungry at the same time more often, and they are too small to nurse at the same time, even with a nursing pillow designed for twins. I am thinking that pumping and giving them expressed breastmilk in a bottle - if doable - might be easier for all of us in the long run. Can exclusively pump and yield enough milk for twins? If so, do the usual guidelines of nursing every 3 hours throughout the day apply or do you need to do more to keep your supply up for twins? I am nursing each boy for anywhere from 5-20 minutes every 3 to 4 hours then following each nursing session with 30 minutes of pumping using a rental hospital grade pump. They get 2 to 3 bottles overnight and I wake every 4 hours to pump. I am also taking fenugreek. I don’t feel like I’m producing an extraordinary amount of milk though… When I pump at night with no preceeding nursing sessions, I tend to get an ounce to an ounce and a half every hour, which would not be enough to feed two growing babies… The problem is, I have no idea how much I am actually producing each day. Can I take one day to exclusively pump and see how many ounces I am producing or will that a) cause my production to decrease, and b) not represent the true amount my body is producing (in ounces) daily because pumps tend not to be as efficient as babies at the breast? I hope this message makes sense and tyhat you can lend some insight!
Thank you!
May 22nd, 2011 at 12:43 pm
Correction to the above: I meant “do the usual guidelines of PUMPING every 3 hours throughout the day apply”, not nursing.
July 16th, 2011 at 9:43 am
I had a ton of challenges with BF (pain and nipple tearing from tongue-tie, which resulted in a low supply and fussy, hungry baby). After a week of extreme pain and having my LO throwing up formula the one time I gave it to her I went to see a lactation educator at the hospital. She helped me get fitted with a pump, she actually suggested baby may have tongue-tie, and suggested supplements to help my supply. Things went slow, but I finally started to get some supply back and then got hit with a clogged duct and an infection. I felt like I was back to square one with rebuilding my supply AGAIN. I have been extremely nervous about loosing my supply again and have been attached to the pump every couple of hours, but my let down is so slow and delayed it takes forever to get my breast empty. Sometimes 20-30 min..mostly 40 or even 60mn!! I know this is not suggested, but I am nervous about not emptying breast because of supply issues in the past or getting another infection from blocked duct. As a result I have worked up to getting on average about 40oz a day (bigger pumps middle of the night and AM, about 4-6 oz total each session during the day). LO is over 7 weeks old now. I started pumping every 2 hours and 3 hours at night at about week 1, then the last week went 3-4 hours…but the last couple of days have been tempted to go longer. When can I be confident that my supply is good enough to go longer between sessions…especially since it takes so long each session. My breasts and nipples ache constantly and I am so tired, but determined to give LO only BM for as long as possible. This past week I have accidently slept through some night time pumping sessions because I was so exhausted (went 7 hours!) and got a huge pump (12 -14 oz total) in the AM. Is it bad to do this every night?? I’ve read you shouldn’t cut sessions until 12 weeks…I don’t know if I can wait that long with my sleep deprivation. I have quite a bit stored in the freezer now, but am still paranoid. I think I am driving my self and my husband crazy with how obsessed I am with pumping for LO. Thanks for your input!
July 17th, 2011 at 6:30 pm
Hi,
I exclusively breastfed my 10 week old for the first 4 weeks and switched to exclusive pumping by around 6 weeks due to going back to work and overactive letdown issues. I started with pumping 7 times a day until I reached an average daily yield of around 35 ounces. Then I started dropping sessions and at 5 sessions totaling about 120 min I average around 37 ounces. I still wake in the middle of the night for a pumping session. Do I risk dropping supply if I try to drop the middle of the night session. I would so love to have the extra sleep. BTW, I use the Madela PIS.
Thanks
Nancy
July 21st, 2011 at 11:32 am
Hi,
I have a 2 month old sweet baby girl who I have been giving breast milk to through a bottle since she was 2 weeks old. I pump every 2-3 hours around the clock. In the beginning I would pump at 9pm and then again at 6am so that I could get some sleep, but after getting mastitis I decided to beginning pumping at 3am as well. The problem I was having was that I was still getting engorged so I now find myself pumping throughout the night as well as the day because I become engorged and I am afraid of getting mastitis again. I produce a large amount of milk each day, I make about 4 ounces every 2 hours.
What I am wondering is if there is a way that I can pump less or none at night but not loose a huge amount of my supply or become so engorged that I get mastitis. Any advice you could give would be wonderful!
Thank you,
Alesha
July 23rd, 2011 at 2:24 pm
Hi,
My daugther is 2 1/2 weeks old. She had a great latch and I breastfeed for the first 2 weeks. My back hurts a lot and I was very uncomfortable (back pain) while breast feeding her. I decided to exclusivible pumping instead of breastfeeding bc of my back pain and to see how much was she getting each time I fed her. I was fine for the first couple days and now my milk production is slowing down. When pumping, I used to get 3-4 oz (both breast) per session, now 2 oz. I have been using the Medela free style pump aprox. 6 times a day, for 12-15 minutes each breast. When the milk supply stopped, I continued pumping for couple extra min hopping for more milk. I feel gilty because I really want to give my daughter the best but don’t know what to do to increase production.
Did I make a mistake swiching from breast feeding to pumping? Was to early to start pumping? DO I need to pump more often or let the pump run for longer even without getting any milk just to stimulate and get more milk? How often should I pump? Could I breast feed my baby once or twice a day and then pump? I just feel exclusively breast feeding is not for me but really want to provide breast milk for my baby. Thanks
September 3rd, 2011 at 11:17 pm
Hi,
I am 4 weeks postpartum and have an abundance of milk which lets down too quickly causing pain for me and gagging/choking for my baby. This has caused her to take very short feedings of 4-10 min at a time and fussy again in a little bit. I have had mastitis twice in the past 4 weeks with antibiotic treatments both times. I have started pumping and she is feeding very well via bottle and sleeping much better as well. I plan to nurse for at least 1 year. I have he feed at the breast 1-3 times a day as well. How can I keep up my supply- I have been pumping as frequently as she is nursing-it is a grueling schedule since I also have a very active toddler.thanks
November 12th, 2011 at 5:26 pm
My son was born at 37 weeks and 5 days, so even though he was considered full term, we have had problems nursing from the beginning. He is now 2 1/2 weeks old, and we start out every morning by breast feeding, however he just sucks and sucks, and I only get two swallows during the first minute of breast feeding. He has continually lost weight. He was born at: 6 lbs 8 ounces, and last week he was at: 5 lbs 10 ounces. We have had to give him formula due to his weight. I have been pumping since day two. He was delivered through an emergency c-section with full anestesia. Unfortuantly, on a good pumping session two ounces between both breasts is the best I can do, for the most part, I am at an ounce total for both breasts. I would like to continute to pump to feed him, however I do not see how I wil be able to produce enough to feed him.
Any suggestions…will my milk increase?
November 15th, 2011 at 3:39 am
Thank you! I wish I had found this site earlier. I have been EPing since my son was about 2 weeks old due to low supply. I was able to bring supply up to feed him breastmilk exclusively until 2-3 weeks ago. :e’ll be three months next week. I have tried everything recommended to increase supply and am only getting about 4-5 ounces of milk (TOTAL) when pumping 6+ times a day. I want to give hime the benefit of breastmilk but does it real
ly help if it is just one bottle a day? I am spending a lot of time for just one bottle and I also have a four year old and am about to go back to work!
November 30th, 2011 at 6:11 pm
Hi,
I have just started eping about a wk ago. My son will be 6 wks old tomorrow, and I was having health issues. I got mastitis when he was one wk old, and thwn got it 2 more times right away. Always in left breast, and it finally cleared up about 4 days ago. I also have a decent size hole in each nipple that makes it hurt to nurse. He had a good latch, but afte doing a bottle for a wk while mastitis finally cleared, I’ve had issues getting him to latch and not get angry at milk letdown. Anyway, my question is I’m concerned over the supply. I’m pumping every 3 hours, with a medela pump in style, for 20 min each time. I am getting approx 4 oz total every time, and am needing to supplement since he still hungry. I’m taking lecithin pills, as well as eating oatmeal and drinking nursing time tea. Should I be producing more, and if so, wh can I do?
I massage while pumping too. My left nipple swells up every time I pump, but I’m using 30 mm shields. I’ve heard othersvwho pump way more, andea that morning pumps should yield more, and I’m not seeing that. I’m really stressed about this, and having a hard time adjusting to ep. The amount of time and trying to make sure I can pump every 3 hours is hard.
Any suggestions would be great
Thanks,
Nikki