Low-Milk Supply: A Case Study

IMG_20150719_074453055Before delivering my little bundle of joy I was confident and sure that I was going to breastfeed. Everything else with my pregnancy went so well, why would there be any problems with something so “natural”? When Fi didn’t pee or poop according to the numbers on our discharge paperwork, the numbers I was so focused on, I panicked a little. Our latch felt great, she was staying awake for feedings, and still nothing. Obviously I didn’t let this go on for long and we met with lactation to get some additional guidance. Something wasn’t quite right. My milk never “came in”. Be it blood loss, or glandular issues, aside from my treasured nighttime and early morning feedings, I’ve always had to supplement. And that is something that was very hard for me to come to terms with. Yes, my baby is fed and she’s doing great, but I couldn’t help but feel inadequate about not being able to exclusively breastfeed; a feeling I’m sure many moms can relate to. As we mentioned in the previous two posts about low milk supply, it’s the number one reason women stop breastfeeding. I’m here to tell you that you don’t have to stop. Any little bit you can give your baby is so amazing and wonderful, and you should feel great that you are able to do what you can.

From the beginning it was really important for me to maintain the milk supply that I had. I pumped after feedings, took domperidone for a couple of months and I still take a combo of galactogogues (fenugreek, milk thistle, and marshmallow root). Supplementing started with spoon feeding and then when the volume increased I started using a supplemental nursing system. We also introduced a bottle around 3-4 weeks because I knew that I was returning to work and someone other than myself was going to have to feed the babe. Below I want to review the methods of supplementation and again, encourage moms to continue to breastfeed, giving their babies any little bit of breast milk they can, despite their milk supply. I know, this can be hard, but it can be done! And you can still breastfeed with low supply! Lets start with what most lactation consultants will start with… spoon feeding.

Spoon Feeding: This is just what it sounds like. In the early days babies have small stomachs, about the size of a marble, increasing to about the size of an apricot by one week. During this time the volume of milk required to fill a baby up is quite small so using a spoon to feed baby is a great alternative to other methods. In these early days we want to encourage nursing at the breast to establish a milk supply. We recommend nursing for at least 15 minutes to trigger the hormonal response required for milk production. Always offer both breasts and if baby is still giving hunger cues after the second breast offer either pumped/hand expressed milk, colostrum, or formula with a small spoon. Spoon feeding in the early days is great because it does not lead to “nipple confusion” and does not push moms to bottle feeding before they are ready. Early bottle feeding is linked to decreased duration of breastfeeding.

Supplemental Nursing System (SNS): Is a wonderful alternative to bottle feeding that allows moms to supplement at the breast, allowing for the stimulation necessary to maintain supply, as well as allowing moms to continue to breastfeed and keep that connection with baby. SNS uses a feeding tube that is usually taped to the breast with the end right at the nipple. The tube is connected to a container with breast milk or formula inside. Baby latches on as usual both emptying the breast and receiving the supplement they require. Medela makes two SNSs, one for small milk volumes and another for larger volumes; the container can be worn around your neck or clip to your bra. Click HERE to take a closer look at Medela’s SNS. When your baby starts to take larger volumes (at about day 10 they can take anywhere from 2-4 ounces at each feeding!) then it can be helpful to introduce bottle feeding, all the while still breastfeeding. I found it helpful to breastfeed first, then bottle feed after if my little bunny was still wanting more.

Bottle feeding: Tips for introducing a bottle while continuing breastfeeding are aimed at pacing baby and providing a nipple with a slow flow. Babies are smart and will eat from whatever gives them the milk that they want FAST. In order to help babies work harder, like they do at the breast it is important to use the slowest flow nipple you can; in our case we used the premie nipples and just recently switched to the level 1. It is also important that caregivers who bottle feed are on the same page as you and pace bottle feeding. Pace feeding involves taking breaks during feedings to let the baby’s stomach catch up with their mouths. It also includes holding the bottle at a 45 degree angle instead of completely upright. This makes it so that baby has to suck to get milk out of the bottle; they don’t just get a constant drip from the nipple. Bottle fed babies can tend to overeat because of the constant drip supplied by the nipple; milk in the mouth triggers swallowing which triggers more sucking and swallowing and repeat. Babies eat quicker than their stomachs realize they are full and often throw up what they have over eaten. Though more time consuming, I have continued to breastfeed Fi first on both sides and then if she is still hungry I offer a bottle.  I’ll be honest, sometimes is it hard because she is a smart cookie and knows the bottle is coming so getting her to stay at the breast can be tricky; often I will switch between breast and bottle in one feeding so ensure she is getting all she can from me

With these tips we hope to show you that even with the best of intentions things don’t always go according to your plans, even for lactation consultants! Breast milk is a wonderful, often taken for granted, substance. Any bit you can give your baby is wonderful and should be encouraged as the benefits are numerous and proven by an overwhelming number of studies. Low milk supply does not need to be the end of your breastfeeding journey. Low milk supply is simply a bump… that you can breastfeed through!

References:

Spencer J. Common problems of breastfeeding and weaning. http://www.uptodate.com/index.

Lowdermilk, D, Perry, S., Casion, K., & Rhodes, K. (2012). Maternity and Women’s Health Care. (10thed.). St: Louis, MO: Elsevier Inc.

DISCLAIMER

Please be aware that this information provided is intended solely for general informational and educational purposes and is not intended to be substituted for professional medical advice. Always see the advice of your physician or medical provider for any questions you may have regarding your or your baby’s medical condition. Never disregard professional medical advice or delay seeking it because of something you have received from this website or blog.

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