Pumping Milk for your Baby

Dr. Ruth Lawrence, professor, author and researcher, serves on Breastfeeding.com's medical advisory board.  Dr. Lawrence is a professor of pediatrics, obstetrics and gynecology at the University of Rochester.  She is also director of the university's Breastfeeding and Human Lactation Study Center.  Dr. Lawrence has answered many of your questions on pumping and storing breastmilk.  Look for more of Dr. Lawrence's answers to your questions next week!

Dr. Lawrence is the author of "Breastfeeding: A Guide for the Medical Profession," the standard medical reference book for breastfeeding.  She was one of eight doctors who helped the American Academy of Pediatrics draft its 1997 policy statement supporting breastfeeding.

Do I have a let down problem or a supply problem?

I started back to work when my son was 6 weeks old and have never been able to get more than 2 oz. total when pumping at work (with the exception of the wonderful 2 weeks my doctor put me on Reglan when I could get 6 oz. per session).  My son seems satisfied when he nurses and is gaining weight (8lbs 11oz at birth to 15lbs 12 oz at 4mo. checkup), but after pumping every 2 hours at work (4 times a day) I only take home about 5-6 ounces. Even when I pump and nurse simultaneously I don't get more than 1 oz. I have taken all the herbs, drink lots of water, use a electric double pump (the Nurture II from Bailey).

Does this sound like a let-down problem or a supply problem? Should I try using a different pump (the Nurture II is self- regulated and takes about 3 seconds to get up to the right pressure, and my son is a VERY aggressive eater)  Please help!  I am also curious as to why my OB will only prescribe Reglan for 2 weeks, when I've heard of women taking it the entire time they breastfeed!





Your question is about pumping and the volume being pumped.  We are concerned that people take all sorts of medications and the herbs taken have potent ingredients.  This is not always good.

You ask about letdown versus supply.  The only way to really know is to use a bit of oxytocin before you pump.  This must be prescribed by a physician.  The product that used to be available specifically for letdown problems is no longer made.  The physician must ask the pharmacist to take the injectable form of oxytocin from the ampoule into a container for nose drops.  This has to be taken nasally, because the strength of the injectable is about 1/4 the strength of the nasal version.  Mom must put 4 drops in one nostril immediately before (1-2 minutes) she pumps. So have the pump ready.  The expected effect would be significant letdown of milk.  If you don't experience this letdown, it is most likely that you have a supply problem.  On the other hand, you comment that you pump every two hours.  Your baby is 4 months old, usually by this age babies don't eat every 2 hours.  You may do better to stretch out the pumping sessions a bit - maybe to every 4 hours - to see if you get more milk this way.  Usually, when you leave your baby, you probably feed right before you leave and right when you get home.  The hassle of pumping so often (4 times) could be hampering your success.

I am not familiar with the pump that you have, so I'm not sure how efficient it is.  If it is not a double pump, you may need to take another dose of oxytocin for the other side.  If this pump is not electric, you need to get a good electric pump.  The brands I recommend are White River, Medela and Egnell.  Most mothers do best if they pump both breasts simultaneously.

About Reglan, your doctor is right, you don't want to take it indefinitely.  The usually time is two weeks.  Sometimes we give a second course of therapy.  In this case, where you have a healthy baby, it would be better to try other measures and avoid a potent drug like Reglan.

If the oxytocin helps and you find that it is a letdown problem, this is probably related to pumping. Usually, after taking the oxytocin for a few days, you don't need it anymore.  Mother Nature gets the idea.  It is typically a pump issue and not a nursing issue - mothers have difficulty pumping but they do beautifully with their baby.

If oxytocin doesn't help, then you probably should try another pump.  I would suggest you go to one of the ones we know well (listed above).  Just because a pump is electric, it doesn't necessarily mean that it is a good one.  Also, follow earlier comment about not pumping quite so often.



 

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