Your Breastfeeding Questions Answered

Am I not producing enough milk?

I am a registered nurse and work three 12-hour shifts rotating each week.  I pump while at work, and usually it seems to be enough to get him through while I am gone.  My problem is when I am home it seems like he never gets enough from me.  When I pump it is only 3-4 oz a session (over 15 minutes) and I pump 2 to 3 times.  Is this all I am producing when he nurses from me, and is this why he seems constantly hungry when I am at home and he is nursing and not getting a bottle from dad?  Sometimes I am so sore after nursing him for what seems like hours, I finally give him a bottle of breastmilk and sometimes formula.  He is eating one meal of cereal, and a fruit and veggie each day.  Please help...this is the longest I have nursed any of my kids and I want to continue for at least one year. I love it.  Oh by the way...the birth weight is a little misleading...he weighed 8 lb even at discharge (4 days later) he had complications APGAR 3 and 8. Nuchal cord X 2 and was an emergency c-section. I didn't nurse until six hours after delivery due to grunting and other respiratory complications.  He was 39 weeks gestation. 

Thanks for any input you may have for me.





Dear Renee,

Congratulations for salvaging breastfeeding against all odds!  A depressed baby, a c-section delivery, delayed initiation of nursing were all hurdles you needed to overcome.  Most likely, you had what we call "delayed lactogenesis," with your milk coming in later than usual.  That must have contributed to Connor's 13.5% weight loss by day four.  Most babies will drop about 8% below birthweight.  If there is a 10% drop in weight, I would certainly be suspicious of breastfeeding problems.  In your case, I am quite amazed and delighted that you were able to eventually produce enough milk to feed Connor.  But having said that, the average baby will have doubled their birthweight by 4.8 months.  Not uncommonly, a mother with delayed lactogenesis may have problems later on producing generous volumes, particularly for a baby who is large for gestational age, such as Connor.   I would respect Connor's cues that he needs more calories that he seems to get from breast alone, but there are some things that you could try to improve your production.

Consider pumping a bit more frequently, maybe even after he nurses on occasion.  Predictably, you won't get much, but this may boost your production.  There are products which might possibly help, although the literature is more anecdotal for the over-the-counter remedies.  I think that it is worth trying fenugreek, and herb you can find at your health food store. Possibly it also would be helpful to try a couple of weeks of Reglan (Metaclopromide) 10 mg 3 times per day to see if this would help.

I would not beat yourself up too much, however, if your production does not respond to these efforts.  You should really pat yourself on the back for succeeding in such a very difficult situation.  Make sure that Connor is getting the calories that he needs, and see if you can make breastfeeding a more comfortable, fun part of your life without volume being the key issue.

One way to know if Connor is getting enough to eat is simply to liberalize his bottle or solid food supplementation.  Babies, if given the chance, will usually consume the number of calories they need. Ask his pediatrician to show you his growth curve and explain to you what normal growth means in Connor's situation.





 

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