Expert: Sally Wendkos Olds - 11/29/2008

Question
I have a 4 year old which I breastfed until she was 26 months.  It was perfect in every way.  She always knew how to latch; I never got any nipple problems; she would feed for about 7 minutes on one side, then we'd be done for about 3 hours in the daytime and longer at night; my milk always seemed to be abundant and I always felt a big let-down.  In short, I really had no doubts about my ability to breast feed my second child.

However, it is proving to be a completely different experience and I am getting discouraged.

My 5 month old has been exclusively breastfed since birth.  Her latch is OK.  I've never had nipple problems or anything of the sort.  Though, right from the start, I found that she was a "fussy eater", lately, it seems to be getting worse.

Morning and night time feedings aren't bad.  It is when we get to the afternoon and evening.  She will get on the breast and feed normally for about 3 minutes and then the problems start.  After about 3 minutes, she starts to pull her head back, still holding my breast in her mouth.  Obviously, she starts to pull at the nipple, looses her latch, moans out of frustration, gets herself back on again... for another few seconds, until she pulls herself back and off again.  

If I try to force her head to stay on the breast, she then tries to turn to the side instead of pulling back (still holding the nipple between her gums: ouch!).  I'm starting to wonder if perhaps my milk production is too low and she's getting frustrated that there isn't more milk coming.  Is it possible for me to increase my milk production so that my breast are as full at 5PM as they are at 2AM?

Bottom line is I'm starting to dread feeding times because it seems like we're always battling; me trying to keep her on, and her pulling back, upset, frustrated and hurting my nipples.  While she was a newborn we would go about 3 hours between feeds, now, it seems that as the day progresses, the time between feedings gets shorter and shorter. I have to feed her every hour, offer both breasts, and we always repeat this same frustrated "dance".

Like I mentioned before, I think this is because of decreasing milk production (why?), but if you have other ideas on the matter, I'd love to hear them.

So, 1- how do I increase my milk, fast? and 2- if my milk production is decreasing, why is that and can I stop it from getting worse?

To note, my baby is gaining weight normally and is otherwise healthy, chattery, happy and has never been what one would call collicky.

Thanks in advance for your help. I really want to continue breastfeeding, but I'm no longer confident in my ability to do so.

Chrystiane

Answer
Dear Chrystiane,

First, congratulations for giving your children the best start in life by breastfeeding them! I'm so sorry to hear about all the problems you're having with this baby. It really shows that each baby and each breastfeeding experience is different.

The good part is that your 5-month-old is healthy and developing normally!

Since your morning and evening feedings go well, it does sound as if it's a milk supply/production problem for the other feedings, so at the end of this message I will attach an excerpt from my book (see below) about increasing milk supply. One good way to do this is to pump your breasts between feedings.

Possible reasons for this decrease in supply might be that there are more distractions for both you and the baby during the day, or that with two children and whatever else is going on in your life, you're getting overtired.

In any case, both Dr. Laura Marks (see below) and I agree that you should take your baby off the breast as soon as she starts to pull away. End the feeding right there. Don't try to force her back on. She will become frustrated and you can injure your nipples.

You can give her extra nutrition by feeding her a little baby cereal during the day. Many pediatricians start solids between 4 and 6 months of age. If his doesn't keep her happy and make your daytime feedings go better and if your milk production still seems low, you may want to supplement with formula.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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Ways to Build Up Your Milk Production
New mothers sometimes fear that they won’t have enough milk to feed their babies. They hear stories about other women who “didn’t have enough milk,” and they worry that they might be in this category. But when you look closely at the situations of these other women, the problem can almost always be ascribed to lack of information, lack of encouragement, or faulty nursing technique by either mother or baby. You need to tell yourself that millions of other women nurse their babies, and you can, too. Following one or more of the suggestions below should increase your milk supply within a few days.
• Nurse your baby more frequently for several days, using both breasts at each feeding. This is the single best way to enhance your flow of milk.
• Wake your baby, if necessary, to feed him more often.
* Pump or express milk between feedings. But don’t get discouraged if your pumping yields as little as half an ounce of breast milk. Your baby is almost certainly getting more than this. Even the best pump is less effective than a vigorously nursing baby. (More about pumping in Chapters 16 and 17.)
• See a lactation specialist if your baby is not suckling well or nurses only a few minutes at a time.
• Cut back on your schedule. Do less. Rest more. Nap at least once a day, more often if you can manage it. Ask someone else to help with marketing, cooking simple meals (or getting take-out food), and doing basic laundry. Most people like to help a new mother, so take advantage of this willingness now. You can always reciprocate later on.
* Even though everyone wants to see the new baby, ask visitors not to come for several days -- or even weeks -- unless they’re people who will wait on you, not expect you to entertain them. Let your answering machine take phone calls – which you can return later when you’re not so tired. Well-meaning family and friends can wear out the new mom.
• If you can, take an occasional day or two off from work or from other obligations (by, for example, having someone come in to care for your other children) so that you can focus only on nursing your baby.
• Check your diet. Are you eating enough? Are you eating the right foods? Are you drinking enough fluids? Some women find that eating or drinking more seems to produce more milk. Keeping a glass of water or juice near the spot where you nurse is a good idea. You don’t need to drink any more than you need to meet your thirst, but some nursing moms find that they are thirstier than usual.
• Make a special effort to relax, as suggested in the box on page tk. Of course, this is hard when you’re concerned that your baby isn’t getting enough milk—but the more you can relax, the more milk your baby is likely to receive.
• Develop a few affirmations that you can repeat to yourself, such as: “I am a bounteous supplier of milk for my baby”; “I am doing the best thing I can as a mother”; “My baby is growing fit and healthy from my milk”; “My milk is my baby’s perfect food.”
* Visualize your baby at a little older age, looking well fed and  happy.
* Galactogogues: Virtually every culture in the world has recommended certain foods or substances to nursing mothers, in the belief that they help to make milk. In China, nursing mothers have been urged to eat “a mixture of pork fat and red gram (a type of bean), cuttlefish soup, shrimps’ heads in wine, and a special sweet wine made from glutinous rice, given together with the larvae of the blow-fly.” In India, it’s garlic, tamarind, and cottonseed; in France, powdered fennel; and in Nepal, chicken soup, buffalo milk, butter, and rice. In the U.S. vitamin B complex, brewer’s yeast, and the herbs fenugreek (also called fenugeek) and blessed thistle are sometimes recommended, as is the controversial prescription drug domperidone, which has not been approved for any use by the U.S. Food and Drug Administration. (See Chapter 10 and the Websites Appendix for more about drugs and lactation.)
  Cheston M. Berlin, Jr., M.D., a professor of pediatrics and pharmacology who has an interest in drugs and lactation, has concluded that the effects of such potions may be largely psychological. The mother thinks that a certain substance will increase her milk supply, so she relaxes and has a good let-down reflex, thus “proving” its value.
As we have stated, though, the best way to build up your milk supply isn’t what you eat. It’s what—and how much—and how often—your baby eats. The cutting edge research of Dr. Peter E. Hartmann’s Australian team (discussed in Chapter 3) has  confirmed what many breastfeeding experts have known for years: that emptying the breast is the best stimulus to milk production. The more often you nurse your baby and the more vigorously she nurses, the more milk you’re likely to have.
• Believe in yourself and trust your body.

Note: Do not offer your baby formula while you’re building up your milk supply. A few ounces soon turn into a full bottle, which soon turns into several bottles, until you find that you’re producing even less milk. If your baby is drinking from a bottle, he is not stimulating your breasts and thus not doing the most effective thing that will increase your supply of milk. In most cases, a breastfed baby should not be offered a bottle until nursing is well established—by at least six weeks of age.
  The only exception to this is if your baby’s doctor (not your friends or relatives!) feels that he absolutely needs a supplement. Your doctor may be worried if your baby is sick, dehydrated, so small that his health is endangered, or if he is not gaining enough weight. Any one of these conditions may leave him without enough energy to nurse vigorously and thereby stimulate your milk production. If you do supplement with formula, you might try offering the bottle first before nursing him. Christina Smillie, M.D., a pediatrician and board-certified lactation consultant, recommends this reversal of the usual order of breast-followed-by-supplement so that the baby’s immediate hunger will be satisfied and that he will receive necessary nourishment – but that he will get his final sense of satiety from breast milk, and associate this good feeling with his mother.
  Once breastfeeding is well established, you may want to give your baby an occasional bottle of breast milk or formula. Ideally, you should wait until your baby is six months old to feed anything besides your good breast milk  (see Chapters 11, 12, and 17).