Expert: Sally Wendkos Olds - 4/19/2008

Question
I have an 8 week old baby.  She gained only a few ounces of weight after 4 weeks, so I was advised to top her up with formula. I had help and advice for latching on, and all the people I saw said that it looked fine, but it was still painful.  I think that this was down to thrush being transferred between us.  Although I have treatments for this, it does still seem to be there, but not as bad.  Anyway - as a result, I started expressing to use that milk to top up rather than formula.  I noticed that expressing followed a similar pattern to my baby's feeding - she'd suck happily for a few minutes, then get frustrated/drop off...  5 minutes in, she'd start feeding again, but for a shorter time.  Same again after another 5 minutes, then she'd give up.  Is it normal to have an intermittent let-down? Other mums that I have spoken to say that their milk flows continuously.
I also don't ever seem to be able to satisfy my baby when breastfeeding, and suspect that it is down to low milk supply - do you have any suggestions as to how I can increase this? I have tried pumping every 1.5 hours and it didn't increase.  Any help/advice is very welcome. Thank you.

Answer
Dear Beth,

First, congratulations for giving your daughter the best start in life by breastfeeding her -- despite the problems you have been having.

As far as let-downs (milk-ejections) are concerned, the typical pattern is for several to occur during every feeding, although usually the mother is not aware of separate let-downs. It's possible that you are not having strong enough let-downs. The problem is that if a baby is not getting enough to eat, she isn't strong enough to nurse vigorously, and so a cycle continues. I am enclosing an excerpt from my book (see below) on ways to increase your milk supply -- I hope some of these suggestions help.

Also, in terms of your pumping: If you are not already used the best hospital-grade electric pump that you can rent or borrow, try getting hold of one of these and see if that helps you produce more milk.

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 Laura M. Marks, M.D.
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APPETITE SPURTS
Very often babies who have been on fairly regular schedules that everyone seems happy with suddenly begin to clamor for more food. This seems to occur most often at about three weeks, six weeks, three months and six months of age. Your baby may be undergoing a "growth spurt," a period of rapid growth that makes her especially hungry. Or you may be in an "activity spurt," doing so many other things that your body is producing less milk. Whatever the reason, the best way to satisfy your baby's expanded appetite is to nurse more frequently for a few days to increase your milk supply. For other suggestions on building up your milk production, see Box 10-2.
  
  BOX 10-2:  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 following suggestions 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 sometimes to deliver your milk more often, or pump or express milk between feedings.
  *  Pump from one breast while your baby is nursing from the other.
  *  See a lactation specialist if your baby is not suckling well or nurses only a few minutes at a time. This may indicate serious problems.
  *  Cut back on your schedule. Do less. Rest more. Nap at least once a day, more often if you can manage it. Maybe you can close your eyes while riding the bus to work or lie down while your older children play quietly nearby. 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. Ask visitors not to come for a few days unless they're people who will wait on you, not expect you to entertain them.
  *  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.
  *  Take extra Vitamin B complex. Some nursing mothers have found that one to three teaspoons a day of brewer's yeast helps.
  *  Make a special effort to relax, as suggested in Box 10-3. 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.
  *  Believe in yourself and trust your body. The most effective milk producer of all is the stimulation of your breasts by a nursing baby.

NOTE:  Do not offer your baby formula. A few ounces soon turn into a 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.
  The only exception to this is if your baby is sick or so small that his health is endangered, and if your baby's doctor (not your friends or relatives) feels that he absolutely needs a supplement. If so, offer it through a nursing supplementer (see Chapter 15 and the Resource Appendix), a dropper, or a spoon.