Expert: Sally Wendkos Olds - 8/17/2008

Question
QUESTION: I have a five month old that is completely breastfed.  I just started a running program to lose weight and also started to feed her rice cereal 2 tbls once a day.  Over the last week I feel like my breasts are empty and she doesnt seem satisfied, pulling off of the breast then trying to latch back on several times after the milk let down.  I drink alot of water and also started to take fenugreek 2 days ago.  I do not want to start supplementing formula.  Do you know any other ways to increase my milk.  I try to nurse her often but since there seems to be little milk she gets frustrated.  She has gained adequate weight thus far.  Any ideas or any other info you need from me to make a recommendation? I nursed my first baby for ten months when the same thing seemed to happen and I finally stopped breastfeeding.  I dont want that to happen again.thank you.

ANSWER: Dear Lara,

First, congratulations for giving your children the best start in life by breastfeeding them!

I'm sorry to hear of the problem you're having now -- I have a few thoughts about the apparent decrease in your milk supply. 1) You may be too ambitious in your running program and may be becoming tired. 2) You may be drinking too much water -- you don't have to drink loads of it, just drink to thirst. 3) The cereal may be filling your daughter up so she's less interested in nursing. 4) Then it's possible that none of these explain it.

The fact that your breasts are softer does not mean that you have less milk. This is common once breastfeeding is well established. The fact that your baby is gaining weight is a good sign -- may mean you have more milk than you realize, and there's some other explanation of her pulling off the breast. If she's arching her back when she pulls off and seems uncomfortable, you might explore the possibility with her doctor that she may have GER (gastroesophageal reflux -- similar to heartburn).

You might try pumping your breasts between feedings to stimulate them and thus build up your milk supply, since nursing frequently isn't working for you. You might also try nursing her when she's half-asleep, when she might not pull off the breast so readily. I'm attaching an excerpt from my book (see below) with suggestions for building up a milk supply. I hope some of them work.

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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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).





---------- FOLLOW-UP ----------

QUESTION: How can drinking too much water decrease my milk supply?  I am going to stop the rice cereal and the running for now and feed her or pump every 2 to 3 hours and see what happens.

ANSWER: Dear Lara,

I'm not sure about the water decreasing your milk supply -- whether it is a factor, and if so, how. I was just trying to sift through all the information you gave me and picking up possibilities. I have recently read research papers stating flatly that the old recommendation for everyone to drink 8 glasses of water is no longer considered necessary. I have also read of situations in which people who drink too much water end up with a physical condition comparable to being water-logged, and so I thought it just might be a possible contributing factor. Basically, the current recommendation for nursing mothers as well as other people is just to drink to thirst, and not make a special effort to drink a lot of water throughout the day.

As a runner myself, I hate to see you give it up entirely, but maybe you can cut down on your exercise. Meanwhile, I hope the frequent feeding and pumping and stopping the rice cereal will help.

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.



---------- FOLLOW-UP ----------

QUESTION: Sally,  What am I supposed to do when I feed her and she doesnt want to latch on any more after the let down because not enough milk is coming out and then 10 minutes later she is crying to eat more so I just keep offering the breast but she doesnt want to suck.  As I listen to her crying right now and I just left her bed 10 minutes ago to feed her.  How long do you think it will take to increase my milk?  i have to work tomorrow as a nurse for 13 hours so I will try to pump every 2 to 3 hours. Im not worried about not running since I know I can start that up at any time.  If there is any chance it is that messing with my milk supply, I dont want to do it right now until things get back in order.  Is it usual for someones milk to just dry up even with frequent nursing?thanks so much for your time.  I just really want this to work.  Lara

Answer
Dear Lara,

It's hard to tell how long it will take to increase your milk supply. Every woman is different.

If you are getting enough milk from pumping, maybe you can try giving her a bottle of breast milk first when she is hungry and then nursing her. You might also try pumping from one breast at regular feedings while she is nursing from the other one, in hopes that the added stimulation would increase your milk supply.

If you have not already seen a lactation consultant, I would suggest that you do this now, let her watch you nursing, and see what she thinks the problem could be.

Also, evaluate your baby to see whether she is behaving differently in any other regard, and if so, she may be having some problem that her doctor could help her with, which may be affecting her nursing.

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.