Expert: ruth kraft - 12/9/2009

Question
My boy is 7.5 months old now. I aim to breastfeed him as long as I could. When he is 1.5 month old, I returned to work on half day basis. I expressed the milk (I don't use the pump) and mum will let him drink the express breast milk from a bottle. And when he was 2.5 months old, I return to full day work and I continue the routine of expressing 2 times in the office (every 6 hours) and it's sufficient for his next 1-2 days supply. I can get about 6oz each time. When I return home, then it's purely sucking directly from my breast. And throughout the night, he'll tends to suck 2-3 times as well.

I have been doing this for the past 6 months, with no formula milk. Since I assume that by 6 months he should start with semi solid, thus my mum give him cereal in the morning, and noon will be the breast milk (store in the bottle) and again cereal in the evening. Mum has also started him with pacifier few months back as he's too attached to my breast and having difficulty to go to sleep when I'm away at work.  

Everthing has went well and he's gaining weight well, no problem with switching from bottle in the day time and taking to my breast when I'm around. However, last week I was away to Amsterdam (it's winter there) for a business trip for one whole week. I keep some stock for him but only sufficient for 2 feedings per day. Night time mum will feed him with formula milk at 9.30pm, then again at 12.30am and another round at 5am and he is used to this for the whole week. As for myself, I still express out my milk daily but due to work schedule, the time gap has been delayed much longer and I didn't really 'emptied' the breast when I express. For the first few days my breast still feel full as before but later on it has dwindled and softened that I hardly feel the need to express, but I still express out for just a short while and even longer gap.

When I reach home, my boy refuse to suck my breast for the first 2 days and there doesn't seem much for him to suck either. And I've no choice but to give him formula which he has been used to during my one week absence. Finally yesterday he was willing to suck again but as it's so softened that he has difficulty sucking and hanging in there and I don't think there's much milk he's getting. Even as I try to express out, there's not much I can get. I'm now trying hard to regain the milk and has been expressing in the office every 2-3 hours but could only get about 30ml in 10 minutes and as the breast is so soft, it's rather painful as well to squeeze out as much milk as I could. (Will I hurt the breast tissue by squeezing out even when it's so soft and quite empty?) But I don't mind the pain as long as I can regain the milk supply.

I'm worried that my milk will dry up and with such a low supply, I'm also afraid that my boy will just give up sucking after giving it a few try and no satisfaction. In fact yesterday nite I let him suck to bed instead of offering him formula milk and he suck for sometime, but after a while he still couldn't sleep and cry out loud for milk. I've no choice but to give him formula as worry he'll be hungry and I don't wan't him to feel stressful trying to suck my breast with no satisfaction. I'm not sure if I've acted correctly.

Please advise on what I can do.
a) I've just been away for 8 days and surprise that the milk supply can just deplete just like that? And though I've been expressing lesser and lesser, but I still do. Can the milk supply stop just like that?
b) My breast is so softened, and with the amount that I described above, will I still be able to regain the amount that I have prior to my trip?  And right now the left breast is at least having slightly more milk but the right one is indeed miserable.
c) I heard of fenugreek and I bought some fenugreek seed from the store and soak it in hot water to drink. But I feel sligtly dizzy after drinking. Perhaps I shall get the tablets form? Any good brand to recommend and how's the dosage like?
d) Could it be that my boy has decided that he doesn't want to suck anymore and prefer to drink directly from bottle? What can I do?

Please help me as I feel so helpless since I've put in great effort to breastfeed him for the past 7 months and though I've started him with semi solids, I still want to breastfeed him for as long as I can, preferably up to 2 years old.

Thanks.

Answer
Fantastic job thus far in keeping your milk supply up to feed the baby! I compliment you on your efforts!

It is such an age that your baby is at that there might be a few thing going on here. It is rare that milk supply decreases so quickly however, being gone for 8 days and getting out of the routine is likely what made the difference in schedule happen and your body thought the baby was weaning. SO, the best way to get it back going again is like you are doing by expressing every few hours as you are. While you are  home after work, I would also maybe suggest a couple extra expressing sessions and maybe 2 in the morning. If you do this for about 2-3 weeks, you should be able to get your supply back up to what it was previously.

Be patient with the baby. He could be going through what is called a nursing strike. Keep offering it and when he wants it, let him nurse as long as he prefers as this is the best way to continue getting more  milk. With the extra expression sessions, hopefully you will be able to give him breastmilk instead of formula more often soon.

Please also know that even if your breasts are feeling less full, doesnt mean there is no milk. Often they are just soft because the body is getting used to making the amount of milk your baby needs. they can feel like nothing is in them, and still the baby will get plenty. Looks can be deceiving...  It is also common that one breast has more milk than the other as well.

Fenugreek is good for many women, you can also try the capsules and see if that doesnt work better for you. There is also something called "mothers milk tea" which has a combination on herbs that many women have success with , along with the extra expression sessions. I don't think the brand matters as much as if it works for you. The dosage you will have to read on the packages and adjust to how your body works with it.

Before expressing sessions, put a warm compress on your breasts to help milk flow easier so you don't have to hurt yourself doing it. You also can take a nice warm shower in the am and then express after that. as this helps you relax. The more your relaxed and body is warm the more milk tends to flow. I don't think you can really hurt your breast tissue by massage yourself, although I would imagine if it is hard enough you could cause issues on the outside of your skin. So be as gentle as possible and try some of those other things first as We dont want you to be hurt..

I hope that helped!

You can google "nursing strike" and see all kinds of things to help him get back to nursing. Basically offering it as often as possible is the best way. and not being upset if he says no. You don't want him to think that it has become too challenging for him.