Expert: Sally Wendkos Olds - 9/30/2006

Question
i started breastfeeding the night i had my son michael. now he's 4months old and i ran out of my milk supply about a month and 1/2 ago, ive asked so many people and the all tell me the same thing: drink plenty of water, eat well, take vitamins(prenatal preferably), get sleep, etc. well first my left breast became flat but i was still producing enough milk while my right breast was always engorged, when i first started breast feeding i was always engorged, my breast pump stopped working and he was always hungry, just like he is now. My breast were at least twice the size they use to be, and about 2wks later my right breast became flat also, then all of a sudden  my supply became less and less and now i dont think im producing anymore. ive done everything right except, i was under alot of stress, im from New Orleans so you know how the story goes, my relationship with my fiance was struggling at the time(now things are going good), i wasnt getting any sleep, and i just started a new job which had me exhausted 24/7 and i really want to breastfeed until he's 1years old. i didnt know if all the stress iwas under played any part in my milk supply loss. it also seems like michael doesnt really "prefer" nursing anymore, he use to rip my shirts apart just to nurse now he wants his bottle or baby food which i planned on feeding him so im not concerned about the baby food. someone once told me that when a baby is no longer in "need" of their mother's milk the mother supply will cease. is this true? and can i get my supply back, and i just realized that ive been having my menustral cycle for about 2months now, i had no idea, i thought it was still postpartum bleeding! whats going on?! thanks for your time.

Answer
Dear Keota,

First, congratulations for giving your son the best start in life by breastfeeding him. And now, I am so sorry to hear of the problems you have been having. You really have been having a hard time, what with all going on in your life.

The American Academy of Pediatrics recommends waiting until about 6 months of age to start baby food. Until that age, they recommend only breast milk or formula.

The resumption of your menstrual cycle should not affect your production of milk. It's more likely that your decrease in milk started when you were having the problems with engorgement on one breast and seeming lack of production in the other. At this point you could try to start up your milk supply again, a process known as relactation, but it is really hard and if you are away from your son for many hours during the day at work, it is especially hard. I am including with this message an excerpt from my book (see below) about relactation, and also one about building up a milk supply. However, given your present situation, you might want to accept the fact that you gave your baby a great start, and that now you may want to feed him formula. I am a great proponent of breast feeding, but in certain situations, the pressure to nurse creates so much stress that it takes away from the mothering experience. Of course, you are the only one who can -- and should -- make this decision.

You may be able to get some help from a lactation counselor. To find one in your area, contact the International Lactation Consultants Association (ILCA). Phone: 919-861-5577. Email: info@ilca.org.

Whatever you decide, good luck!

Sally

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.
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SUCCEEDING AT RELACTATION
  * Be prepared for a stressful first few weeks, during which time your baby may resist suckling at the breast, your milk may be slow in coming in, and you'll be nursing almost constantly around the clock and supplementing your baby's diet with formula.
  * Find a support system, consisting of people who will encourage and help you through the difficult days. These people can include your husband, doctor, lactation consultant, La Leche League leader, and, most important, another woman who has done what you want to do, either relactated or nursed an adopted baby.
  * Expect initial resistance from your baby, who is used to getting milk some other way. It may take ten days or longer for him to nurse well, but after that he is very likely to become an avid nurser. Don't give up too soon.
  * Nipple stimulation is the most important mechanism for bringing in your milk. The best kind of stimulation is your baby's suckling. Other techniques include breast massage, nipple rolling, and hand expression or breast pumps. (Expressed milk can be fed through a nursing supplementer.)
  * Nurse your baby frequently, whenever she shows any signs of hunger, such as increased alertness or activity, smacking her lips, making sucking motions, or moving her head around in search of the breast. Do not wait until your baby begins to cry, which is a late sign of hunger. In one study, most of the relactating babies nursed eight times a day, at intervals of two to three hours, with two night feedings. (This is an average; some babies need to nurse more often than this at the beginning.) The average duration of each feeding was about 20 to 25 minutes.
  * The most popular form of supplementing the baby's diet is the use of a nursing supplementer (see Chapter 15 and the Resource Appendix). This ensures your baby of adequate nutrition while providing stimulation to your nipples. Many women who considered their experience highly successful continued to use a supplementer throughout the course of breastfeeding.
  * It is extremely important to have your doctor follow your baby carefully for adequate weight gain. The suggestions given in Box 6-4 in Chapter 6 will help you and the doctor assess whether your baby is being well enough nourished for healthy development.

TECHNIQUES THAT ARE HELPFUL INCLUDE:
  * Increasing your fluid intake and the amount of protein in your diet;
  * Resting as much as possible, and lying down to nurse when you can;
  * Stroking your baby while she's nursing to help you relax and let down your milk.
  * Providing as much skin contact as possible between you and your baby. (See the description of "kangaroo care" earlier in this chapter.)

TECHNIQUES THAT ARE NOT HELPFUL INCLUDE:
  * Keeping the baby hungry to try to encourage him to nurse;
  * Using nipple shields;
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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.
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  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.