Expert: Sally Wendkos Olds - 9/16/2004

Question
I am a mother of two now. My daughter was born 6/30/04 and I have been nursing her from day one. Well she never seemed satisfied after feeding and I have talked to nurses and they said she has to get used to it, my milk needs to build etc. Well she was a big baby (10lbs 2oz). So I would nurse her and then give her a couple oz of formula after each feeding to keep her satisfied. Well I was very torn beacause I hate to think she is not getting enough to eat and she started demanding more and more formula. I have a two year old at home and that made nursing hard also because it is very time consuming. I never gave up becasue I feel that even if she is only getting an ounce of breast milk at each feeding and then formula its better than none. So I bought a pump (pump in style) because I had to return to work on 9/13 and now I am pumping and I really think because I was giving her so much formula my milk supply is low. I think it always was because she was never satisfied after just nursing but I really don't know how to determine that either. I can say that I used to get more when I would pump than I do now. I can go a whole day with out nursing and not get engorged or leak. When my milk first came in if I missed a feeding I would feel it.
I would like to know how to build it up naturally. I try to pump evey 3 to 3 1/2 hrs up to 11pm then I start again at about 7am. By doing this I am only getting about 6oz of milk a day and I am really concerned. what can I do? I work a 9-5 job. I don't know what a normal amount would be but I'm thinking I should be able to get at least 3 oz per pumping? Help!!! :>)  

Answer
Dear Emily Lee,

First, congratulations for giving your baby the best start in life by breastfeeding her!

Generally the best way to build up milk supply is to nurse frequently, since the vigorous suckling of a hungry baby provides the best stimulation. Pumping is good -- but not as good as a baby. I understand that you cannot nurse that frequently if you are working full-time. The fact that you can go an entire day without nursing and not get engorged or leak does suggest that you are not producing much milk.

I would suggest that you find a knowledgeable lactation consultant and ask for in-person advice. A consultant can watch you nurse and tell you whether your baby is latching on correctly, raise other concerns and possibly help you. You can find someone in your area by contacting the International Lactation Consultant Association. Phone: 919-787-5181. Email: ilca@erols.com

Meanwhile, I am appending an excerpt from THE COMPLETE BOOK OF BREASTFEEDING (Eiger & Olds, 3rd ed. 1999, published by Workman Publishing & Bantam Books & available in most public libraries, bookstores & La Leche League chapters), offering suggestions for building up milk supply. You may want to try some of these ideas. If you don't produce more milk within a couple of weeks, you may want to consider switching your baby to formula. I hate to even raise this possibility, but you have already given your baby precious antibodies and a good start, and with a two-year-old and a full-time job, you have a lot on your plate!

Good luck! Sally Wendkos Olds
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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. Also try pumping on one breast while your baby is nursing on the other one.
  *  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.