Expert: Sally Wendkos Olds - 9/7/2007

Question
Hello. I am needing help figuring out what to do about breastfeeding my 14-
week-old son. He was exclusively breastfed until starting daycare two and a
half weeks ago when I went back to work. I started pumping when he was a
month old, to build up a freezer stash, but it’s never worked well for me. I
can only get 1/2 to 1 1/2 ounces in a 20-30 minute pumping session. I was
told it would improve with practice, but nothing has helped. (I’ve never really
felt a letdown reflex, even when actually nusring, but I think no letdown is my
problem pumping.) Since returning to work, I have been pumping three times
a day for 20 to 30 minutes, which only gets me about 4 ounces total for the
day. I use a Medela Pump in Style and have tried ALL the tips, from visualing
him eating, to flowing milk streams, to looking at photos, to smelling his pjs.
Nothing works. So, I started giving my son formula for the rest of the meals
he needs at daycare.

So here’s the problem. I know that there is a really good chance that my milk
supply is or has diminished, since I’m not emptying my breasts at all from 7
a.m. to 4:30 p.m. My hope was that my body might magically adjust, allowing
me to continue nursing. I know it’s possible, but for the past week or so, my
son has been waking up a lot earlier at night for his middle-of-the-night
meal. He’s always been a good night sleeper, typically eating around 7 p.m.
and waking at 2 or even 3 a.m. to nurse, then going back to sleep for a
couple more hours. Now he’s eating at 7 p.m. and waking at midnight. Today
he woke at midnight and again at 4 a..m. Two wakings is highly unusual. And
I’ve even been feeding him at 4:30 p.m. when I get home from work, since
I’m feeling super full by then, so he’s had two meals back-to-back before
bed the past few weeks. Could his waking so much sooner be an indication
that he’s not getting as full as he was before I started back at work? How do I
know if my milk supply has started effecting his night meals? It’s hard to go
by gauging wet diapers, as he drinks about 15 oz of breastmilk and formula
at daycare each day.

He also has been really, really fussy lately, unable to calm down for naps, so
he’s a miserable, overtired boy. My daycare provider mentioned he seemed
like he’d like more to eat in each of his bottles. I had been giving him two 4-
ounce bottles (I had no idea what amount he eats, so I guessed and he had
seemed OK), and we’ve slowly upped them to 7 ounces each. She said
yesterday he was a completely different baby. He took a very long morning
nap, was happy most of the day, and didn’t spend an hour crying before bed
last night (for the first time in a month). I’m worried the entire problem is that
he’s not been getting enough to eat.

I am willing to switch to fornula, but would prefer to be able to continue
nursing. Does it sound like thinks are starting to unravel a bit? If it’s possible
to continue this way, would it make a difference on my supply if I didn’t
pump out those 3-4 ounces each day? Pumping an hour and a half out of my
day (for such a small amount) is beginning to be a real problem with my
workload. Thank you for your advice. I’m sorry the question is so long, but I
wanted you to have all the info you could possibly need to help me.

Answer
Dear Sara,

First, congratulations for giving your son the best start in life by breastfeeding him!

It sounds as if you have done all the right things since going back to work, in terms of choosing a good pump, using the little tricks to encourage milk production, and timing your pumping sessions. And it sounds as if you have evaluated your situation accurately -- that is, that your son may be waking sooner because he wants more to eat, and that when he does get more formula in his bottles he seems more content. You have gotten this feedback from your daycare provider -- maybe you can see for yourself over the weekend while you're at home with your baby.

It's a little hard to say what will happen if you stop pumping during the day. Since you have not been producing enough to satisfy your son even with pumping, and since you are willing to switch him to formula, you might stop the pumping (which will help with your workload!) and try nursing your baby once in the morning and once at night, and give him formula for his other feedings, and see how that goes. I'm sorry I can't give a more definite instruction, but so much of managing breastfeeding is improvisation.

I'll be interested in hearing how you and your son make out after a week or two on the new schedule.

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.