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The (Preemptive) Undersupply Battle Plan

May20

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Advice Smackdown ArchivesDear Amy,

OK, you were once so kind as to talk me down off a teeny postpartum ledge regarding my overbearing in-laws blaming me for the baby being unable to nurse well. Which I totally still have issues about, but whatever (STILL MAD). My son was never able to nurse well, and after three months (THREE!) using a supplemental nursing system, taking Reglan and fenugreek, and pumping after every nursing session for 20 minutes, I still had a crap milk supply. While I was able to nurse him until a year, it was never without supplementing and I never got more than a few ounces when I pumped. And I don’t think i want to spend my time that way again! The boy would be awake for two hours and spend an hour and a half of that nursing. And then I’d have to pump. Sigh.

Now, I know your oldest Noah had nursing difficulty, but you had an easier time with your second. As my husband and I have just started trying for a second, and I still totally have nursing trauma, could you tell me some of the things you did to make nursing go better the second time around?

Getting a Head Start On My Worrying

I would be HAPPY to tell you. Because seriously — I’m not sure there was anything about the whole second-time-around-motherhood that delighted me more than the realization that HOLY CRAP I AM NOT FAILING AT NURSING AGAIN!

One big caveat, though, before anybody is tempted to hold me up as some kind of One Size Fits All success story: A lot of my nursing issues with Noah actually had to do with Noah. We mothers tend to shoulder (and often accept) all the blame for these situations. We’re doing something wrong. We’re not trying hard enough. We supplemented too soon, used a pacifier, caused nipple confusion, couldn’t find anyone willing to prescribe Domperidone from a shady international online pharmacy or didn’t nurse enough or let an injury or infection derail our efforts or SOMETHING.

But nursing is a two-person endeavor. And my particular other person turned out to be a little boy with a TON of oral motor issues. Issues that were present right away, from day one, when it came to his willingness/tolerance for nursing and his ability to suck. From the outside, things looked fine, latch-wise, but I really believe NOW we had a lack of a strong suck (and a baby who tended to pop on and off and on and off and go on very early nursing strikes) and thus, my boobs never got the signals they needed to produce the levels of milk I needed them to. Plus: scar tissue in my right boob from a botched cyst aspiration. I’m now comfortable enough with the situation to give myself golf claps for managing to nurse Noah for as long as I did (just shy of six months, when I seriously just dried up) AT ALL, even if it wasn’t exclusively.

I hope you’ll get there too, about your experience with your first. Because yeah: It definitely sounds like you did EVERYTHING you could, including most of the stuff I’m going to include here, on my action list. But I also hope have the same kind of healing experience I had the second time around, when I realized that even my little tongue-tied baby was just…different at nursing. It was easier for him, and thus easier for me.

Not that I necessarily left everything to chance and nature, mind you. I attacked the undersupply problem before it ever even had a chance to rear its annoying head. I think a lot of it is a question of timing — I pumped and took fenugreek and all that with Noah, too, but didn’t start UNTIL it was already clear that I wasn’t making much milk. The second time, I just assumed I wouldn’t make enough, and piled on the galactagogues and extra pumping from practically day one. Here are the deets:

1) Mother’s Milk Tea. In the hospital bag. Started drinking three to five cups a day on the day of delivery. And instead of straight-up fenugreek capsules, I went with a multi-ingredient supplement called More Milk Plus. Also started taking this on day one. (Neither are recommended during pregnancy, as they can potentially cause uterine contractions. Read the packages and instructions, and all that.)

2) Probiotics. I had an emergency c-section with Noah and thus, an unexpected round of antibiotics. I’m allergic to most antibiotics and NEVER take them, so I was completely ignorant about the whole “increased likelihood of thrush” thing. And we got thrush almost immediately. Which DID NOT HELP ANYTHING. So now I start taking a probiotic supplement about two weeks before my due date and continue to take it throughout the first month or so. We did not get thrush last time. Whew. This time, my prenatal vitamin actually contains a probiotic, so I’m covered. But if yours does not and you have ANY reason to suspect you might need antibiotics during delivery, get yourself some capsules.

3) Pumping. I wasn’t really prepared for pumping, last time. I figured it was something I’d start trying mid-maternity leave, when I needed to stockpile milk for my return to work. But instead, I got hooked up to one at Noah’s first check-up, the one where we discovered he was barely an ounce above the re-hospitalization weight loss point. My milk still hadn’t come in and emergency supplementing was implemented (by an LC who just FIVE MINUTES BEFORE compared formula to crack cocaine, and who then bizarrely told me to pump at home INSTEAD of nursing, while Jason fed Noah bottles, because she thought I needed/wanted…a break? And I listened because I didn’t know any better and I felt like the biggest failure and cut off from mah baybeeee?). And I basically sat there traumatized and sobbing and it was awful.

The second time around, the pump and I were allies. My LC (a different one, OBVIOUSLY) advised me to continue to nurse on-demand first, but to tack a five-to-10-minute double-side-pumping session onto the end of every (or every other) nursing session during the day. “Trick your body into thinking you have twins,” she said. I did this for about four weeks. I stopped when I realized I had gone and swung myself into oversupply territory. But I found THAT much easier to deal with than undersupply, so yeah, I plan to do it again this time. Plus, I actually was pumping ACTUAL OUNCES OF MILK in no time, which made me feel 1) totally awesome, and 2) like I could leave the house on my own or have dinner or see a movie with my husband because behold! ENTIRE BAGS OF BREASTMILK IN THE FRIDGE YAAAAY!

4) Preemie-flow nipples. One thing that wasn’t different the second time around was the fact that my milk didn’t come in until day five. Five days is a long time of just colostrum and for an increasingly alert and hungry baby to be nursing every hour (or less!) on empty, sore boobs. Add in Ezra’s tongue tie (which wasn’t corrected until day seven)…well, YEAH. Ouch. Frustration city. DEEP DARK CONFESSION: I gave him a damn bottle of formula the evening of day four. Two whole ounces of evil. HA. SO THERE. And I don’t regret it. I used a preemie-flow nipple so he still had to “work” and I used preemie-flow nipples on every bottle of pumped breast milk he received for the first three months or so. Maybe even longer — I’m not sure we even moved up to level two nipples until he’d completely weaned from the breast. We just always tried to keep the bottles as slow-flowing as we could, while the boobs were still in use.

5) Realistic expectations. I had no idea if any of the above were going to work. At the time, I still thought most of the undersupply problems had to do with ME. I’d read online that scar tissue and damaged ducts quite often healed themselves more and more with each subsequent pregnancy and lactation, so…that was really all I was pinning my hopes on. (And I believe it is true, though my right boob still remained my underachiever, so to speak.) I figured I would try again. I would hope like hell and do what I could, but if it didn’t work, well, I WOULD NOT LET IT DESTROY ME. Or color the entire early postpartum experience or remain a black mark of failure on my motherhood record. If it didn’t work out, I would stop. I had all of the above supplies pre-purchases and ready to go…but I also bought bottles and formula and I would use them if I had to and nobody was going to make me feel badly about it.

(This time I located the bag of hand-me-down bottles in our basement, but have not actually inventoried or washed them or purchased new preemie nipples. Or formula. Great expectations, ahoy! Also, there’s a 24-hour Giant two minutes down the street that sells alllll that crap. Jason can go buy it if we need it. Blah.)

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If there is a question you would like answered by Amalah on the Advice Smackdown, please submit it to amyadvice@gmail.com.

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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17 Responses to “The (Preemptive) Undersupply Battle Plan”

  1. Linden May 20 at 2:20 pm Reply Reply

    I was in a very similar situation, with major supply problems with my first.  The good news is that I was able to nurse my second successfully (no supplementing, tube feeding, or even much pumping).  My situation may be very different from yours, but you can take a look at a post I wrote describing all of the things I did differently the second time around:

    http://cornettandcompany.blogspot.com/2010/06/breastfeeding-take-two.html

    Hope this helps!

  2. Dawn K. May 20 at 2:51 pm Reply Reply

    As a mom who is still trying to align what my nursing goals were (1 year+) with acutal reality (4.25 months), this is a question I wish I would have asked BEFORE it became a problem (and much harder to solve, just like Amy mentioned). A few more tips:

    Seriously consider HIRING an LC to assist you. The ‘specialists’ in my hospital weren’t all certified, and honestly some were horrible (YES, babies can have sensitivity to what I eat, you dope).
    Don’t just rely on the traditional support groups. My local LLL consisted mostly of SAHMs, so when I really needed advice about pumping at work and my supply, I could never get any actual help (I’m still waiting for calls back on those 5 messages I left, thank you very much). I’m sure this is not always the case for each group for an organization with a wonderful purpose, but the league/Dr. Office, etc. is only as strong as its leadership.
    Don’t be too hard on yourself. I realized, in the end, that the hour at night I’d fight with the baby wasn’t worth it. She still ended up with some formula, I spent less time with my husband and stepdaughter, and I was a constant ball of stress. Caring and loving your child to the best of your abilities isn’t about winning, it’s about attempting the fight in the first place, regardless of outcome.

  3. Infochick May 20 at 2:51 pm Reply Reply

    Your story sounds very similar to my nursing experience with my first child. While pregnant with my second child, once again not having my breasts grow at all, I was finally diagnosed as having insufficient glandular tissue. I still can’t make a full supply, but I’m a lot more accepting of the situation this time around. I still take galactalogues and pump, but I’m not beating myself up over not being able to exclusively breastfeed. I *am* breastfeeding since he’s getting everything I make.

  4. laura May 20 at 3:07 pm Reply Reply

    I just wanted to say that I’m a second time around success story too. So hold on to the hope! and I second the pump advice!! My daughter ended up spitting up CSI-amounts of blood from these nothing-compared-to-what-my-first-did-to-me cuts so I had to pump for three days to let them heal and it actually saved my supply. She was jaundiced and sleepy and wouldn’t have told my body to make the amount of milk she’d need once she was totally better. And also, I’d like to say, waiting for your milk to come in, I have never felt farther from a benevolent God in my life. and it only took me 48hrs. I FULLY SUPPORT SUPPLEMENTING THEN! I decided it was cruel for both of us. even if you just give half an ounce (obviously pump! pump! pump! when supplementing). I didn’t and like I said, it just made me question any good in the world. Nipple confusion is crap. total lies spread by people who want you to blame yourself when you struggle with breastfeeding. I had to give three bottles of expressed milk from day 4-7 and we were both FINE. OMG, better than fine. It stopped hurting to nurse her once I healed and she was getting food.
    best wishes! and no matter what happens, you’re a great mom and don’t let anything or anyone make you feell otherwise because of how you feed your baby. That’s what happened to me when baby 1 was exclusively given pumped milk :(

  5. laura May 20 at 3:10 pm Reply Reply

    oops-I meant to say I gave *only* bottles of expressed milk from day 4-7 and she latched right back on afterwards, no problem.

  6. Katie May 20 at 3:27 pm Reply Reply

    Nothing cuts to the heart like an LC telling you that you’re about 24 hours away from rehospitalization and handing you a bottle of formula. My milk never came in, despite six dark weeks of nurse/feed formula/pump hell. I love the stories of second time success…they give me hope.

    Next baby, I’m going to implement a plan similar to Amy’s and if it doesn’t work, there’s going to be a can of Gerber Good Start on the shelf. And I will not feel guilty about it.

  7. Katie May 20 at 3:29 pm Reply Reply

    Laura, waiting for my milk to come in thoroughly convinced me that God is a man!

  8. Bridget May 21 at 7:53 am Reply Reply

    So I have a question – can you start pumping too early? I am having a c-section this time around, and after really rotten undersupply issues last time, I really want to get the ball rolling ASAP. When is the earliest I could start pumping?

  9. Kate May 21 at 8:27 am Reply Reply

    Bridget – pumping before the baby is born is not recommended because it can cause contractions and bring on labor (in fact, some women who are overdue use it as a “natural” way to induce labor). 

    ***************************
    Thank you, Kate.

  10. IrishCream May 22 at 11:06 am Reply Reply

    Bridget, I pumped at 2.5 days postpartum (with LC’s okay; def. check with your own) after my daughter had gone 12 hours without nursing. I only got maybe three-quarters of an ounce of colostrum, but we were able to cup feed it to her and get some fluids in her while we waited for the LC to make a house call a few hours later.

    Not related to undersupply, but I also pumped for a minute before nursing in those first few days when my milk came in; otherwise I was so engorged my baby couldn’t latch on.

  11. Kaela May 22 at 12:40 pm Reply Reply

    I second Amy’s admonition that it could be the baby’s fault too. I had about 20 nurses over the course of my hospital stay trying to help me figure out why my son was tearing up my nipples because my latch looked great from the outside. My pediatrician recommended the most amazing LC who specialized in cranial therapy (who knew?) and she basically gave my son a massage/chiropractic adjustment and literally fixed him over the course of an hour. He went from chewing to sucking – it was amazing and in all my pre-baby research on the internet, I’d never come across anyone mentioning the potential need for an LC/cranial therapist.

    My long winded point being – you never know, every baby really is different and nursing is definitely a 2 person job. Also, I never managed to pump more than a few ounces. My son was EBF and never went hungry though. Ma boobs just didn’t respond to the pump the way they did to a hungry baby, so don’t panic if you’re still not able to pump much as long as baby is gaining lbs.

  12. Amy J May 23 at 7:58 am Reply Reply

    I am still in pumping hell. Most days I can pump JUST enough to fill the daycare bottles. Other days I am ounces short. I consider it a victory that it has been a week since she has had to have formula supplementation. BUT! She gets my milk, maybe not exclusively, but in the end she gets it. Please don’t beat yourself up or allow someone else to do it for you. And for heaven’s sake don’t let your husband even hint to your in-laws what you are doing! (I pump 11 ounces or less a day in 4 pumping session)

  13. Lisa M May 23 at 3:17 pm Reply Reply

    heh heh…I was so paranoid about undersupply issues with my second that I implemented a similar plan, and low and behold…the milk overfloweth. Greatly.

    Thankfully, block feeding fixed it. But yeah, I was there and remember the bright green poops (too much foremilk).

    Now I really wish I hadn’t been so hard on myself with the first. He’s 6 now, and really, I can’t say that breastfeeding/formula feeding had anything to do with the person he is now.

  14. Kim May 24 at 12:14 pm Reply Reply

    My nursing issues were reversed. My first and I did great for the entire 18 mos we nursed – no thrush, no cracked nipples. My second, though, different story. She was a late term preemie (36w) with a tiny little head and mouth and jaundiced to boot, and she tore me up. I pumped and I supplemented (formula when I had to, friends’ milk when they had some to spare,) and I cried and the only thing that kept me going was the knowledge that I knew how to do this, I just had to get my baby on board. After 6-7 weeks though, my Yep, my baby had occupational therapy for nursing, and it made an immediate impact. She had me doing things like running my pinkie over her gums to get her tongue moving the right way, and lsticking my finger back where her molars will be and letting her chew to strengthen her jaw muscles. We never looked back after that, and are still going strong at 17 mos. I had never heard about OT for nursing, but if you are having serious issues, I would seek it out.

  15. kim May 24 at 12:16 pm Reply Reply

    Whoops, a sentence got deleted. “After 6-7 weeks, my highly esteedmed and trusted LC kicked me upstairs to the OT dept.”

  16. Zanbar May 24 at 4:22 pm Reply Reply

    I loved Amy’s advice. I just wanted to add that you should firmly tell your overbearing in-laws to go stuff themselves. Stress is not condusive to good milk supply, so they should butt out. I’m sure it’ll go great this time round. My best friend had a similar problem but the problems were on her second. At least this way she knew it probably wasn’t her fault.

    Oh and in Ireland they say drink lots of Guiness (something about the iron?), if that helps! Good luck!

  17. Sydney Jul 24 at 1:38 pm Reply Reply

    Hi! I’m hoping you might be able to tell me which brand of nipples you found that had preemie flow? I have only been able to find newborn…I am from Canada, so it could be that we don’t have them here, but just thought I would ask!

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