If you are struggling with your milk supply… I am so sorry. I hope and pray you do not have to deal with supply issues long and that you can get your supply flowing quickly and reach your breastfeeding goals. And, there is the reality that it might just not happen for you, and I want to tell you that yes, this does feel like the worst thing ever, and you will have to grieve this loss of not being able to supply your baby with all the milk they need. Yes, yes of course your baby will grow and be healthy on formula. Yes, of course they will do just fine being bottle fed…. but saying, “it’s going to be ok” doesn’t grieve with your heart and all the emotions and thoughts you are going through now. You are likely wrestling with all the places you feel like your body has failed you and your baby, you may feel like you are literally not enough and you don’t know how you will deal with this. That’s exactly where I was 2 years ago, and it’s a hard place to be. 😦 After the first 3 months of incredible struggle I ended up doing a supplemental nursing system with my baby for a full year, which means he got both breast milk and formula through breastfeeding (more on that in step 6) and we were both very happy with that solution.
So, since I am an avid researcher, I thought I would share all the practical advice I gathered through my year of low milk supply struggles
FIRST CONSIDER YOUR GOALS!!!
If your goal is to breastfeed for a year or more then give the following steps a try.
If your goal is to breastfeed for six months or less, I would advice to deeply consider your emotional health and really decide if its worth the struggle or if your emotional energy could be spent on better things. You’re baby will benefit more from your happy mental state then you being stressed all the time trying to give them breast milk. Ask yourself if you let your goal of breastfeeding go, would you feel relief?
Step 1: Get a lactation consultant ASAP!
Before you run yourself crazy with attempting all that the internet suggests, find a lactation consultant. If you don’t know where to go, or if you’re like me and live in rural Africa, then you can still make an online video appointment. After 2 months of going down a dark hole of internet research, finally meeting with an online lactation consultant was a turning point in my sanity. If I were to do it again, I would meet with a lactation consultant within the first week and probably schedule several follow-up appointments. They really know their stuff!!!
Some resources to find a consultant:
My Nursing Coach – Online or in person
Lactation Link– Online or In Person
KellyMom– Directories to find a lactation consultant near you
Step 2: Check if you REALLY have low milk supply
If your baby is not sleeping well, cries frequently, or is just simply losing weight then you might be dealing with low milk supply. If your baby is becoming a real chunky monkey but cries frequently or wakes often then you are likely dealing with GERD, acid reflux or other tummy troubles… not supply issues.
You’re baby’s weight is the best way to know if you have a supply problem. Their weight loss is significant when they drop from their expected growth curve. Check the weight chart here. My baby started in the 50% percentile and dropped down to the 13% percentile after 60 days. My milk supply was actually fine, as far as I could tell, until our 2nd and 3rd week when I got a high fever for 12 days straight from a blood clot. We dealt with it in the best way that we could, living in Uganda, but the damage to my milk supply was permanent and I never caught up. My son, also had a milk tongue and lip tie which meant his latch wasn’t so great either, so many things…. sigh.
To give you some numbers…. the MOST milk I could pump was 4.5 ounces total. I think I managed to do that twice during my year of breastfeeding. I did manage to increase my supply from the first month at 0.5 oz total up to 3 ounces total (from about 4 months old through 12 months old). But trust me, I was an emotional wreck and peaking at 4.5 ounces somewhere around month 5 did not feel like an achievement. How many ounces of milk you should be making varies on your baby. The best way to figure out how much milk you’re making is to go to a lactation consultant and have them weigh your baby pre and post nursing session. Don’t assume that how much milk you pump is the same amount of milk that your baby gets while nursing, babies tend to be more efficient and give our bodies better signals to let down milk than a pump will. But if you can’t access a lactation consultant and need to use pumping to give you an estimate of your milk supply here’s an article from KellyMom on pumping enough milk.
Step 3: Take care of your health
Seriously, if you are trying to increase milk supply do all that you can to make the rest of your life low stress (since you’ll certainly be freaking out about your milk supply and won’t be able to stop that). Some things to make sure you are doing for your health:
- Sleep– like all the freaking time. Any time that you are not nursing/pumping and you feel even the slightest bit tired… go ahead and sleep. Do whatever it is that you need to do to make this happen!
- Eat nutritious foods – this is not the moment to live on takeout! Get a friend to organize others to make meals for you. Or ask someone to do batch cooking for you. However you can get nourishing foods (veggies, fruits, protein, starches) into you!
- Simplify– Unload EVERYTHING you can to someone else, so that you only have you and baby to care for.
Step 4: Check your mechanics
The first thing to check once you’re in this step is if you have a good latch and positioning. KellyMom has an excellent summary of articles on this topic. Definitely have a look through.
Secondly, check if your baby has a tongue or lip tie. Mommypotamus does an amazing 2 part post all about this and gives you info on how to get a free diagnosis of tongue and lip tie…. so I’m sending you to her. My little guy had a mild upper lip tie and a tongue tie, and therefore our latch was never fantastic. If you happen to be like me and can’t get access to anyone who can or will correct the ties surgically, I recommend still doing the recovery physical therapy exercises with your baby even without getting the tie surgically removed. I did them twice a day for 2 weeks with my guy and they helped a ton with his latch abilities. Here’s a video for post tongue tie surgery exercises.
Step 5: Try Galactagogues & Pumping
I spent 6 straight months of last year thinking about one word… galactagogues. Yes, galactagogues does sound like the name of an alien high council, but in fact galactagogues are anything that will help you to increase your milk supply so that you can breastfeed.
I’ve become an expert at naming all the things that are supposed to help you increase your milk supply, not because I found what worked for me…. in fact… nothing worked for me. I tried almost EVERY trick, every galactagogue, every pumping/nursing technique and my supply would absolutely not increase. But this is not the case for everyone. So here’s the list of things to try:
- Post Nursing Session Pumping – it’s possible that while you’re nursing your baby is not fully emptying the breast. If it continues to have a bit of milk leftover in the breast from each nursing session, then that signals your body to make less. So, even if you’re not sure if they’re emptying the breast or not. You might want to tack on another 10 minutes or so of pumping after each time your baby nurses. Even if you don’t get any milk from the pumping session, the pumping will still signal your body that you need to be making more milk.
- Nursing Frequency– Don’t believe anyone that says you need to be on a schedule!!! They have no idea what your milk capacity is, if your baby is going through a growth spurt or if you’re having supply issues. I learned this the hard way! It is great to have your baby on a routine… NOT a schedule. After trying a schedule that harmed my supply I finally landed into the routine of nursing the baby, playing and diaper change, then let him sleep (hopefully). When he woke up again we would start the routine over with nursing. This way he never got used to being nursed to sleep, but I still fed him as frequently as he needed.
- Water– drink a ton of water, way more than you think you need sometimes that’s all it takes
- Eating– make sure you get enough calories in and increase your green leafy vegetables to twice a day at least.
- Fenugreek (Methi) seeds –take tablets or buy them in Indian markets and take the seeds 3 tsp a day till you smell like maple syrup (this was my husbands favorite).
- Oatmeal– a bowl of oatmeal daily
- Supplements and Teas– Just search on Amazon and there are a ton of teas and supplements to help with milk supply. I didn’t have access to these, so I’m not sure how well they worked. Some recommended by friends were Go-Lacta and Mother’s Milk Tea.
- Domperidone (Motilium)– this one is OTC in Uganda and many countries, I think you need a prescription from a sympathetic doctor in the USA.
- Power Pumping– every couple of weeks pick 2-3 days to do a power pumping schedule. To do that you do a power pump session 2 times a day. It’s 20 minutes on, 10 minutes off, 10 minutes on, 10 min off, 10 min on. For your remaining nursing sessions, try to nurse every 2 hours. If you’re baby’s a bit older and not interested in nursing that frequently, then alternate nursing and pumping sessions as long as you are getting your milk emptied every 2 hours or more frequently. This is not a fun day. You will feel like a milk machine when you pump and nurse all the time, so try to make it as enjoyable as possible. Lots of food and water and relaxing with your favorite book or movie.
Step 6: Supplement with Formula
My little guy was 9 weeks old before my doctor said it was time to start supplementing formula (she let me try for much longer than most would!). If you were like me and so sure that you were going to breastfeed for a year and then met with this reality, its a hard place to be. Try to remind yourself that your mental health is even more important than the type of milk your baby gets, so if trying to do only breast milk is stressing you out then supplementing is the right decision.
There are 2 ways to supplement: Bottle feeding and a Supplementary Nursing System (SNS). We did both, and once we did it CORRECTLY it worked out great!
How to bottle feed your Breastfed baby
Doing a paced bottle feed will reduce the possibility of your baby preferring the bottle over the breast. Yes, they might suck in more air during the paced feed… but you’re planning to burp them anyways! Start bottle feeding once your baby is 3 weeks old if you’d like them to do both as they continue to grow. Let someone else bottle feed baby while you pump or prop baby up on pillows and feed them yourself while you’re pumping. If whoever is feeding your baby just sticks a bottle in your baby’s mouth and lets them suck it all down at whatever speed they choose…. your baby will start to refuse the breast. If you want them to keep nursing then you need to do a paced bottle feed. You’ll need a “slow flow” nipple for the bottle, and any ole bottle will do.
Paced Bottle Feed Steps
- Begin your bottle feed by sitting baby more upright so the milk doesn’t flow out of the nipple too fast due to gravity.
- With an empty nipple of milk (bottle is tilted down) tickle the baby’s lips then let them suck on the nipple for a few seconds before you tilt the bottle up to fill the nipple with milk (bottle is horizontal).
- Watch the baby as they drink and let them get 4 good swallows of milk (their chin drops down more than when they are just sucking) then tilt the bottle down to let them suck on an empty nipple for the count of about four sucks.
- Then you are going to continue the feeding session with that 4 swallows, 4 sucks for the rest of your session.
- Additionally, while they are getting the nipple filled with milk you might want to play a bit of tug-of-war with them. So that they have to work harder with their mouth and tongue to keep the bottle nipple in their mouth. This will help with their strength of latch for breastfeeding.
Here’s a video of how to do this. Instead of 30 seconds method that she talks about, I just do the sucks and swallows method (recommended by my lactation consultant) that I mentioned in step 3 above.
How to use a Supplemental Nursing System (SNS)
This was THE THING that allowed me to continue to nurse my son for a full year! SNS is a bottle or bag of milk with 1 or 2 tubes coming out of it that you simply hang from your neck or tuck into your bra and you slip the tube from the SNS into the baby’s mouth alongside you’re nipple once they’ve latched on. Some people tape the SNS tube to themselves before the baby latches but I found that frustrating once my baby started popping on and off the breast as he got older since the tube would continue to drip milk. I would just slip the tube in when he was nursing and then if we stopped for some reason I could grab the tube and point it upwards so that the milk didn’t drip out.
Here’s a video of a homemade SNS (with a syringe, not the bottle I recommend below) in action!
I would recommend using the official Lact-Aid SNS or making a homemade SNS:
The official Lact-Aid system which hangs around your neck, the bag of milk hangs between your breasts and the tubes come out of the top. If you’re going to do long-term SNS in the States then I’d recommend going with this one. However, if you’re like me and you’re access to supplies is quite limited, as well little access to as clean hot water in order to clean the system, then you might want to try a homemade SNS.
A homemade SNS is any baby bottle, with a hole cut in the nipple and 1 or 2 tubes coming from the bottle. I used this system for almost a full year! You will probably need to search for the Number 5 French nasogastric feeding tubes at your local medical supply stores. Some stores need a doctor prescription, but others do not.
Here’s a How-to for making a Homemade SNS
Tips for usage:
- If your baby has a hard time getting the milk into the tube by themselves then you can suck a bit into the tube first to get the milk flowing before inserting it into his mouth.
- If your baby (like mine) is incredibly slow at getting the milk out of the tube, you can use 2 tubes at once with this system. This took our SNS nursing sessions from 45 minutes down to 20 minutes!!! Glorious!
Tricks for cleaning:
- If you don’t like washing all the time or don’t have quick clean water like me, then consider getting multiple tubes and multiple baby bottles for your homemade SNS. I used about 6-4oz bottles and 12 of the tubes.
- To clean them fill the bottle with clean water and set it on the kitchen counter. Then put the tube of the SNS in the sink to let the water from the bottle drain out through the tubes (otherwise the formula would get dry and stuck in the tubes). You might have to suck a little bit of the water up into the tube to get it started, but once its going it will drain out nicely.
- Once we’d used all 6 of our homemade SNS systems then we’d wash them all properly at once with hot soapy clean water and rinse well. Start with disassembling the SNSs (since we had used masking tape to keep the tubes attached to the nipple, and also taped the 2 tubes together about 3 inches away from the end that goes into the baby’s mouth). To clean the tubes we used a syringe from an old liquid Children’s Tylenol dispenser to shoot hot soapy water through the tubes, then the same method to rinse with clean water. Then hang the tubes up to let them drain over the sink or a towel. Wash the bottles with hot soapy water like normal and let air dry. I’m saying “we” a lot because my husband did a lot of these cleaning duties with me.
OK Mamas! That is all that I know about how to deal with low milk supply. I pray that you find the solution that works the best for you and your baby’s feeding relationship!
Did I miss anything? Let me know in the comments!