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**ASK THE LC, Kathy** questions here ...

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  39705.16 in response to 39705.14
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  edna63
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  8/29/2002 4:21 pm

Attention milk monsters, tips for taming monster milk supply inside........................more

You know I sometimes would *rather* deal with under supply than over supply b/c oversupply can be tricky and risky business. That's b/c with oversupply the very things you want to do to tame the supply monster might put you at risk for all the complications associated with oversupply and the back up of too much milk in the breasts.

Ok but here goes. The trick is to signal your breasts to SLOW DOWN for goodness sake!!!! The way that *normally* happens is that as milk backs up in the breast the breasts get the signal to slow down on production. For some reason it seems as though in moms with oversupply the breasts aren't getting the signal or they are responding very slowly to it.

Of course any time milk is excessively backing up in the breast you are at an increased risk for mastitis, plugs, and just generally feeling over full and uncomfortable. So part of the trick is to allow milk to back up to help signal the breasts to slow down without allowing it to back up so much that you get into trouble.

Sometimes it is helpful to do more frequent feedings. It may be more comfortable for the baby because the milk let down will be less forceful. It may be more comfortable for mom b/c she is not having long stretches without any milk drainage.

Of course you have already heard to just use one breast per feeding. Let the baby tell you when she is finished, she will either come off the breast spontaneously or remain on the breast without any sucking for a long time, then you can remove the baby. If the baby needs a burp and diaper change and wants to go back to the breast to get settled again, put her back on the same breast.

Some moms find they need to use one breast per 2 or even 3 feedings in a row but work up to this gradually. You can also try one breast per block of time. For example, only the right from 8am to 10 am then only the left from 10 am to 12 noon. If that isn't enough you can increase the length of the block of time but again build up gradually. Start with 2 hour blocks and increase in 1/2 hour increments until you are at the point where it works.

When you first start using only one breast per feeding you may need to express milk from the "unused" breast, but only pump as much as you need to for comfort and reduce the amount you pump daily until you don't need to pump at all so you don't overstimulate the supply and perpetuate the problem. Some women notice the need to pump diminishes gradually without doing anything special. Others need to systematically keep records and reduce in a methodical way. For example if you notice you need to pump off 2oz from the unused breast each time try to reduce that to 1.5oz for 3-4 days and then if all is ok reduce to 1oz, etc.

Experiment with different positions to see what seems most comfortable with your baby. Some like positions that make the flow of milk work against gravity, such as a reclined position with the baby face down on mom. Others may prefer an elevated football hold (baby sitting up facing mom), some like side lying.

Some may prefer to come off or be removed from the breast when the milk lets down until the flow slows a little. Just catch the extra milk in a towel if needed.

Between feedings you can discourage blood flow and milk production by applying cool compresses to the breasts. Leave them on for 30 minutes and off for 60 minutes before reapplying. Keep repeating this procedure until you get the desired results.

You can also try cool green cabbage leaf compresses to the breasts, they are thought to reduce milk supply (no science on this one yet). Change them every 2 hours or when they wilt, whichever comes first. Apply for one day then watch for results the next day, reapply every other day until desired results are seen.

Avoid unnecessary breast stimulation, such as using breast shells (plastic domes some women use inside the bra to hold the cloth off of sore nipples)

It is also good to know that for most women the monster milk supply will come more into line with exactly what the baby needs by about 3 months or sometimes sooner b/c of hormonal changes.

HTH Kathy

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**ASK THE LC, Kathy** questions here ...

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  39705.17 in response to 39705.1
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  8/29/2002 2:42 pm

I feel like I have been guilty of child abuse! (m, extremely long)

My question is whether or not domperidone can help me this late in the game. My frustrating experience of the past 7 months follows.

My son was born on February 6 at 8 lb. 2 oz. By our hospital release 4 days later he was down to 7 lb. 6 oz. At his 2 week checkup he was STILL 7 lb. 6 oz. and I was instructed to supplement. I immediately consulted with our hospital's lactation consultant. I was careful to only supplement enough to ensure that he nursed every 2-1/2 to 3 hours and as soon as his weight was in the acceptable range I slowly weaned him from the supplement. I also began taking fenugreek (and still do) and experimented with Oxytocin nasal spray to help trigger let-down. I also pumped as often as possible (tough with 2 other kids), used warm compresses and visualization and relaxation techniques to help with let-down. I've eaten so much oatmeal, I can't stand it! If someone said standing on my head would have helped I would have done it!

This process was repeated 2 more times as it seemed like I could never make enough to keep his weight in range. He settled in at the 10th percentile for a couple of visits and it seemed like he had settled in by his 4 month checkup.

At his 6 month checkup (actually 11 weeks after the 4 month checkup) he had dropped to the 5th percentile (13 lb. 5 oz.) even though he is now eating solids twice a day (which by the way most are in the ballpark of 20 calories per ounce even though I keep seeing the argument that solids have less calories) In 11 weeks he had only gained 23 ounces! Once again we are supplementing and the doctor was very concerned. She said if he did not gain in the next two weeks, we were looking at failure to thrive and she would start some tests!

This week I rented a baby scale to see exactly what is going on. Imagine my horror when over 6 nursings yesterday he only got 12 ounces of breastmilk!!! Even feedings that sounded good -- lots of swallowing -- were misleading! A feeding I thought was awesome turned out to be .8 ounces (yes the decimal is in FRONT of that number...) Today has been even worse. Even the first feeding of the day was only 3.2 ounces.

I feel like I should be arrested for child abuse. I have been starving my baby and he has learned to be satisfied and not fuss with not enough to eat.

In the week that I have been supplementing he has put on almost 1 pound. It's clearly me and NOT him.

The lactation consultant that rented me the scale suggested that I try domperidone to try to get my supply where it should be. She pretty much made it clear that this is my last resort, since I have been trying everything else under the sun.

Does anyone have eny experience with domperidone this late into breastfeeding (almost 7 months). Do I have hope of building a normal supply? If not, this may be the end of the line for me. I feel like my entire family has suffered as I struggled to do this and I'm not willing to continue the torture.

Any experience in this area would be welcome. Thanks for reading this epic post!

Grace

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**ASK THE LC, Kathy** questions here ...

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  39705.18 in response to 39705.17
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  8/29/2002 3:35 pm

*******EXPERT HELP HERE, PLEASE*********** (nt)

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  39705.19 in response to 39705.17
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  8/29/2002 4:00 pm

Grace... are these scales specialized digital scales that are ONLY for test weighs? Also have you checked thyroid? (m)

Your thyroid, not baby's. How often are you nursing? One breast or both? What type/brand of pump have you been using or did you use? (assume since you're working with LC it was a good one <g>) Are you on any medications?

Note that around 4 mo it is normal for baby's rate of gain to drop... the average bf baby gains from 3 - 5 oz per week from 4 - 6 mo, the 23 oz in 11 weeks averages out to about 2.09 oz per week, which yes, is lower than "average" but it IS a gain. That at least is something to go on.

If baby weighs 13.5 his intake should be somewhere around 33.75 oz per day (24 hrs), however this figure would be too high because he is on solids, and solids replace the breastmilk and "change" the intake amounts. So if you were nursing every 2 hrs for example, he'd need approx 3.5 oz of ebm per bottle. If he were nursing 9 x in 24 hrs, he'd need approx 3.75 oz per bottle. So.. if the first nursing revealed that he took in 3.2 oz then he's at least in the ballpark of what we might expect.

Will flag Kathy, and am sure she'll have some expert input for you, but IMHO, would go for the domperidone and nurse nurse nurse, and remember gain should be in the area (at this age) of 1.5 - 3 oz per week for the AVERAGE baby (some are below this and gain steadily, others are above the "average").

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  39705.20 in response to 39705.19
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  8/29/2002 4:20 pm

Yes, it is a Medela scale especially for determining the amount (m, long)

taken in a nursing.

Blood work was done last month and my thyroid function is normal. So is my iron level (not sure if that can impact supply...)

We are nursing 5-7 times per day. Usually at least 6 unless we are on the run all day. Always both breasts. Usually twice on each side and a feeding lasts from 30-55 minutes (hence, my comment about this process taking a toll on my whole family!)

He gets about 8 oz. per day of solids, split in two feedings. Can I deduct this from the 33.75 ounces you quoted to determine his needs? So far today we have nursed 4 times and he has gotten a total of 9.0 ounces (3.2, 2.4, 1.8, 1.4) If it is like yesterday the last two feedings will be less than 1 ounce.

It seems unlikely to me that domperidone could double my supply. If I am only making 12 or so ounces a day, I would think I would need to increase it to at least 24 ounces to meet his needs.

I have been supplementing about 8-10 ounces per day and he has put on 14 ounces in 8 days! Clearly he desparately needed this...

Thanks for your input.

grace

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