Serving Size and Supply Drop

iVillage Member
Registered: 03-29-2013
Serving Size and Supply Drop
4
Fri, 03-29-2013 - 4:37pm

Hi there!  Some background: My daughter is 20 weeks, and we have been EPing since week 3, with random bouts of nursing.  She's sort of a mystery case - she has always had a great latch, there is no pain during nursing, but she's inefficient at transferring the milk.  She would take in anywhere from .5oz to 2 oz, the higher side being quite rare.  She was diagnosed with tongue-tie, and we had her frenulum clipped, and it didn't make a difference.  She lost quite a bit of weight during this journey, and we moved to bottlefeeding pumped milk.  Because she was unable to empty the breast, my supply tanked, and I have been battling ever since to get it up and maintain it. 

Where we are now: I pump anywhere from 22-28 oz per day.  I pump 6-8 times per day, and usually get 3-3.5 oz per 15 minute session (though occasionally I'll get as little as 2.5 or as much as 4.5).  Daughter is fed on demand, mostly 3oz servings about every two hours during the day, then two overnight feeds, for a total of 24-27oz.  Some days, we will have a single nursing session, but she most often still needs a bottle after. 

Two questions: first, my supply suddenly dropped somewhat significantly.  Pumping sessions where I would normally get 3-4 oz have turned into 1.5-2 oz.  I have done a power pump every day for the last three days, and have seen it come up a bit, but I can't figure out what caused the drop.  I have heard that the return of your period can cause a drop - I haven't gotten it yet, but maybe that's the case?  I'm on domperidone - currently 40mg per day, but I can increase it to 60 or 80 if needed.  I drink a ton of water, and eat plenty of calories...

Second, yesterday the daycare fed her 5oz, then 4oz, then 4oz.  She seemed to take it, but didn't go much longer between feedings.  But I don't know what's appropriate for her now.  Should she stay on 2-3 oz?  Or should we be increasing her serving size? 

Thanks!

iVillage Member
Registered: 09-21-2011
Mon, 04-01-2013 - 1:21pm

For a breastfed baby who nurses directly, it is generally recommended not to go above 4oz per feed.  I was advised by a lactation consultant that it was good to keep the feeds smaller because using a bottle is fundamentally easier than directly  nursing from the breast, so the baby is more able to over-eat from the bottle.  She told me not even to get the big sized bottled--just to stil to the small sized ones to avoid the temptation to over feed.  The milk comes more easily and faster in a bottle that it will in a breast.  So increasing the amount of milk per bottle sets moms up to think they are under producing milk because the baby can over eat by maybe half an ounce or an ounce a few times a day and then be less hungry at night when he or she should be nursing from mom (not your case I understand, just explaining here).  She also pointed out that a baby who nurses directly never gets to the point really where he or she is eating 8 ounces 3x a day--a nursing  baby always eats small amounts more often.

As far as supply drop, if you are 20 weeks pp, it might be that your supply is regulating.  It is common for the milk composition to change at a certain point.  Usually between 4.5-7 months.  At this point, it seems like your supply is dropping but the milk composition is changing.  The milk actually becomes lower volume but more nutritionally concentrated.  The lactation consultant I worked with actually advised me to decrease DS's bottles at this point and feed LESS per bottle because the milk was higher calorie ounce for ounce.  So we did.  We took him from 4oz down to 3.5 and then eventually down to about 3 per bottle and kept him there.  He was always fed on demand and we always told the daycare provider to feed him more if he needed it, but generally he didn't.  Ususally I sent 2-4zoz bottles and 2-3oz bottles with him for a regular 9 hour day at daycare and he got fed about every 2 or 2.5 hours.  I also send an emergency back-up pack of formula so that they would have more to feed if they really felt he needed it and the day's supply of milk was gone, but that never happened.  I ended up throwing away the 4 pack of formula when it expired unopened.  I suspect this sounds kind of crazy, but breastmilk is really matched with your child for her development. 

iVillage Member
Registered: 03-29-2013
Mon, 04-01-2013 - 1:33pm

Thank you so much for your reply!  I had heard that it is very easy to overfeed a breastfed baby through the bottle, and I guess that's part of why I wasn't sure about the 4 and 5 oz feedings.  They were using a different bottle on that particular day with a higher flow, so that may have been why they thought she wanted that much. Since I struggled with supply so much at the beginning, I became a bit of a millk-hoarder, and sometimes my husband accuses me of withholding milk.  I absolutely do not withhold milk from her, but I don't really want her to over-eat either.  So it's been hard for me to be objective about how much she actually needs to eat, and I appreciate your response that her existing serving size is sufficient.  I have let the daycare know that they can feed her more if she needs it, but I think I will ask them to keep the servings at 2-3 oz.  They also have backup milk in the freezer, and I work just a few minutes away, so worst case scenario would be me driving over to deliver some freshly pumped milk.

So if my supply is regulating, and she generally consumes most of what I pump, should we start feeding her less?  How did you know your son was okay with receiving less in his bottle as your supply was regulating?  I'm sort of gun-shy about reducing her food, because over the course of this journey we have tried to go back to full time nursing, and she's lost weight.  She's currently in the 4th percentile for weight, and I'm so nervous about her dropping even more.  I'm fortunate that our pediatrician is supportive of the benefits of breastmilk, but I know she's concerned about her dropping percentiles.  Though, my daughter has always made it very clear when she's hungry, so maybe that's not really a concern?

Thanks again for your response!

iVillage Member
Registered: 09-21-2011
Wed, 04-03-2013 - 9:43pm

Sorry it took me a bit to get back.  Work is crazy right now. 

How did I know my supply was regulating?  My wonderful lactation consultant told me.  I freaked out becasue my pump outputs were dropping and I was afraid I was strangely loosing my supply.  So I rushed out and bought a new pump and went to see the consultant, who told me to calm down and that this was completely normal.  She also said that right around the 4-6 month mark was the most common time for people to consult with her, other than in the newborn period when they were just learning to nurse. I didn't know anything, but I talked to someone wonderful who helped me.

 

As far as how we did the bottles with my son, we just gave it a shot.  We reduced some of the bottles for the day by half an ounce and made sure to send extra. So we cut back from 4 to 3.5 ounces and explained everything to the child care provider so she wouldn't try to fill from the other bottles.  Then when it seemed he was comfortable with that, we cut it back a little further to 3 ounces but started sending one extra bottle.  The Lactation consultant suggested offering less milk more often.  Some days the kid will eat more and other days not, but this is the pattern of feeding most like direct breastfeeding so it will, theoretically, help conserve your milk supply and get her fed adequately.

I am not a doctor and I can't tell you what is right for your kid.  4%ile is pretty little, but some kids--like some adults--are just petite.  My son is not one of them.  Just be sure that your doc is using the WHO growth charts for exclusively breastfed babies....because some are still using the older APA charts that overstate size expectations because of formula (over!) feeding.  It can make a significant difference.  If she is developing normally, hitting her milestones and being fed on demand--I think those are the mose important things.  But I am not a doctor, or her mother.

Let me know how it goes!

iVillage Member
Registered: 04-05-2013
Mon, 04-08-2013 - 4:29pm

My first DS made it to 1 year in the 110th percentile for weight and never, ever got more than 4 oz 3x/day at daycare. That was only for about the first month he was there (starting at 3.5 months old) and then it went down to 3.5 at about 24 weeks and 3 after he started solids at 6mos and kept dropping from there to about 2 oz at 14mos when we finally quit. Day care is used to feeding formula, I have found, so strict instructions on how to tell if she really needs more may be helpful. My kids all spit up to self-regulate, but that is heartbreaking when you're pumping, so I'm also very cautious about overfeeding- I have to check myself to make sure I'm not witholding, too! Ultimately, if they're sleeping, peeing/pooping, and alert and content, they're getting enough.