(2006/01) Jan 2006 MTBs

Causes of low MS:

There are many reasons for low milk supply. The primary control of milk supply is related to the amount being taken from the breast. Anything that inhibits the amount the baby can take from the breast or that is being taken from the breast can inhibit supply. The most common causes that are related to inhibition of the baby's ability to access the milk are:
1)when the baby is not latched deeply enough on the breast, and
2) babies who are not at the breast long enough or frequently enough. These two causes probably result in the vast majority of low milk supply, they are extremely common and also happily generally easy to "fix".

Another common cause of low supply is supplementation with formula or solids, since that will cause the baby to take less bresast milk from the breast and ultimately the breast will produce less.

Sometimes babies are too sleepy, though this usually only occurs in the beginning or if the baby is ill, and don't take enough milk, leading to low supply.

Sometimes there is something dysfunctional about the baby's suck, such as a short frenulum that restricts the baby 's ability to suck and therefore take milk from the breast though suck and tongue problems are usually accompanied by nipple soreness.

Most of the common causes of low supply can be fixed easily by fixing the cause such as improving the latch or increasing the frequency of bf.

True low milk supply, where the mom is truely unable to produce adequate milk even though all the management issues of bf are going well is pretty rare. One cause is retained placenta, which can be corrected by taking the retained placenta usually. Retained placenta generally occurs in the early weeks. Hypothyroidism (low thyroid hormone), which can be corrected with medication, is another potential cause of low milk supply. Excessive loss of blood during the birth can cause low supply. And very rarely inadequate breast tissue. Polycystic ovarian syndrome can also create low supply.

Low milk supply is also a problem that many moms think they have when they don't. *Perceived* low supply is a very common problem. Many moms think they have low supply when they actually do not b/c they are using the wrong signs to judge milk supply. Here is a post on how to assess milk supply:

http://messageboards.ivillage.com/n/mb/message.asp?webtag=iv-ppbreastfeed&msg=63037.3
 


Increasing your milk supply
Milk production is a demand & supply process. If you need to increase milk supply, it's important to understand how milk is made - understanding this will help you to do the right things to increase production.

To speed milk production and increase overall milk supply, the key is to remove more milk from the breast and to do this frequently, so that less milk accumulates in the breast between feedings.

OK, now on to things that can help increase your milk supply:

- Make sure that baby is nursing efficiently. This is the "remove more milk" part of increasing milk production. If milk is not effectively removed from the breast, then mom's milk supply decreases. If positioning and latch are "off" then baby is probably not transferring milk efficiently. A sleepy baby, use of nipple shields or various health or anatomical problems in baby can also interfere with baby's ability to transfer milk. For a baby who is not nursing efficiently, trying to adequately empty milk from the breast is like trying to empty a swimming pool through a drinking straw - it can take forever. Inefficient milk transfer can lead to baby not getting enough milk or needing to nurse almost constantly to get enough milk. If baby is not transferring milk well, then it is important for mom to express milk after and/or between nursings to maintain milk supply while the breastfeeding problems are being addressed.

- Nurse frequently,
and for as long as your baby is actively nursing. Remember - you want to remove more milk from the breasts and do this frequently. If baby is having weight gain problems, aim to nurse at least every 1.5-2 hours during the day and at least every 3 hours at night.

- Take a nursing vacation.
Take baby to bed with you for 2-3 days, and do nothing but nurse (frequently!) and rest (well, you can eat too!).
Offer both sides at each feeding. Let baby finish the first side, then offer the second side.

- Switch nurse.
Switch sides 3 or more times during each feeding, every time that baby falls asleep, switches to "comfort" sucking, or loses interest. Use each side at least twice per feeding. Use breast compression to keep baby feeding longer. For good instructions on how to do this, see Dr. Jack Newman's Protocol to increase intake of breastmilk by the baby. This can be particularly helpful for sleepy or distractible babies.

- Avoid pacifiers and bottles.
All of baby's sucking needs should be met at the breast (see above). If a temporary supplement is medically required, it can be given with a nursing supplementer or by spoon, cup or dropper (see Alternative Feeding Methods).

- Give baby only breastmilk.
Avoid all solids, water, and formula if baby is younger than six months, and consider decreasing solids if baby is older. If you are using more than a few ounces of formula per day, wean from the supplements gradually to "challenge" your breasts to produce more milk.

- Take care of mom.
Rest. Sleep when baby sleeps. Relax. Drink liquids to thirst (don't force liquids - drinking extra water does not increase supply), and eat a reasonably well-balanced diet.

- Consider pumping.
Adding pumping sessions after or between nursing sessions can be very helpful - pumping is very important when baby is not nursing efficiently or frequently enough, and can speed things up in all situations. Your aim in pumping is to remove more milk from the breasts and/or to increase frequency of breast emptying. When pumping to increase milk supply, to ensure that the pump removes an optimum amount of milk from the breast, keep pumping for 2-5 minutes after the last drops of milk. However, adding even a short pumping session (increasing frequency but perhaps not removing milk thoroughly) is helpful.

- Consider a galactagogue. A substance (herb, prescription medication, etc.) that increases milk supply is called a galactagogue. See What is a galactagogue? Do I need one? for more information.
 
Hope you all find the info useful. Just seems like quite a few of you are concerned about low MS which I think may not be necessary the case for some of you. As long as the amount of poo/pee and weight gain is ok on breastmilk alonf, shouldn't be too concerned about MS. Supplementing with FM may make things worse.

Anyway, subsitute direct latch with EBM for 1 feed just now and hmy Isaac took in only 90ml. He's into 8 weeks and currently weigh 4.25kg. Going to take 100ml as benchmark when I return to work coming Monday. Aim to pump 450 - 500ml, 3x a day to last 4 to 5 feeds while I'm at work. Dunno can or not... just now could pump only 140ml. Best ever also only 170ml...

Re. BB smile
Any of your BBs started smiling real smiles and spontaneously? Or responding to your smiles? My Isaac only smiles widely when he's half asleep. My dad claims that he gave him little smiles when he was holding him. My HB says when he stroke his cheek, he also gave little smile. How come when I hold him, talk to him, smile at him, he never smile at me even though he's looking at me??? I think he has yet to really smile leh. Already 2 months liao.
 
Hi Queen...thanks for the info...really useful...hehe...

Baby James is currently 5kg at 4 weeks old...I think he drinks alot becos each time after nursing...my breasts turn really soft...He smiles spontaneously when I speak to him...he also seems to start recognising voices...hehe...
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mamachan
my expereience with KKH LC is ok. just that i prefer home visits.

mongs,
did she tell u to cut back on FM? i forgot to ask. my bb also drinks that amt of FM. now i only manage to latch for likr 5-1- min each time . he prob knows he has his FM waiting for him.

queen,
thanks for the info. i saw that on website too. i try to empty frequently but milk production is slow. if i cut back on FM, then bb won't sleep when hungry.

my bb does smile at different times, sometimes when he is sleeping, when i sing or when we tease him.
 
i realise my bb can follow moving objects to. when i put him on my bed and walk from side to side, he will turn his head....
 
Joanna,
your bb so cute, can latch on correctly liao, my bb will hold the nipple in her mouth, and yank it aournd until she is comfortable, wah, cannot tahan the pain! So have to hold her head fast...

re: bb sling aka meet up
good idea to meet up, I also having problems with sling... though maybe someone's place may be good to meet up, or at least somewhere with breastfeeding friendly facilities, like Novena Sq, as many mummies breastfeeding?

SY/Sept 03 brides,
ok, no problem, will PM tonight or tomorrow. I prefer home visits also, more comfortable...

Cookie/ Sunny,
replied you liao
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queen,
thanks for the info. just curious, what is the interval for lsaac feed? 3hrs or 2 hrs interval? he seems to be taking not a lot.
 
sleepingdeer,
u getting her to do homevisit? it's ok. cookie passed me the contact already. when are you meeting up with her?

my bb also like yours. he latched on and will hold the nipple and turn left right up down until he likes and suck at the same time. and he stay on the breast at most 5 min...
 
MIL
I didn't really have a choice with my MIL cuz my hb is 90% filial son type. My hb calls me unreasonable if I try to blow up at my MIL.

Durian,
R u free this evening? Maybe I'll come over to learn how to use the sarong tonight if my full month cakes are delivered here early.

May,
My girl is also 4 weeks and she's taking 100ml max also. In fact, during the day when she nurses more, she only drinks 70ml. At night, she'll drink about 100ml to store up for the longer night rest.
 
cookie,
its common to have babies sleepy by day and alert at night. Read that after some time, they'll settle down and their biological clock will set back to normal. meanwhile, just get yourself geared up for the night feed battle. Also, I found that using my own BM does not soothe my sore nipples. I apply Medela PureLan to the nipples immediately after a feed to soothe it.
 
Hi Mummies,
for those who wanna meet up and try the sling, though my home is little inconvenient to access, and best to get there by cab or car, I'll be happy to offer it up for meet up venue. I live very near Bukit Batok...
 
SY,
yah, have used her for 3 home visits so far, now I am learning infant massage from her as well, as she is trained in that area too. Supposed to see her tomorrow, but dunno whether she managed to make it back in time, she supposed to call me, but silly me left my HP at home...
 
Hi Ladies!

I'm from May 06 thread. Would like to get some comments and advice from some of the mummies here who are using Bumwear diapers. Are they good for night use? Any leakage? Thanks!
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sleepingdeer,
u have already used her for 3 home visits? all for bf or other purpose? she does infant massage? how does she charge for that? i m interested to learn that.
 
RE: Massage

I had a pre-natal massage last time by a Thai lady, she managed to "push" my placenta up as I told her gynae say it is low. So now thinking of asking her for post-natal. She say C-sect got to wait till 6th week. And had provide me a package.

90mins - $65 (Package 10 times get 1 free)
*include aromatherapy massage, herbal binding treatment, slimming treatment.

Is it worth?
 
queen,
thanks for the BF info... I keep thinking I have low MS cos each session I can only pump 20-40mls. Then, in one of your links I read that the ave. milk per pump session is 0.5-3oz so I dont feel so bad..

Mongs,
Could your baby be going through a growth spurt thats why suddenly u don't appear to have enough to satisfy her.. when my baby was 3 weeks she went through this phase and she had to be on my breast for 1 hour and then, be hungry again in an 30min... I thought I was going to die of exhaution.. now my baby is abt 6 weeks and she's doing the same... I am hoping its a growth spurt, but what I do is supplement her after she has latched on for at least an hour. At least that way I know that she is giving me max. stimulation for increasing my supply despite supplementing. However, its quite tiring to latch for so long..

RE: breastfeeding
There were times when I struggled so hard with breastfeeding that I cried and cried and I just told my hubby that I just want to give up and give total FM cos I keep thinking my baby isn't getting enough. Also cos my baby was small at birth only 2.4 kg (2.2 kg at dischare) and her weight is still quite low at 3.4 kg... I am wondering it she gaining enough all the time. i feel guilty that I'm not feeding her enough by forcing her to be on TBM. Luckily my hubby is quite supportive and so far my PD seems ok with her weight gain so I guess it should be okie.. I'm quite insecure about this.. esp when everyone who sees my baby comments on how small she is.. luckily she does appear to have chubbier cheeks and thighs now but everytime someone asks if I have enough milk for her I feel really guilty.


Re: Lac consultants
I've tried Yen peng from KKH and Thomson, Grace/Mrs Wong cos I keep having a problem of blocked ducts. Their approach are slightly different andtheir techniques are different too (different breast massage tech). To increase MS, TMC Mrs WOng is quite fixated on the booster dose of papaya and fish soup.. booster dose as in 1 bowl for 5x per day for 3 consecutive days and you must also drink nutritional drinks eg milo/ horlicks in between. I am trying this out now... I dunno whether it helps very much cos my pumping volume fluctuates quite a bit from 20mls to 50mls per session.
 
Mongs,
normally Isaac's feeding interval is 2.5 to 3 hours. Early last week, he was feeding like every 1+ to 2 hrs due to growth spurt I think. Yah... my boy not drinking a lot of EBM hor, some of your BBs who is younger is drinking more. could be related to weight? Bigger BBs drink more? Feel that he seems to take in more by direct latch somehow. Anyway, since he has gained almost 2kg from birth weight (was 2.45kg and 2.38 when discharged) and grew 8cm, I think his milk intake still ok. Doctor never say anything also...

Joanna,
Really, your BB can smile spontaneously when you speak to him? And your BB only 4 weeks old? My BB going 2 months already and yet to have a real spontaneous awake smile from him. Sigh...
 
tabbeisus,
Yen ping suggest i take fenugreek also. u want to try that?

1 bowl for 5x a day is a lot!! can fish soup work as well?
 
SY
dunno if the fish soup really makes a difference but i did manage to pump 300ml of excess milk for storage after taking it

where can u get fenugreek? what's the dose?
 
may, durianlover, sleepingdeer, sy
thanks.. must monitor my boy liao.

rena
thanks. my friend bought a travel striliser, think can keep 2 bottles. i find the nepia diapers qt good loh.

queen
thanks for the v informative article on bf... v useful.
 
tabbiesus,
u can get fenugreek from GNC. i can't remmeber whehter it is 6 or 8. let me confirm.

u mean u manage to get 300ml of excess milk a day after taking the papaya fish soup? must use those green papaya is it?
 
Krissie,

could you ask your friend for me .. I would like to purchase it...As for nepia diaper where could I purchase? how much is it?

Thanks
 
rena
my friend not in sing liao. if i rem wrongly, she got from robinsons. maybe u can call them to ask them. maybe avent?

nepia is $14 per pack. hv to buy 4 packs & they will deliver. the no is 62262650.
 
RE: 5in1 vs 6in1 jab
I think most of the baby going to have jab soon. Can I check with u all.. which is better huh? 5in1 is offered by polyclinic and 6in1 is offered by PD. Anyone done a research on this? Cost?
 
Krissie,

so far is it good? is it cotton ? how many hours have to change the diaper? for fitti is 2 and half hour have to change, huggies 2 hours.. my bb is wearing M size for both brands.. how is the cutting ? is it smaller? coz if it is smaller then I will have to order L ..
 
May,

5 in one is cheaper.. but you will have to take more jabs.. especially when bb may get fever after the jab.. therefore 6 in one is better but more expensive.. many times more..
 
queen,
thx for article. Really helpful!

wendy,
sorry wasn't online yest coz my bb kept crying to be carried...i had no time or energy to do other things. Suggest if u'd like to come over to my place to try out sarong sling u contact me by HP faster - 93831991. But i'm also not v gd at the sling...bb's head looks like it's dropping out!

may,
i'm bringing my girl for 6-in-1 jab at PD coz my fren says it's better - spare bb the torture of 1 less jab, plus the quality of jab at PD supposed to be better. My fren says polyclinic jab not so gd...babies will always kena fever. But PD jab better quality so less chance of fever. My PD charges $147 for 6-in-1 jab. Sounds pretty ex but i think i'll go for it!
 
re baby sling

Do you put the baby's head near the ring side or the opposite side? I am confused cos in the video the lady teaches to put the baby's head near the ring, but on the instruction pamphlet, it says put the baby's feet near the ring.. My baby's so small she gets lost in the sling!! I've tried it a few times but I don't know if I am using it right but I must say it is useful for breastfeeding.

RE: PD
Are any of you seeing the PD from KKH? I am getting the 6 in 1 jab from there, do you know the cost?
 
rena,
may i know how big is ur bb? how come so fast wear M size? i'm asking coz i have alot of M size huggies diaper from the hampers that i received, but i tot since my boy still using newborn size, so i put the M size aside. so juz wondering issit becoz huggies cutting is small.

nepia:
i'm using nepia newborn for my boy now. it's not bad, cotton kind. cutting is slightly smaller than pampers.
 
rena
yup, cotton feel. hmm.. not too sure abt the cutting. the NB seems sllightly smaller than Pampers Premium, but S seems qt big. sorry, i dun use other brands, so cant compare. we also change bb v frequently, so, nvr monitor how many hours it can last. my boy is still wearing NB, abt 3.8kg during last visit to PD.

may
the PD i'm going charges $130/JAB FOR THE 6-IN-1. need to take 3 times, so $390 inlcd consult, excld fever medicine.
 
Re. Baby Sling
I have tried both the head-to-rings and feet-to-rings method. Personally I feel that the head-to-rings seem more secure. Initially when I out BB in, he got 'lost' in the sling as well!
1. Ensure that inner edge of the sling pouch is pulled high and tight across chest such that the 'padded' part of the inner edge is almost at the rings.
2. But for the outer edge, leave some allowance from the rings to the 'padded' part, say about 10cm or so worth of cloth. This is where your BB's head will rest on.
3. Follow the VCD on how to put BB into the sling pouch. Basically is cradle BB close to chest, fold BB's arms & legs and use the free hand to wrap BB into the sling by pullinf the outer edge over BB's body.
4. Rest BB's head on the outer edge's 10cm or so cloth allowance from the rings. As long as the outer edge can cup BB's head (but not cover entirely), BB's head will not fall out and there is enough support.
5. Pull/loosen the sling tail for better fit.
6. May have to make minor adjustment to the cloth at the rings to tighten/loosen the inner or outer edges.

Dunno id you all understand what I'm trying to describe....
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tabbisus,
The fenugreek really so good ah???
300ml from both breasts? Wow! Like that I also want to try man!
 
queen

no lah, not 300ml from both breast but 300ml in excess of feeding baby for one day's worth of pumping and not the fenugreek but papaya fish soup.

thanks 4 the baby sling advice. will practice..
 
Hi all,

I understand there's a new 7-in-1 jab now. My pap smear test results just came back. So has any of you gone for yours yet or planning to?

Was using Pampers Premium (S) for Cephas. Really love it but it's quite expensive as I am replenishing the diapers once a week. Just switched to Drypers. $10 cheaper than Pamers Premium. Bought S but realised this past week that it is shorter in length than Pampers Premium & so just changed to M for him today.
 
sysac,
wow what's the 7-in-1 jab? Haven't heard about it yet. Haven't gone for my pap smear either...will be going sometime in Mar i think. Can't remember the date.

How's Drypers? Any comments?

Re: baby sling
i put my girl's head near the ring side but her head seems like it's falling out of the sling! Hmm dunno why...shall try again. Perhaps coz she's a big baby so that's why she looks like she's falling out.

Re: baby's weight gain
Went to PD today and found out that my girl is now 4.44kg and 56cm long! So shocked that she grew so much within 3 weeks. She was 3.6kg and 50cm at birth. i think she's a huge baby...kinda mixed feelings coz i actually hoped for a petite little baby since i myself am quite petite! haha
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sysac,
I have the paps smear appointment on 21 March. Gynae ask me to go back one.

RE:Diapers
Drypers is not bad. I am using it and 1pack of 64pcs can last 2weeks. Tried pampers also, good but abit ex. Giant brand not good.

RE: BB weight gain
My Jamie is 1mth old tomorrow. Had tried to weigh myself and weigh myself together with her. So the difference is her weight. She is abt 5kg and 55cm long now. At birth is 3.6kg and 52cm.
 
sysac
i'm supposed to go for my pap smear this fri. was it painful? i'm afraid tha my wound will still be painful.
 
Hi Ladies, I am from March MTB thread, I guess most of u have completed yr confinement or completing soon. Any good confinement lady to recommend? It's pretty late but the CL I have booked some months back "played me out" so I gotta to find a new one now. Can give me the contact no of yr CL if u find her good? Thanks for the help!!
 
hi all

wanna ask for advise... I believe most of your baby's umbilical cord should have fallen off.
May I know.. after the cord fell off, do you do anything special?

My MIL just told me ytd that aft umbilical cord fell off... before bath must apply Seasame Oil to prevent water from gng in...
Have you all heard abt this before?
I find amusing and skeptical.

As usual MIL will say threathening words like if water get in... Shen xian also cannot help etc ect... big problem...
I'm vex when she come up with weild idea and accompnay with threat when we dun believe her... as if a curse
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tabb and queen
envy you all have good milk supply... my supply now bearly satisfy my baby's need...
so depressing...
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patience... patience....
 
Hi durianlover,

Injection: I have no idea abt the 7-in-1 jab. Just heard that it's new in the market. I have to call either NUH or the polyclinic to ask abt it. Scheduled Cephas for his 3mth jab on 23 Feb at NUH. Nothing abt 6-in-1 or 7-in-1 jab was mentioned. Will ask when I go for his appt.

Diapers: I have no complaints abt Drypers though I prefer Pampers Premium because it is thin while drypers is slightly thicker.

Hi Krissie,

My pap smear was done abt 2 months aft giving birth. It was not painful. Just need to relax.

Hi Cookie,

Need not do anything. Just keep the belly button dry. There will be a bit of blood for a few days. Just dab the area dry after bath & need not put anything on it. That's what the PD told us.
 
sysac
that's what I think so too...
it's taunting to think to apply sesame oil on the belly button...
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Angry with MIL for giving out stupid threat..
 
Hi cookie,

Kaelyn looks so alert
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Must be aft a feed
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Cephas is like that b4 he dozes off aft his feed.

If u are not comfy with her sugg, then jus ignore it. Rem to dab it dry aft bath. Take care!
 
Mummies,
going back to work tomorrow! Mixed feelings lah, will miss my boy so much. Feels a bit daunting to face the hectiv wrokload again. Worried about expressing in office... Worried about whetehr can pump enough or not. Worried about having to bear with the engorgement cos can probably pump every 5 hours so. Sigh...

Yesterday went out to buy working clothes cos pre-preggy clothes are all quite fitting, though now can wear, feel quite conscious about the size of my boobs when it becomes full. will hae to wear my non-nursing bras for some padding cos scared nipples will show even with nursing pads, but worried that the bra cups may be small when boobs become bigger. Damn stupid worries right?
 



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