Is this bad advice?

My girlfriend has a 2 week old baby and is breastfeeding, she has had problems with supply and has been told by the midwives at the private hospital she gave birth in that they are concerned he had not regained his birth weight. He gained 40g in a week. They have told her she has a low supply and she has hired a medela lactina breast pump and was expressing between feeds, and to make sure he was feeding a minimum of 4 hourly.

When she went back they told her that her supply was too low and she needed to take motulium to increase her supply. She then went to her OB her prescribed 1 tablet 3 times a day when the hospital information sheet she was given suggested she should take 8 within a 24hr period

I am really concerned that the midwives have told her to express and feed her baby the expressed bm to check if her supply was increasing. My understanding is expressing bm will not give an accurate picture of milk production as it is less effective than bf directly?

I suggested my freind see a lactation consultant as the midwives she is seeing aren't trained lactation consultants, she is worried that if she sees someone else the scales will be different when they way bubs so she is not keen.

She is trying so hard to build a breastfeeding relationship with her little boy and Im not sure if the advice she has been given will do this, and I also told her to speak to her OB about the dosage reccommended by the hospital.

Does anyone know if expressing to check supply ever has a place in the management of low supply?

I don't know about anything else, but I have a really good supply and can only express 40mls in an hour. Going by the midwives logic my 2.5yr old would be starving.

I had very low supply and was suggested I see a private lactation consultant. Your local ABA can help with this. There's also a good book published by the ABA - "the breastfeeding mother's guide to increasing your supply" which I highly recommend. My LC had me with exercises for the bub, expressing for me, lactation cookies (they really do work!!!), no-alcohol (cooper's) beer, motillium (eventually around 1500/day) and fenugreek plus blessed thistle. There's a supplement available at the herbalist or organic shop called "breastfeeding gold" which had BT & F in it ... however, you have to go on slowly to get the effect.

I would strongly recommend she contact her local ABA and a private LC ...

Expressing does not give an accurate measure of her supply. Perhaps the midwives meant for her to try and boost her supply? As someone who had lousy supply that just got worse with the stress and fatigue caused by expressing between feeds, I'd be suggesting that your friend a) see a lactation consultant asap and b) sleep whenever she can and eat right.

Hi,

it is really a very hard thing when a mother is told she doesn't have enough milk for her baby. In fact, nearly every mother can make enough milk for her baby and very often (and this sounds like it could be likely the case with your friend) sometimes babies don't take enough milk (not having enough milk and the baby not taking enough milk are not the same thing - although if not sorted out, the two can become the one thing.)
It sounds like your friend has got into a cycles that is very familiar to lactation consultants and many mums. Sleeping for long periods and just not taking enough milk. Crazily we are often led to believe that a sleeping baby is a *good* baby. The opposite is the case. Feeding 4 hourly just isn't enough. Most babies feed at least 8-12 times in 24 hours or more. As a first strategy I would be suggesting that your friend wake her baby every 3 hours day and night (no, it's not forever, just until you get on top of this) And see a good LC asap. Jill Bruce in Adelaide is good (if that is where she is) the good news is that this is a problem that can easily be solved and mum and baby have every chance of going on to breastfeed for as long as they both desire.

In terms of the motilium 3 x daily didn't work for me and I think the recommended amount to increase supply is much higher than this. I take 8 x daily.

The other girls have good advice about supply and expressing. Wishing your friend good luck with it all. Feeding and weight gain issues can feel overwhelming.

Thanks ladies,
she has been sleeping during the day when bubs is sleeping. Today she visited us and bubs woke hungry but she drove home to express so she could then feed him the expressed BM. I hope he hadnt worn himself out crying before they got home. I realise that for some people bf when out at first can be difficult.

Barb, yes she is in Adelaide I think I might give her a call and give her Jill's number. She seems to be quite 'happy with how well he sleeps' I was wondering if it was due to him being sleepy from not feeding enough. I know how frustrating it can be waking a sleeping baby to feed as DD was early and jaundiced and we had to waker her frequentlyto start with, as she grew she certainly let us know she was hungry. I dont to be too pushy but I really think she might benefit from seeing a LC, Ill giver the number then leave it up to her.

It's really important that if your friend wants to breastfeed that she gets good advice. I worry that all the expressing might wear her out and might not even have the desired effect. Hopefully if she can talk to a good LC then she'll have a good plan in place and get on top of this soon.

your poor friend - she must be even more exhausted with the expressing on top of feeding, driving home to express then feed the expressed milk would be enough to have put me off! hopefully a good LC will help sort her out.

i was never a public feeder (absolutely for it, just no good at it myself!) but i found a groove that suited me & didn't stop me from being out & about - it just takes some time to find places where you have privacy & can relax enough to feed comfortably. hopefully she can find her groove soon :)

I think the PP have provided some great advice for your friend.

By the sounds of it, I had very similar problems to her when DS was born. He was a sleepy baby, had trouble attaching, became jaundiced and wasn't gaining enough weight.

On day 3 when he became jaundiced the Paed adviced us to top him up with formula to help flush it out. I was also advised to start expressing after each feed to help get my milk to come in initially and them to stimulate supply. This way I was able to top him up with as much colostrum as I could get, before he had the formula. But, that only lasted a couple of days.

After week 1 he was weighed and his weight gain was low. The MCHN told me at this point to not let him go more than 3 hours without a feed, and to continue expressing after feeds to stimulate supply. We did this for a couple of weeks and were able to get everything back on track.

So in my case, I found the expressing was great for getting my milk to come in faster and also for increasing it in the early days. I think you're friend really needs to make sure that bubs is being fed every 3 hours (at least). Making bubs wait for a feed while she drives home and then expresses (probably as least 30 mins) is not good, especially if they're weight gains are slow. I know I was also a bit uncomfortable BF'ing around people in those early days, so I can understand where she is coming from. Like the others have said, the help of a good LC would be invaluable for her right now.

I read some good advice that has stuck with me. I think it was in Sleeping Like A Baby. It was about the difference between women & the amount of milk their breasts could hold. Basically, each woman will usually produce what the baby needs but their breasts might have different holding capacities. Some women who have smaller holding capacities think they have low supply when in fact they just need to feed baby more often. A simple analogy - You can drink a litre of by having 4 drinks of 250ml or 10 drinks of 100ml. It's still a litre just from a different cup. I found this advice helped me through when DD was wanting to feed every 1 - 2 hours during the day & 3 hourly overnight. Also, I could never express either. Whenever I tried I'd get about 20ml after 1/2hour & sore bruised nipples. My babies were gaining weight so I knew they were getting enough. From my understanding (I'm not an expert), as long as baby is gaining weight, the amount doesn't matter. Some babies are just smaller than others. And it can vary based on things like - just had/due for a feed, just filled/about to fill a nappy. I hope your friend gets the help she needs.

How is your friend going now SR?

Hi ladies thanks for your input

MR- her baby is now 4 weeks old and has still not got back to his birth weight so on the advice of her paed she has just started comp feeding with formula. She increased day feeds to 2.5 to 3 hourly and has seen a lactation consultant. She is still determined to continue breastfeeding and is hoping the comp feeding with formula is temporary. At the moment Im trying to be someone she can chat to without being overbearing or offering more advice as she is getting different advice now from the hospital she birthed at, her ob, the paed and the lactation consultant.

She has had a reaction to the motulium and has had the runs for a week so is going to look at starting to reduce the dose slowly as she cant look after bubs as she would like to while her tummy is so upset.

I have my FX for her that they will get though this struggle and that she can keep bf as she desperately wants to.

Oh dear about all the different advice! That makes it so hard. And yucko for the runs, poor thing.
can you quietly suggest 2-hourly feeds? If she's pumping after feeds, maybe also suggest using the breast to top-up instead.

she is using any EBM first for top ups but is only getting about 30ml a day. Im trying not to push too much at the moment, she has said he is cluster feeding in the evenings sometimes 1-2hrly which I told her is often normal for babies and she has been going with that in the evenings and waking him up if need be for more frequent feeds
thanks xx

ah good. well, probably what she really needs is an understanding ear and a good friend

Sounds like you've got some great advice from PP and are being a great friend!

A hungry baby wouldn't be able to go 4 hours (or even 3) between feeds, if the mother did have a really low supply. I do not have enough glandular tissue in my breasts to produce enough milk and fall into the small category of those that genuinely, not matter what, can't produce enough milk to feed a baby. My baby would be on the breast for 50 minutes, sleep for ten and then want to go back on the breast for more food.

But, while it is great to support breast feeding, if she really does need to top her baby up with EBM or even formula, please be supportive! I was very, very, reluctant to top baby up with formula (but I just couldn't express any significant amounts). I had one good friend who I've nick-named the "anti ABA" (just jokes!) as she was 100% in support of me to use formula for top ups after the pediatrician and 3 different lactation consultants suggested and then really insisted on it. In retrospect, it is clear that my baby needed it and it was my friend's support that made it easier for me to accept this.

So while the feed more etc advice is generally good, sometimes you need to think about what the baby needs to be healthy and support that. I know may people give lots of pro-breastfeeding info to help make a mother feel more confident, but it might just make her feel like a failure and guilty.

I hope that makes sense!