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Old 10-11-2013, 07:54 AM   #1
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How do you know when you're not producing "enough"?

My sister had her first baby on 9/1. She's very committed to making exclusive breastfeeding work.

Whenever my sister has to leave the baby with me for a few hours, she must pump for about a week prior to that, and she barely accumulates 4 oz to give me. Meaning she really has nothing to spare.

Also, the baby seems *constantly* hungry. Each time he nurses, he will completely dry out both of her breasts, and then want to nurse again very soon. My sister reports that there are really bad days where he is constantly fussing, crying, sometimes at the breast.

All of this seems to indicate she might not be producing enough, and may need to supplement. However, she feels strongly that her supply is fine and the baby *is* gaining at a good rate (about 14 oz per week thus far). She says she feels the fussiness is due to colic/reflux.

Is good weight gain enough indication that milk production is sufficient, or is it possible she needs to supplement? What is the best indicator of that?

I have no experience with this, as I had a major oversupply with all 3 of my kids, and was able to donate enough to feed another baby simultaneously and still have so much left I was tossing out at least a cup a day due to lack of storage space.

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Old 10-11-2013, 08:17 AM   #2
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Re: How do you know when you're not producing "enough"?

Good weight gain is really the only indicator to know that her supply is fine. It's very normal for a baby to empty both breasts and feed frequently. Pumping output is NOT a good indicator, some peoples' breast just don't respond to the pump well at all. I had to ''train'' mine to get a letdown and have to keep using the letdown mode on my pump at least 2-3 times per pumping session.
Most people do produce enough milk, only 3% of the population doesn't. Most people begin supplementing because baby is fussy, etc. and supplementing is a slippery slope. It can cause the mom to stop producing enough.
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Old 10-11-2013, 08:31 AM   #3
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Re: How do you know when you're not producing "enough"?

14 oz a week is an incredible weight gain! or did you mean 4 oz?

If it is 14 oz gain a week, then she is certainly producing enough and baby is fussy for other reasons. Could be colic, tummy trouble/gas, or maybe silent reflux. All which can cause a baby to want to nurse often for comfort.

If it is 4 oz, that is still a decent weekly gain but on the low end. Boosting her supply just a little might help. Upping water intake, eating some oatmeal, pumping a couple times a day at the same time.

There are things she can try to get her body to respond to the pump better but pumping is not at all an indicator of supply. She can try warm compress, hand massaging, different pump to see if that helps her let down for the pump.
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Old 10-11-2013, 08:37 AM   #4
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Re: How do you know when you're not producing "enough"?

It's 14 oz (or least it has been for the past 2 weeks).

Both she and I really really prefer that she not supplement. It just seems that the baby will often finish draining of her breasts and not really appear "satisfied"...
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Old 10-11-2013, 08:38 AM   #5
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Has she tried giving the baby a pacifier. I'm right in the middle of not knowing if my baby is getting enough! I found that if he is really hungry and not just tired, gassy, wet diaper, etc he will spit the paci right out. If he's not hungry he quiets down right away and then I can address his other needs. Crying and fussing is the only way these little peanuts can communicate so they like to do it often and loudly .

I have also found that nipple confusion is pretty much a myth and her baby is old enough it shouldn't matter anyway.
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Old 10-11-2013, 09:24 AM   #6
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Re: How do you know when you're not producing "enough"?

Also seems like the baby is just about 4-6 weeks which is time for the first growth spurt so all the extra nursing and not appearing full is exactly what needs to happen to tell her body yo produce more. Is this something that has been a problem all along or just the last couple weeks? May just be a growth spurt and get better soon
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Old 10-11-2013, 10:07 AM   #7
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Re: How do you know when you're not producing "enough"?

14 oz a week is an insane amount of growth. The average growth per week is 5-7 oz. He is doubling that, so her supply is 100% fine! That said, babies like to suck and they like to be attached to mom. If it is reflux, the sucking feels good.
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Old 10-11-2013, 02:35 PM   #8
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Weight gain is enough. I was very concerned as DS literally lived on the boob or was crying for at least the first 6 weeks. But he kept gaining and the pediatrician and LC both said he was fine and just colicky. He did eventually take a paci but still doesn't pacify much and is still a bit of a grump.

this site really helped me. Particularly this part because a nurse I trust told me that my small breasts just had a small capacity. Then on DS, people would tell me that was crap and you couldn't tell the milk capacity by the size of the breasts. Well, turns out that the nurse was correct, but it's just that it's not so cut and dry like 'large breasts always make more milk' since large breasts can also have a small capacity. and other examples.. anyways:

Breast milk is produced continually and it accumulates in the milk ducts between feedings. During feeding, a baby typically empties about 70-80% of the milk in the breast. Hartmann found in his studies that some women had 3 times as big a storage capacity than others - but that all of them produced the same amount of milk over a 24-hour period. In general, bigger breasts of course would have a bigger storage but it was noted that breast size was not always a good predictor of production or storage capacity.

In practical terms it means that women with small storage capacity breasts need to nurse more often, and the babies take in less per feeding. Women whose breasts have a larger storage capacity can 'deliver' more milk in one feeding, and so the baby needs to nurse fewer times per day. This further confirms the need of cue feeding or demand feeding where the baby sets the frequency of breastfeeding - and not the clock or the pediatrician or the grandmother.


point being that regardless of breast size, some women have an ADEQUATE... but smaller storage capacity and therefore, baby will simply nurse more often. It's enough to feed baby, it's enough for baby to grow strong and healthy and everything baby needs to be. But it might not be enough to go hours and hours between feedings like other women. So, you might feel like you aren't producing enough and need to supplement, but the truth is.. you just need to feed as often as the baby requests.

http://www.007b.com/breast_size_breastfeeding.php

oh.. and another thing to check is the newborn's hands. When baby is empty, they have clenched fists. As they fill, they relax and their hands open. For me, my time between was very short. Baby would be full and then very very shortly thereafter, hungry again. It has gotten better now that he's more efficient.

I also got a tongue tie clipped at 5 weeks.. she might double check that because that can affect a lot of things, such as length of time it takes to nurse and therefore the length of time between nursing sessions.
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Old 10-11-2013, 05:59 PM   #9
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Re: How do you know when you're not producing "enough"?

Fussiness and crying at the breast can sometimes indicate something in the mother's diet is bothering the baby's digestion. Dairy is a likely culprit. If the baby is gaining adequately, its not likely a supply issue.
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Old 10-11-2013, 06:12 PM   #10
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Re: How do you know when you're not producing "enough"?

If baby is gaining 14 oz a day it is no wonder she feels empty. He is way ahead of the weight gain race. My son gained at a similar rate. He wound up being a 20lbs 4 month old.

I never could get much milk pumped either. My son did have acid reflux which often caused him to be a very fussy baby.
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