Very low supply — what is reasonable hope for improvement?

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confusedone070289

New member
TLDR: I’m 2 weeks 5 days postpartum and produce ~10ml per feed. My baby takes ~100ml of formula after breast feeding. Has anyone seen increases in production in the 5x to 10x range after 3 weeks?

We had lots of lactation support in the hospital — I produced colostrum and the baby had a good latch and strong suck. He has no tongue or lip ties. We were feeding him every two to three hours, as recommended. When we found out he’d lost too much weight, the pediatrician told us to triple feed, and feed what was pumped to him. In the first days, nothing came out when I pumped, so we had to start supplementing formula.

We went back to lactation at 8 days pp, and did a weighed feed. He transferred ~10 ml. At 14 days pp we had a similar weighted feed. We are now triple feeding with extra pumps between feeds (8x a day pumping, 4-6x feeding at the breast on demand). I take one feed off between 8pm and 2am to sleep. I am pumping around 50 ml in 24 hours, between the after feeding pumps and stand alone pumps. I’m taking Moringa, Shatavari, Goats rue, and Torbungan drops. We see lactation every week. I drink ~100oz of water a day.

The baby is typically happy to breast feed, though he gets hardly anything from it. He can be pretty sleepy at the breast. We did try an SNS (Medela), but it leaked and then broke.

I have hypothyroidism and PCOS. I’m also of advanced maternal age with my first child. I didn’t have any issues getting pregnant, nor gestational diabetes. The baby’s birth went smoothly. Blood work has shown I’m over medicated for my thyroid (which should cause over supply from what I’ve read). I’ll hear from my endocrinologist early next week for a medication dosage adjustment. I also had a high fasting glucose, 96, when my last reading three weeks before birth was 77. This coming week I’ll get A1C, testosterone, and prolactin tested.

I’m wondering if anyone has seen dramatic increases in production after three weeks? Or if anyone has suggestions on how to increase production? Additional tests to run? I’m considering reglan, but the side effects are unnerving, particularly if the increases from taking it may only double my supply. The amount of pumping I’m doing is not sustainable, so I’m trying to figure out how much longer to pursue this.
 
@confusedone070289 I'm facing the same issues, I pumped religiously for the first 4 weeks postpartum but only got 40-50 ml in 24 hours and didn't see any improvement with my supply. My baby doesn't latch so I haven't breastfed but I'm now 6 weeks postpartum and kinda stopped pumping since it was a lot of effort for very little benefit. My IBCLC couldn't figure out why and neither did my obgyn. Right now I've kinda made peace with my baby being 100% on formula. But I really would like to know what's affecting my supply and there's very little information on the Internet. I also have hypothyroidism and I'm on medication for that so it's under control. Kinda lost with respect to next steps. Let me know what you end up trying and what worked out for you.
 
@rachelvaught Will do! I’ve ordered some 18mm flanges to see if sizing down helps, particularly on my left breast, as it’s nipple was a bit smaller than the right and I always get less from it pumping. At the moment I’m waiting to see if my prolactin levels come back low — if so I’ll try reglan to increase it (I’m in the US, so domperidone is harder to get).

If my prolactin levels and other blood work come back normal, and smaller flanges make no difference, then I suspect it’s insufficient glandular tissue. My breasts are asymmetric, which is a sign of that issue. In addition, my mother and sister had supply issues, so it maybe be hereditary.

Anyway, I’ll let you know if I figure anything out.
 
@rachelvaught Hi, I wanted to update you — I didn’t see any improvement from the 18mm flanges. In fact, they rubbed uncomfortably on one side, so I went back to my 20mm.

I had my prolactin levels tested. I was 188, when my OBGYN would have expected 260-310 after nursing at 3 weeks 2 days postpartum. All other tests came back normal. Based in that, I started reglan, since it is supposed to increase prolactin, and that looked like it could be the source of my issue. I’ve been taking it for two days now and have yet to see any improvement, but I’m not having any side effects either. If there is no improvement in the next 2-5 days, from what I understand, there is likely not to be any.

So, still no real answers…
 
@rachelvaught Hi! No, not really. The reglan may have slightly increased my supply, but we never did a weighted feed to confirm that, as it would have been on the order of going from 10ml to 15ml. At present I have stoped triple feeding and only pump in the morning and before bed (I get around an ounce a day doing that. The pumps in the middle of the day weren’t producing milk.). The baby is still happy to nurse before getting formula, so we do that. While I wish something would have worked, I think I’m happier now that I’m not pumping all the time, because I can spend more time with my baby.
 
@confusedone070289 I had a lowish supply and had a baby who slept at the breast. What worked for me was CONSTANTLY latching baby, triple feeding with 8 pumps a day. I now have quite an over supply. I don’t have the health conditions you have though, so I’m not sure how well this would work for you, but I hope it does! Good luck! 💕
 
@confusedone070289 It’s so hard to remember it’s such a blur even though it was only a few weeks ago. I want to say maybe 4-5 weeks? It’s hard to do for that long of a time, I was lucky my husband was on parental leave and my
Mom was here so I had a lot of help
 
@confusedone070289 Yes but I had to do bloodwork to find the root cause. I have PCOS and hypothyroidism due to hashimotos. I needed medication to help manage those, and even then I still needed domperidone to get a full supply. There are several health issues that could be impacting your supply and if you’re doing everything else in order to increase it and it’s not working I would bet there’s an underlying medical condition.

I strongly recommend asking your IBCLC to request a blood panel from your doctor and have your IBCLC review and recommend a course of treatment based on the results.

Edit: I totally skipped over the paragraph you mentioned the same issues I have. I had to adjust my medication 4-5 times in the first 6 months pp. It helped but ultimately I still needed domperidone.

Oh! And get your iron levels checked!!
 
@confusedone070289 Yes! I’m not sure it helped at all though. I got off it after taking it for 4 months (before I started taking domperidone) and my milk supply saw no difference.

For me I think it was definitely something specific affecting my pituitary gland because my prolactin levels were below the threshold of what’s normal for lactating women at 3 months pp (before and after nursing). Then it was above the threshold 3 weeks after starting medication. But I saw an immediate improvement (I’m talking 2 days) with my supply. Went from underproduction to overproduction in that time. 10mg/8 hours.
 
@confusedone070289 You need to see an IBCLC that is very skilled in pumping.

I’d bet your flanges are a wildly incorrect size. I think you can very easily increase your output with the proper support!

I’d also recommend having baby evaluated by a pediatric physio or similar. Often tension from positioning in the womb can make it very difficult for babies to transfer milk, which impacts your supply.

Was baby born early, or with instruments, or cesarean?
 
@3rdeye I did take my pump flanges to my IBCLC. We bought 20mm based on Spectra’s measurement guide, and the IBCLC agreed that was the right size for me. We also discussed how to use my Spectra S2.

My baby was born on his due date. It was an uncomplicated vaginal delivery. Labor was a total of 18 hours.

Thank you for the suggestion about taking the baby to a pediatric PT. I’ll look into that.
 
@confusedone070289 The Spectra measurement guide says it should be 3-5mm larger than your actual measurement, which is generally incorrect and they end up being way too large that way.

I’d honestly seek out a second opinion on that. I’d recommend a consult with Be My Breast Friend or someone similar, virtual is fine. But getting this dialed is really key.
 
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