Dear Lactation Consultant,
I am nursing my second child and did not have any serious milk supply issues with the first. With the second, he is beginning to outpace me - he's drinking 14-18 ounces per day at day care (I work full time) and I produce 12-15 via the pump. The only differences are that I am taking Ortho Micronor and that my job is more intense (and more enjoyable).
Over the weekends, I do not pump at all -- I feed him. I would prefer not to supplement. Do you have any suggestions to ramp up my supply?
I doubt that the Micronor has any adverse effect on your milk production. Many mothers find that keeping their supply up when they return to work is a challenge. Most moms don't get the same stimulation when they are separated from their baby that they get when they are at home. At home, you tend to do little "snack feedings" throughout the day, and when you're at work, you tend to pump on a set schedule. Also, there is no pump on the market that is as good a healthy nursing baby, so the stimulation you get is not the same.
Solutions range from pumping more often during the work day (this may not be realistic for you since you are already pumping so often), pumping after feedings or on the other breast when baby only takes one side at home, nursing more often when you are together (especially during the night) and feeding less during the day, taking herbal supplements (Fenugreek works better than any other herb, and I suggest trying it first), using techniques to facilitate let-down when you pump, and supplementing with formula.
Unfortunately, drinking water doesn't have a big impact on your supply. Drinking too much water can actually inhibit your supply. As long as you are drinking to thirst, your urine is pale, and you aren't constipated, then you are getting enough to drink and don't need to push fluids. I wish that increasing milk supply was as easy as taking a herbal supplement, or drinking more water, but it isn't. Domperidone is very effective in increasing your milk output, and is safer and has fewer side effects than Reglan. If you have tried everything else, then you might want to consider this option.
The longer you attempt to maintain your milk supply primarily by pumping, the harder it gets. Most nursing moms who return to work find that their supply does decrease after a period of time, especially around the middle of the first year when babies start solids, and are going through so many developmental changes so quickly.
There is something called "reverse cycle nursing" (RCN). This is when babies whose moms are working sort of reverse their nursing schedules: they nurse often during the night and less during the day, so they end up taking in most of their milk at night, and don't take much at all during the day.
Continuing to nurse after you return to work can be very challenging, but it is a real labor of love and is well worth the effort. It is especially challenging when you return to work when your baby is so young and try to maintain your supply over a period of months, but even if you end up having to supplement with formula, it is worth hanging in there, and every drop of milk your baby gets is beneficial. The good news is that by this age, most babies are able to handle formula just fine, because their digestive systems have had time to mature and they are much less likely to suffer allergic reactions, colic, or digestive problems.
Try not to stress about this so much. You are doing everything that you can to produce as much milk for you baby as possible, and that's all that anyone can do. You have done a great job with mothering your baby and giving him the best possible start in life, and you need to stop being so hard on yourself. He'll be fine, even if he does receive a combination of formula and breast milk. Within a few months, he'll be feeding himself and will become more interested in solids, and soon, he'll be drinking cow's milk from a cup. That doesn't mean that he will stop nursing, but it is a normal part of natural, baby-led weaning.
-- Anne, IBCLC
Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.
Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.
Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.