First, I'm sorry that so many of you are experiencing troubles, too. I hope it helps you to know you're not alone, but I'm sorry for your sake that you're struggling. It's so hard, and it can really be a blow to your mommyhood self esteem. Don't let it be! Keep plugging away, if continuing nursing is what you want!
These are some other things I've learned about improving and maintaining my milk supply. These are in no particular order, other than the order I thought of them in :)
1. Don't use a second-hand personal pump, if you can at all afford it. Ok, before you ignore this, here's why. The manufacturers tell you not to, in case some milk backflows and contaminates the pump. Honestly? I ignored this. I'm cheap and I trust the woman who shared her pump with me. I thought the odds of contamination were pretty small. My friend is healthy and monogamous and even if there was a tiny bit of contamination, I wasn't concerned that she was going to give Matthew anything. However, personal pumps are designed for only about 400 hours of use. So if a mom pumped a combined total of an hour a day, that pump motor would be exhausted in just over a year. In my case, my friend was a work outside the home mom, so I know her pump got more than an hour of use per day. So unless you know first hand that the pump had very little use, there is a possibility that your second-hand pump could just have lost its "umph" and sucking power. Your own pump that you bought new could have lost its umph if you've been breastfeeding a long time or on your second or more child.
2. Hospital grade pumps are more affordable than you think to rent. They run anywhere from $50-$70 per month and some offer discounts if you rent in blocks of time, like 3 months. That's not pocket change by any means, and I know it's hard to swallow when a personal pump is only $200ish to BUY, but if you're having supply issues, seriously consider it. It's certainly not any more expensive than buying a lot of formula (again, NOT knocking formula at all, but if you're going to have to spend the money either way and you WANT to keep nursing, at least consider renting a hospital pump). Some hospitals rent them, as do some lactation consultants, and mother-type stores. Call the hospital where you delivered or your midwife for a referral. There are some online vendors who do it, too. It's not just that these machines are stronger. Stronger/faster sucking isn't always better. It's also that they're more similar to a baby's suck, which stimulates your milk supply better. The hospital grade pumps run smoother, and allow for more combinations of speed and suction to figure out the best fit for you. Pumping isn't just about RETRIEVING milk. It's about telling your body to make more. Even if you're never away from your baby and never think you'll need stored milk, pump anyway if you're struggling with supply. Milk production is supply and demand. The more your body detects a request for milk, the more your body will make. The smoother function is also more comfortable on you, making it easier to pump more frequently, and less likely to cause you to give up because it hurts too much or because you're not seeing any results.
3. Pump both sides at the same time. I didn't think it made a difference if I pumped both at once, or one side, then the other. But, it does! It actually makes your body think you have twins--"Whoa! Two babies want to eat at the same time! I REALLY need to make more milk!"
4. Longer isn't always better. Neither is stronger/faster. You want to mimic a baby's habit as best you can. Babies don't suck at 80 sucks per minute for the entire feeding. They fast and shallow at first as they're stimulating and swallowing the let down. Then, they slow to long, slow, hard sucks and swallows. He may speed up again if you have another let down. Watch your baby and try to mimic his eating habits with your pump. The LC I saw yesterday said that pump for a while but when it slows to a dribble and then you get nothing for 2 minutes, stop. She said it's better to turn it off and wait for 10 minutes, then turn it on again for 10 minutes. She said it's called "power pumping." Pump 10 minutes, break 10 minutes. Pump 10 more, etc. Great to do while you're watching TV. She also suggested waiting 10-15 minutes after baby is done eating before you start pumping, rather than right after. I can't really explain it well, but somehow the starting of a "new" session sends a different message to the body than continual, endless pumping. DON'T stop a baby while he's eating (as long as he's getting milk and is hungry), but do consider these techniques when pumping to stimulate/retrieve supply.
5. Your supply can take a nose dive when baby starts sleeping longer. My dip in supply corresponds with when Matthew started sleeping between 8-12 hours a night. However, to keep your supply up, your breasts need to be stimulated 10-12 times per day. Sometimes, older babies just don't need/want to eat every 2 hours anymore. If you're up later than or before baby, pump right before you go to bed, or right after you wake up to get an extra session in. If you're not struggling with supply, these things may not be necessary, because your body adjusts to what the baby needs, and if the baby is sleeping through the night, he doesn't need the milk made during those sleeping hours, but if you do have supply issues, keeping your supply up around the clock is crucial so that your body doesn't back off production.
6. Try adding some galactagogue foods to your diet. My favorite, easiest one is oatmeal (not instant or quick oats). I make steel cut oats in my crockpot overnight and have them for breakfast. You can make Mama Jeeper's Lactation bars-bonus, they taste good! This recipe makes about 40 bars, so feel free to make in smaller batches. My friend Jess has had good luck in freezing them.
2 c. butter, Crisco, or margarine (can mix and match to equal 2 c.)
1 c. granulated sugar
2 c. packed brown sugar
1 Tbsp. vanilla extract
1 tsp. salt
2 tsp. baking soda
2 1/2 c. flour
1/2 c. wheat germ
1/4 c. brewer's yeast (not baking yeast) or nutritional yeast powder
1/4 c. flax meal (or whole flaxseed milled fine in a coffee grinder)
4 c. oatmeal (old fashioned, or as thick-cut as you can find)
1 bag mini semi sweet chocolate chips
1 c. nuts (optional)
Cream butter and sugars well, then add eggs and vanilla. Beat until well blended. Mix all dry ingredients (except for oats, chips, and nuts) in separate bowl. Combine the wet and dry ingredients all at once, stirring as well as possible by hand. Mix with beaters until smooth. Add oats and chips (and nuts, if desired), and stir until well blended. Divide dough into five parts.
Line a 10 X 7 cookie sheet (with shallow sides, like a jellyroll pan) with foil. Spray foil with nonstick spray. Spread 1/5 of the dough into the foil-lined pan and bake for 20 minutes at 350 degrees.
When done, simply lift out foil to remove the bars. Place another piece of foil into the pan and spray for the next batch. Allow to cool at least slightly before cutting each pan of bars into eighths.
7. Water, water, water. Divide your weight in half. Drink that number in ounces of water, every day.
8. Drink a lot of water right before you pump. I have to say I got this tip from Dr. Sears, so, milk fountains aside, that one helped!
9. Have skin to skin contact with your baby as much as possible. Skin to skin contact stimulates prolactin, which is what makes milk. Strip your baby down to his diaper when you feed him, and hold him against your bare chest/torso whenever possible.
10. Prime the pump often. Put the baby to the breast whenever you can, and pump in the off times. Especially with older babies, they may not ask to eat as often as you need to be stimulated. Try to squeeze in an extra session if you can. Especially in the summer heat, the extra hydration for baby is good anyway.
11. Don't rule out other issues like hormones, medications, and diet. Do you have diabetes, or PCOS, or some other endocrine issue? Talk to your endocrinologist or your RE, or even your OB if you're having issues. I linked to a great resource in my last post about PCOS and milk supply. You could do all of the things above and your body could still be working against you. Hormonal imbalances can affect your milk making hormones. Also check to see if any medications you're on could be impacting things. If you're not drinking enough water, or if you eating/drinking things that dehydrate you, that can affect you.
12. Consider supplements. Fenugreek is easily available (grocery stores, drug stores, etc sell it) and has been used for ages to help with milk supply. It makes you smell like maple syrup. Blessed Thistle, Nettle, and Fennel can help, too. You can try Motherlove's More Milk Plus or More Milk Special Blend products, which have all of these in one capsule or drop. My farmer's market grocery store sells it, as does the breastfeeding store, and Amazon.com. Check with a Lactation Consultant or your doctor before taking anything though--DON'T take my advice.
13. Look for help. There are free things. Your hospital might let you use their LC for free--every hospital is different. Watch youtube videos on proper latch, position, etc, if those are your problems. Try kellymom.com. Try La Leche. Try breastfeeding stores. Try breastfeeding support groups. I will say that as much as the breastfeeding activists can be extreme, they are passionate about it, and many are often willing to help you, even if they're a little too helpful or passionate ;) I just ordered this book--I'll let you know if it helps and I can post anything I find to be helpful. You can also hire a lactation consultant to do a private session with you. The going rate around here seems to be $60-$80ish for 1-2 hours, depending on the consultant. They might be less in your area, or if you do a session in her office or at a neutral location, rather than at your home.
14. Get help early on. I regret not getting help earlier. It's easier to keep a supply up, rather than reverse or improve a dwindling one. I wish I would have just gotten over my hangups with the extremists and sought help sooner.
15. Milk production hormones are highest in the early mornings, around 4:00am. If you're up then and can manage a few minutes of pumping, do so. If you're not, don't wake yourself up to do it. Sleep is important to milk production, too. But, just try to pump as often in the mornings as you can without exhausting yourself. The hormone drops throughout the day and is lowest around supper time, so don't be discouraged if evening nursing/pumping is harder. This is normal for EVERYONE.
16. If you're pregnant, ask to see the Lactation Consultant in the hospital when you deliver. They all have them, but each hospital only has 1-2, so by default, you'll just see a nurse who has a basic knowledge of nursing. You usually have to specifically request to see the LC. It's free while you're there. They'll probably say something like, "Oh, the nurse can help you." Politely request to see the LC anyway. :) Even if you think nursing is going great or you have no reason to suspect a problem, ask to see her. Professional help can't possibly hurt, and it ISN'T as simple as just sticking the baby on the boob, even if you don't have any supply problems. I asked every day was in the hospital. One day, they were too busy with day 1 moms, but I did get to see one the other 4 days. Pump in the hospital if you have the energy. First, you get to take home the pump parts you use (free!), so you don't have to buy them later. Even if you have a personal pump, if the hospital pump is the same brand, you can use the parts on your personal pump. And even if you rent a hospital grade pump, you have to buy the flanges and tubes and valves, so it's nice to get these things for free. If you have the space, even if you don't think you need them right away or at all, take them home and stick them in a closet and hang on to them until you're done nursing. Save yourself the money. But beyond that, pumping in the hospital just gives you the added time with that great resource for free. You can retrieve more colostrum (it was great the first time Matthew was sick--I pulled out a tube of his colostrum and gave it to him for the added antibodies) and it can encourage your milk to come in sooner. You can take home whatever you pump in the hospital. Breast milk keeps up to 8 days in the fridge and the hospital will refrigerate it for you. No sense in NOT pumping and bringing that milk home, if you have the energy, time, and physical comfort to squeeze in some sessions. Even if you never have any nursing issues, the freezer milk is nice to mix with baby's solids, to give you and DH a date out, to feed to baby in a bottle or cup if he's congested or his teeth are bothering him or he otherwise can't/won't suck. Take advantage of the free resource while you can!
17. Save your receipts! Check with your tax-preparer, but the woman who owns the store here that I mentioned said that under new legislation, breastfeeding supplies are now tax-deductible. If you have an FSA, you can rent/purchase your supplies with your FSA.
Ok, I think that's everything I can think of. I'm not an expert by any means, but those things have helped me in just under 2 weeks time. Several people have been offering to babysit DS so that DH and I could have a date. I haven't been able to take anyone up on it because of the supply issues--DS still eats every 2 hours (not really long enough for us to go anywhere if he eats at both the top and the bottom of the 2 hour window), and I had only 1 2.7oz tube left in the freezer that I wasn't willing to use except in an emergency, and I wasn't able to pump anything else. I now have about 9 precious ounces in the freezer and add a little more every day, plus I have enough to make Matthew's oatmeal with every day, too. A date with my DH might be in my future after all. :)