Pumping humor.

This has totally happened to me. And I really did cry. After I yelled at someone and cursed the universe.

My milk supply is dropping. What can I do?

Here are some recent tips from group members:

• Pumping is supply and demand. Try increasing the time you pump, even if you don't seem to be producing more milk immediately; you should see results in a couple of days. 
• Also try increasing how many times you pump per day. You may be able to cut down again once your supply is established.
• Make sure you have the right size horns for your pump. A lactation consultant can help you determine if yours are the right size.
• You may also try fenugreek supplements or lactation tea to help boost your supply.
• Drink lots of water!
• Try to relax as you pump.

Pumping Tips

Here are some tips that one of the pros at Primary's on pumping gave for one mom:

• To begin with, if the pumping is painful, something is probably wrong.
• Over 50% of the time, it is that the flange size is incorrect.
• Medela and Ameda both have several flange sizes. A good website for mom to look up is ameda.com which shows a short video of a mom pumping and how it should look if the flange size is correct.
• The other possibility is that this mom is using a small electric pump that is meant only to be used a few times per day. She really needs to rent a hospital grade electric pump. This will be more comfortable for her and also much quicker.
• Milk is made on supply and demand.
• Most mom's need to pump at least 6 times/24 hours to have enough milk.
• Decreasing to only 2 - 3 times/24 hours will significantly decrease production most likely to less than 50% of the need.
• Mom's goal for total production should be 24 ounces/day when baby is 2 weeks old and should be ~30 - 32 ounces per day when her baby is a month old.
• Mom's milk is made perfect regardless of how much stress she is under. The problem with stress is that it impacts production resulting in less milk. Hope that helps!

And some more tips:

• More suction doesn't always equal more milk; it may just make you sore, resulting in less milk. Keep the suction at a comfortable level; you may want to start low, then increase it slightly once milk starts flowing.
• You may also want to try varying the pumping speed rather than the suction if your pump has that capability.
• Drink lots of water and get plenty of calories and nutrition! Like stress, lack of nutrition won't significantly decrease the quality of your milk, but it will decrease the quantity you produce. Breastfeeding/pumping can burn 200-600 calories per day (depending on who you ask).
• There are great tips and guidelines on the Ameda website for mothers who exclusively pump here.
• There are also tips from Dr. Sears here, including tips on massaging prior to and during pumping. I have found this to be really helpful in producing more milk.
  
• There isn't always something wrong if pumping is painful, particularly at first. Breastfeeding is generally uncomfortable at the start, and pumping is no different. However, if it continues to be really painful for an extended time period, then some adjustments may be helpful.
• Have your baby sit with you while you are pumping; it can help you to produce more. I used to feed my baby while pumping - it was more efficient, I was more likely to pump as much as he needed, and it helped my let-down.
• Figure out a way to pump hands-free. They sell bands that hold up the horns online, but they are a bit pricey. You can also try cutting slits in the front of a sports bra, or just propping the horns in your regular bra by pulling the cups up over the bottom of the horn and pulling your shirt down over the top. This way you can hold your baby or do other multi-tasking that helps the time to go by.
• Have snacks, water, etc. on hand at your pumping "station." Make it a relaxing spot.
• Get an extra set of horns so that you don't have to clean them as often. You can also put them in the refrigerator between pumpings to reduce washings (since the milk on the horns will stay good in the fridge).
• Some women take Fenugreek supplements to increase their milk supply. They are available at health stores like GNC. You may want to ask a lactation consultant about it.
• You may also use a little bit of vegetable oil to lubricate the horns and reduce irritation; creams like Lansinoh are often not smooth enough.
  
• There is also a Yahoo! group here for mothers who pump exclusively for medical reasons.

I'm sure there is more wisdom out there, and I'll add more tips as I come across them!

One final note: if you are in the beginning stages, be encouraged! It's not easy, but it can be done, and you may find that it gets easier with time. My son is 9 months old now and eats 5 times a day, and I have been able to cut down to 4 pumpings a day and haven't had to supplement with formula. I tried to mimick nature and decreased my pumpings as he spread out his feedings. That being said, if you aren't able to pump for your baby, don't let yourself feel guilty about it! Everyone's circumstances and bodies are different. It is easier for some than others, and with a baby with special needs, you have enough stress on your plate! Plenty of babies thrive on formula. I think that I have had it relatively easy, but even so I have been tempted to quit many, many times. And if I have another baby with a cleft, I don't know if I'll be able to pump like I did for my first; we'll have to see what our circumstances and my sanity are like then.

Will I be able to breastfeed after surgery?

The answer to this isn't particularly clear. Some babies with clefts are able to breastfeed from the beginning, particularly if the cleft only affects the lip. And a few babies are able to gain suction after a full or partial repair, but often the combination of little to no suction due to the cleft and having chewed a bottle to get milk rather than suck makes it difficult for babies to transition to breastfeeding. Here are a few comments from parents that were posted to the group:

"I also had high hopes for breastfeeding after the first surgery. However, [my baby] was just so used to basically a chewing like motion with his feedings that he was unable to suck at all. Dr. Warnock explained that some babies are able to breastfeed if your letdown is powerful, but you would likely still need to pump in order to get the hind-milk since suction is needed for that. I felt that it was just too frustrating for him and me that it interfered with the process. Every situation is different so I encourage you to give it a try."

"I think that if you want to give it a try, then you totally should!  I would contact a Le Leche League person, to help you have the best chance possible.  However, I do know that after my son had the hard and soft palate fixed (about 1yr old) he was still not able to even use a normal sippy cup.  It is not just the fact that the holes are all gone... it's also an issue of these kids not using the muscles in the soft palate... so it takes a while for them to learn to use them and to have the normal sucking strength.  So, it may take you longer, but if it is something you really want to do, then  you should go for it!"

"I think that if your baby's cleft is small enough and the prosthesis seals off the cleft, you might be able breastfeed. Medela makes a Supplemental Nursing System that you could try. It enables babies to feed at the breast before they know how to suck by giving them either expressed milk or formula through a device that is hooked up to you. It might be a good way to try to see if your baby can suck without starving him or losing your milk supply. I read an article once about a woman whose baby's palate was completely repaired at 6 or 7 months and she used this until her baby mastered sucking."
 

Milk Money

I was reading some random site online like I like to do, and saw several people mention that they spend about $120 a month on baby formula. So I proudly announced to my husband that by pumping I was saving us $120 a month. Being the numbers man that he is, he of course had to spoil it by figuring out how much per hour I was "making" by pumping. Six times a day, times about half an hour each time for the whole ordeal, times 30 days a month... Turns out I am "making" $1.33 per hour. Awesome.