Adventures in B-Feeding: Supply and Demand

Just a few weeks ago I was patting myself on the back for breastfeeding for almost 6 months. And then just a week after that I was mentally beating myself up for the last 6 months. All because Brighton was initially diagnosed as being potentially too skinny for her age at her 6 month wellness appointment.

Brighton is a breastfed baby. No formula. Just milk and two meals of oatmeal or fruit or pureed veggies. And she was labeled "too skinny" because of it. Because of me. Because of my milk and the food I fed her. The guilt I felt was so intense I barely slept for two days.

At her 6 month appointment, Brighton weighed in at 13 pounds 7 ounces. She had gained a little less than a pound in 4 months. She had grown an inch in length and continued to be in the 90th percentiles for height, but had dropped off the weight chart from the 50th percentile at birth to the 30th to the 25th and was now down to the 10th.

As the nurse logged her head circumference, height and weight into her file, she made one of those under the breath noises you hate to hear - the "hiss" sound that translates into "uh-ho". And then our pediatrician made the same sound when she read the number. Then a barrage of questions started: How often do you nurse in a 24 hour period? On one side, or both sides? For how long? When you work how many ounces does she drink per bottle? How much solid food does she eat?

- Brighton nursed 5-6 times in a 24 hour period.
- For the last 3 months had only ever nursed on one side at each feeding. Every time I offered her the other breast she would refuse me. So for almost 3 months she had alternated sides at each feeding. I never thought anything of it because she never acted like she wanted more.
- She also got faster and faster at eating and was down to 6-8 minutes for a nursing session (on one side).
- When I went back to work, I put 4 ounces of milk in each bottle and most of the time she would drink all of it, but there would be days when she would only take 3.5 ounces.
- She had 2 solid food meals a day - one mid-morning and one around 5pm. Each one was 4-5 tablespoons of food.

The last question the doctor asked me was this: How much are you pumping and how many ounces of milk are you getting each time you pump?

This is when I felt tears welling up in my eyes. I was only getting 1-2 ounces total each time I pumped. I knew my supply was dropping. I knew that eventually I was going to have to supplement with formula if something didn't change. I tried not to worry about it. I tried to listen to all the advice that told me my pumping output had nothing to do with my overall supply - maybe my body just didn't respond to the pump well. I had even made a lactation consultant appointment the week after Brighton's 6 month appointment because I wanted to make sure I was doing everything I could to keep my supply in tact.

So Brighton was cautiously deemed "too small" for her height and age. She was in the 10th percentile on the WHO chart for breastfed babies and while her doctor said she could potentially just be a super skinny and tall kid, she wanted to explore everything before she decided that was the case.

I spent the next few days in a constant state of worry over Brighton's eating. I went to my lactation consultant appointment and after weighing her before and after, we realized she was only getting about 4 ounces from me, even when she nursed on both sides for as long as she liked.

My supply had dropped. The fact that Brighton had only been nursing on one side each time made it drop. Going back to work made it drop. My stress about being away from her made it drop.

As my sweet LC told me this news, I started crying. I know it seems silly to feel such emotion over breastfeeding, but I felt I had failed my daughter. She was eating just enough to take the edge off of her hunger and because I wasn't able to provide her more milk when she nursed, she didn't attempt to nurse more.

After the tears and the questions, we decided to take a swift course of action. I was to call my OB-GYN and get a prescription for Reglan, which is a drug for gastrointestinal reflux, but a side effect of taking it is an increase in the production of prolactin. I also was to start taking More Milk Plus, make Brighton nurse on both breasts each time for at least 10 minutes on whichever side she starts, and increase her bottles from 4 ounces to 6 ounces. I had a friend who had weaned her daughter give me all her leftover frozen milk so I could use it to feed Brighton while I pumped and built my own freezer stash back up.

So we began. Brighton was initially reluctant to nurse on both sides, but I kept at it until it became our routine. We increased her bottles and after a few days, she started drinking 6 ounces each time. I added liquid formula to her solid food meals to add more calories. After a week, I started pumping 4 ounces each time I pumped. My supply had increased. She was eating more. Nursing more.

This past Monday I took her back to the pediatrician. She wanted to see how my supply was doing, how much Brighton weighed and talk through the next steps. She was weighed and the nurse made that noise again. The "uh-oh" hiss.

She had only gained 5 ounces in almost 3 weeks. Only 5 ounces. She was taking in 30 ounces of milk a day, eating more solid food fortified with fatty filled formula and it didn't seem to make much of a difference.

Her doctor still wants to keep watch on her weight, but is leaning heavily on her original theory - Brighton is a skinny and tall kid. Her dad is a skinny and tall guy. Her mama is not skinny or tall, but I was on the smaller side as a kid. She eats enough. She is hitting all of her developmental milestones. She never stops moving. She is fine.

I still worry though. I still get sensitive every time someone picks her up and says, "Wow she's so light!" or "Are you sure you feed her enough?" I still feel guilty for all the months she wasn't getting enough from me. I think about milk supply more than I should. I count every ounce of milk Brighton drinks, every tablespoon of food she eats, every minute she nurses. I count and worry, and count and worry, and then when my mind is spinning out of control, I try to remember that she is just fine.

But I've started to research organic formula just in case...