It’s been three days since your baby’s relatively uncomplicated delivery. Your nipples are extremely sore, bleeding and cracked. But, the nurses at the hospital told you it was fine. You notice your baby isn’t stooling much, but figure maybe he is just taking his time. When you go to your one week checkup, your baby is not gaining any weight. In fact your baby has lost over 10%. The doctor might say, “He needs a bit of supplemental formula, in order to gain weight.” You go obediently to the store and purchase the formula your doctor recommends and begin the supplementation plan in which you and your doctor feel comfortable, aided by your breastfeeding counselor. It’s a difficult process, but with support and education, after a few weeks your baby is on a good gaining trend. Now what? You might worry that you will ever get your milk supply back if that was the problem, and wonder about weaning baby off formula.
Weaning Baby Off Formula – the Safe Way
This is a very familiar story for many women. Your details might be slightly different, but rest assured, in many cases, rebuilding your milk supply and weaning off of supplements is usually possible. In a biologically typical woman with a term healthy infant, as long as baby can adequately remove milk from your breasts, you can wean off of supplements slowly, over time.
The first thing to do, if you haven’t already been tracking, is to write down a three-day journal of how much supplement your baby gets over a 24 hour period. This includes any pumped milk your baby gets. There are two schools of thought in regards to supplementation weaning. One says to reduce supplementation very slowly over time until your body catches up. The other says to pump and nurse in addition to your supplements to tell your body to make more, which will cause the baby to take less supplement.
Reduce supplements gradually first.
Start by reducing the supplement by very small increments over the course of an entire day. Try reducing supplement by one ounce total. So if your baby gets 11 ounces supplement in a 24 hour period, try giving 10 ounces each 24 hours, for the next three day period. If baby is doing well, decrease your supplement amount by another one ounce, so that it is nine ounces in a 24 hour period for the next three day period. Waiting to reduce the supplement amount every three days gives your body time to make more milk and catch up to your baby’s needs.
Increase milk supply first and have baby reduce supplements on his own.
You can increase your supply simply by removing more milk. You can do this by adding in pumping sessions into your day. If your baby nurses every 2-3 hours, you can pump in between sessions. You can also pump during the early morning hours of 1am-6am as your prolactin levels are the highest during this period. Do your best to pump both breasts if you can as this will stimulate milk to increase at a faster rate than just pumping one side, although any extra milk removal is moving in a great direction of supply increase! Pump as often as you are able to do so, but at a minimum aim for 2-4 sessions. You can give your baby pumped milk instead of supplement if you would like, watching your baby and baby’s weight gain.
Here are some resources for picking out the right pump. If you need tips on how to actually pump, check out this article here on Breastfeeding Place! Use olive oil or coconut oil to lube your breasts and nipple and pump flanges so you can reduce painful chafing. Also, if you cannot access a good breast pump due to financial constraints, consider applying for WIC since most offices provide a hospital grade double electric pump to moms that meet the financial requirements. And finally, consider hand expression. Here is a video demonstration using the Marmet Technique.
Evaluate – are your techniques to increase supply effective?
Make sure you are getting frequent, as in every 3-7 days, weight checks to make sure baby is continuing to gain. Per the World Health Organization, if your baby is 0-4 months, you’re looking to see about an ounce a day, or 5.5-8.5 ounces a week. If your baby is 4-6 months, expect 3.25-4.5 ounces a week, and if your baby is 6-12 months old, the range is 1.75-2.75 ounces a week. Remember, where your baby is on the growth charts isn’t as important as your baby staying on his own curve, whether that is a 5% curve or a 95% curve.
Ask – is there anything else I can do?
If you are reducing supplements and/or pumping frequently and effectively, but still haven’t quite met your baby’s needs, and, it has been determined that the baby is not being unintentionally overfed, consider the use of galactagogues. Galactagogues are simply herbs or medications that increase milk supply. Here is a great article by one of our authors about their use.
Two popular medications are domperidone or reglan. Speak with your doctor about their use. Domperidone is not FDA approved, but can be prescribed by your doctor and filled by your pharmacist at a compounding pharmacy. Many people order it online at pharmacies in the Netherlands or Canada. Reglan has also been shown to increase milk supply but can come with some potentially difficult side effects. Your doctor can go over the use of these medications in your particular situation.
The final piece of information is the length of time it can take to do this. This will depend on several factors: how much supplement you are currently using, how often you can pump, how often you nurse, how frequently you can reduce supplement without jeopardizing the baby’s weight gain, and if you decide to use galactagogues in addition to your pumping and/or supplement reduction technique. What you may find is that with dedication and persistence, over 1-3 weeks, give or take, you will see the changes you would like to see. At the very least, you can reduce supplement almost entirely if not completely.
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