Breastfeeding Resources

My problem started about six or eight weeks after I went back to work, when Aaron was about four months old. The day care providers were using frozen milk to supplement what I brought. Whereas I had been pumping 10-12 ounces a day, now I only got 7-9 ounces. I don't think it was every day, and it took me a while to realize there was a definite trend. I was starting to wonder what to do about this when I opened the freezer and there was no stash--I hadn't even monitored how much we were going through.

I'm pretty sure the cause was stress. My sister got very ill at the beginning of September and it was weeks before we knew what her prognosis would be. All my extra time was spent at the hospital, or feeling like I should be there.

I read a lot of articles to figure out what to do. Skip to the end if you want the quick answer on what I think helped most. Here's what I did:

Take More Milk Plus. Taking the herbal supplement More Milk Plus was helpful when I was building supply in the weeks after Aaron was born. It was hard to remember to take it consistently, and I don't think it worked this time.
Relax while pumping. Maybe the stress of work was creeping into pump time, especially if I kept working on the computer while pumping. I stopped working, turned on music, played a game, read about breastfeeding, looked at photos. I don't think this was helpful, and eventually added to my stress because I wasn't getting enough work done during the day.
Engage a lactation consultant. It was nice to talk with someone who took the problem as seriously as I did. She brainstormed with me and was the one who suggested the things that worked best. In the second consult, I reported back on some suggestions and got more.
Take a power pump day. One day at work, I pumped as often as I could. The lactation consultant suggested, do what the baby would do: put in an order for more milk. I got more milk that day (which was unexpected) and the next. The third day was my day off, and the fourth day the output was back down. That made my lactation consultant wonder if the baby "right sized" my production back down, and really started me down the path of thinking, maybe this isn't me. Maybe it's how Aaron's being fed.
Find a way to relax. I thought about my problem all the time. I worked myself into a endless frenzy over it. By Fridays, when the underproduction was clearest, I was a mess. I knew I needed to get more milk, so I started pumping at home whenever it made sense--an hour or two after Aaron went to bed for the night, once in the middle of the night if he fell asleep before the second side. I built up my freezer stash so I didn't feel on the edge of not being able to feed my child at all. It wasn't even that much, less than ten ounces total, and once I got there I stopped the extra sessions. But it helped me relax tremendously.
Talk with my day care providers. Finally I decided I needed to have an in-depth talk with my day care providers. I had been telling them to "feed less", to make sure Aaron was hungry before feeding. But in this conversation, I said that I was having trouble keeping up with the demand, and I needed their help in tackling this. I felt awkward about talking about pumping with my dcp who formula-fed her kids. I told her I knew he'd be fine if he had formula, but that it was hard to change course when I had worked so hard to breastfeed Aaron all along. She pointed out that her 2-year-old was fine as a formula-fed baby. Arg. The conversation wasn't entirely satisfying, but I felt better with her knowing that I needed her help. And I mandated no more than three ounces in each feeding.
Check pump pressure & fit of valves. Just to be sure, I brought my Pump-In-Style in to the store to have the pressure tested. It was fine. I examined the white plastic valves to make sure they were tight enough. They were.
Feed closer to day care drop off. I appealed to the community on the breastfeeding & working group on Yahoo, and one woman had a suggestion that really clicked: feed Aaron when I drop him off at day care. It dawned on me, the difference between a good day and an undersupply day is one feeding. If Aaron ate three times a day, he'd take 9 ounces. If he ate four times, he'd take 12 ounces. So how could I minimize the chance of him eating four times? Feed him as close to when I left him as possible. If he woke at 6:30, I used to feed him at 6:30 and then drop him off at 7:30 or 8:00. Now, I feed him at 6:30 and again at 7:30 or 8:00 (at my house--still don't feel great about doing it at the dcp's house). And I leave work as soon as I can at 5:00, and work for a little at home in the evening if I have to.
Use a different pump. The last thing I tried was switching to a different pump, a Medela Symphony, which is a rental. The lactation consultant said that the PIS and the Symphony have different sucking profiles which different people react to differently. And it was certainly true for me. I saw a difference right away. And I was able to pump faster--15 minutes instead of 25.

Things have been going well for three weeks. I think the biggest factors were the power pump day, building the freezer stash so I could relax, feeding as late in the morning as possible, and switching pumps. But everyone's different. I think the biggest lesson is that I had to try a bunch of things over the course of six weeks to figure this out. But I did. And things are going well now. I get 9-10 ounces in three pumping sessions at work now. And that almost always covers Aaron's needs.