Hello
Since your baby was accustomed to bottle feeding in the initial few days of life, it will take some time for him to get acclimatized to exclusive breast feeding. Please be patient, and do not give up your efforts, meanwhile here are a few points to help you along :

1. Your baby won’t drink breastmilk appropriately when she is sleepy or shortly after she wakes up. Time the feeds properly.

2. Inability to latch on - There is a possibility that your baby isn’t positioned properly or she isn’t latching on appropriately, particularly as it was bottle fed initially. Please learn the proper technique from a trained midwife / nurse.

3. Poor physical condition of the baby - Constipation, insufficient burping, stuffy nose, fever, temporary bad health, inability to relax , allergies, some anatomical defect etc.

4. Problems with breasts and nipples
(a) The nipple is inverted or flattened
There are several methods that can be used. Moms can use a method called “reverse pressure softening”--a technique in which a mom can use her fingers to gently soften the circle around her nipple and areola. Alternatively, a mom can use a nipple puller to evert the nipple using gentle suction.
・If the nipple is flattened because of breast engorgement, a little milk expression makes the breast softer and makes it easier for your baby to latch on. Be sure that production of breastmilk from both breasts is stable.
(b) Engorgement（engorgement of one breast makes it difficult for your baby to latch on）
When one breast is so engorged that it's hard for your baby to latch on
Method of coping:If the nipple is flattened because of breast engorgement, a little milk expression makes the breast softer and makes it easier for your baby to latch on. Be sure that production of breastmilk from both breasts is stable.

5. Impatience due to insufficiency （pressure to product breastmilk）, mental fatigue caused by stress, etc. Both you and your baby need to be relaxed.
The mother’s ability to relax is the most important factor in the baby being able to latch on comfortably. If your baby is agitated, relax her by taking a walk in a park or by holding her tightly in your arms. Meanwhile, do not stress out about exclusive breastfeeding. It is a natural phenomenon, and WILL happen, stress will only produce negative hormones.

The baby's appearance, how the baby drinks breastmilk, the amount and frequency of urine and stool output and the baby's body weight are indicators of whether enough breastmilk is being produced. Most mothers " feel " that they do not produce enough breastmilk, only rarely is this the case.

1. Stress is the main culprit as I pointed out. Relax and take it easy.
2. Hormonal disorders such as thyroid or pituitary imbalances or retained placental fragments can cause problems. Many mothers find that their supply goes down when they have a cold, or when they return to work.
3. If your nipples are very sore, pain may inhibit your letdown reflex, and you may also tend to delay feedings because they are so unpleasant. Use an ointment like Nipcare. Breast milk itself is a great emollient for sore nipples.
4. Rarely, some drugs you might be taking, or surgery you have had affects breast milk production.

Take care of yourself. Try to eat well and drink enough fluids. You don’t need to force fluids – if you are drinking enough to keep your urine clear, and you aren’t constipated, then you’re probably getting enough. Drink to thirst, usually 6-8 glasses a day. Your diet doesn’t have to be perfect, but you do need to eat enough to keep yourself from being tired all the time. It is easy to get so overwhelmed with baby care that you forget to eat and drink enough. Don’t try to diet while you are nursing, especially in the beginning while you are establishing your supply. Nurse frequently for as long as your baby will nurse. Try to get in a minimum of 8 feedings in 24 hours, and more if possible. Offer both breasts at each feeding. Try “switch nursing”. Try massaging the breast gently as you nurse. This can help the XXXXXXX higher calorie hindmilk let down more efficiently. Consider renting a hospital-grade breast pump for a few days, unless you have a good quality double pump at home. Hospital grade pumps have stronger, more powerful motors, and are the most efficient pumps you can use. They are bigger and heavier, so they aren’t as portable as other pumps. The best way to increase your supply is to double pump for 5-10 minutes after you nurse your baby, or a least 8 times in 24 hours. Try to set the pump on maximum unless your nipples are very sore. Most pumps work better on the higher suction settings.

There are certain food supplements that may increase your milk supply. Before using any of these, it is important to consult your doctor and the paediatrician as many marketed " lactogogues " are pointless and ineffective. If all other methods of increasing milk production haven’t worked, there are two prescription medications available that may be used to increase milk supply: Metroclopromide and domperidone. Studies have shown an increase of 66 to 100% in milk production, depending on the dose given and how much milk the mother was producing before taking these medications.

If you are one of those women who fall into the very small group of those who can’t produce enough milk no matter what you do, you can always combine breast and formula feedings. Any amount of breastmilk that your baby receives provides nutritional and immunological benefits and the special closeness that you feel while nursing your baby is not dependent on how many times a day he nurses, or how much milk you produce.

All the best and enjoy your motherhood !
Feel free to ask for further clarifications.

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Hi,
Thanks for getting back.
You first need to treat the sore nipple on the left side ,before pumping from that side.
Please do go for a lactation consultation. I advised Nipcare cream for the sore nipple, as well as applying breast milk on it locally, but if the problem is severe, and you are seeing blood, then you need to show it to a Specialist.
Yes, as long as the stools are soft, it does not indicate constipation. However, following up your child with a paediatrician at regular intervals for a check up is always a good ideal.
Please do not stop taking medication for hypothyroidism, as it is one of the leading factors affecting breast milk supply, your mood, bowel movement etc.
As I mentioned, new mothers tend to neglect themselves as far as food, diet, hydration, medication and exercise is concerned.
Please take time out for yourself in order to give the best output to your baby.
Get your recent thyroid levels checked and please restart medication accordingly after consultation .
Do take adequate iron, calcium, protein and Vitamin D supplements, as breastfeeding is a more demanding situation for your body than even pregnancy.
Take care.

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Hi,
Of course, with proper lactation consultation , and ironing out of the minor problems, you will gradually be able to lactate normally..
It is not too late to train your child to breasfeed.
Also, do not give in to the stress, particularly imposed by other family members, since ultimately its the bonding between you and your child that matters.
Please take the requisite measures as early as possible, so that once the situation improves, you will get more motivated to breastfeed your child.
All the best.

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