This does not sound like oversupply at all, but like infrequent milk
removal leading to engorgement.  Pumping only every 4-6 hours while
using formula on day 4 and 5 can certainly hurt a developing milk supply.

I would encourage this mom to breastfeed much more often than every 3
hours, take the baby for another weight check (she should be gaining
about 6-8 oz per week by now), and pump only if she needs to make more
milk and the baby is not nursing well.  Pump in Style would not be my
first choice of pump if there truly is low supply.

As for pumping,  every three hours is a guideline that works out to 8
times a day.  Research on pumping to bring in and maintain a supply for
preterm infants shows that the number 8 is the important one.  Women who
pumped 7-9 times a day made adequate milk supplies, women who pumped
less usually did not.  It is far more helpful to tell mothers who really
need to pump (when their baby is not latching) to pump 8 times in 24
hours, but that they do not need to be evenly spaced, within reason.
You need to be clear about why a mom is pumping in order to give her
good guidelines about how often to pump.  A case of true oversupply
would be managed with gradual increase in the amount of time spent
offering one breast, leaving the other fuller for gradually increasing
periods of time, not by pumping.  Early postpartum engorgement, on the
other hand, is managed by frequent pumping until the breasts are totally
comfortable, or the baby can latch and remove milk, whichever comes
first.  There are always exceptions, and that is what makes the
difference between the novice and the expert, the former follows rules,
and the latter is able to weigh all the clinical and psychosocial issues
and make individualized recommendations.

Warm compresses are a waste of time, they don't help engorgement, and
don't help milk ejection.  We do not want to be reducing milk supply at
this juncture, especially when the baby has not gained well.  Mom needs
to be sure of the diaper count.  I often tell them to put out 2 plastic
bags in the morning, one for wet and one for soiled diapers.  Soiled
ones count as wet as well.  Then they are to count the diapers in the
soiled bag the next morning around the same time.  Normal for 2 weeks
postpartum is 5-8 stools per day, light to medium yellow in color (like
yellow mustard), at least the size of a quarter (US) coin each.  One apt
description for our geographical area is "French's yellow mustard with
cottage cheese curds".  Most parents can picture that and describe any
variations from that expectation.

Your info on watching for feeding cues was good, but eye movements are
really a sign of REM sleep, which is the lightest stage of sleep and
easiest time to wake baby, not really a feeding cue.  Feeding cues
include mouth movements, bringing hands toward mouth, rooting.  If the
baby is running out of energy reserves, she might not have the strength
to bring the supply back up on her own.

This mom and baby should definately be assessed in person, by an IBCLC.
Glad you referred her to one.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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