Susan,
I'm just wondering about the statement you make below of offering more
supplement than it is though needed and breastfeeding less frequently. I
can't understand how this would lead to weaning from supplements.

Something that I have seen with breastfeeding supplementers is that
sometimes women expect to be able to use them and automatically the amount
in them will decrease and they will increase their supply. This happens
sometimes but certainly cannot be relied upon. However, we know that more
breastfeeding/more emptying of the breast = more milk (I'm not convinced
that the prolactin receptors theory has enough evidence to be confident and
coming from a situation of looking at cases of relactation/induced lactation
I know that early stimulation isn't the be all and end all). So encouraging
more *effective* breastfeeding is important in my opinion, not less. Thus,
working to improve latch and suckling technique, maximising transfer from
the breast and encouraging breastfeeding without the supplementer as much as
possible would be things I would suggest. Consciously decreasing supplement
and carefully watching the baby are both things I would do.

Does this mum cosleep? Does she wear the child in a sling? is the baby
willing to suckle without the supplementer for comfort through the day and
night? We know that women in developing countries are much much better at
relactation/induced lactation than women in the West at milk production and
a lot of the reason for this is to do with how close they keep their babies
and how often they breastfeed, emulating their practices where possible
therefore is helpful.

A consistent problem with breastfeeding supplementers is that babies can get
hooked on them and refuse to breastfeed without them, not providing the flow
of milk immediately (ie stimulating the wait for MER), encouraging
breastfeeding without it (possible first morning feed) etc can help with
this.

If babe's suckling cannot be improved then pumping may be necessary but
coming a less gagetised locality, more breastfeeding is something I would
see as being more important.

It sounds like this mum may be supplementing long term and so encouraging
her in the amazing stuff that is happening between her and her baby as she
breastfeeds may be something that helps her to continue with the hassle of a
breastfeeding supplementer. Breastfeeding is way more than the provision of
nutrition, in fact I would almost go so far as to say that that is only 1/3
of the story. Encouraging her that some women do use them long term and do
get very good at using them and that eventually she will be able to
breastfeed without it (if her child does not become addicted).

Karleen Gribble
Australia

> The first thing I would do is explore why she is needing to nurse 12x/day
> with the SNS.  Usually with the SNS, infants only need to nurse 8x/day.
> Having worked with many women and the SNS, I have NEVER known a woman who
> could manage to use the thing 12x/day.  No wonder the woman is asking how
> long this will last. The questions that come to mind are:
>
> 1) Is trying to limit the supplement in the hopes that the baby will start
> taking more from the breast?  Who could possibly blame her for hoping that
> would happen, but I guarantee that this approach has NEVER worked and
often
> backfired. If the baby isn't finishing a feeding, then the baby would be
> waking sooner and the mom is only succeeding in exhausting herself and
> possibly the baby.
>
> 2) Is the baby tiring out on the breast, when the mother puts the baby
back
> to the breast without the SNS? Again, who can blame her when she puts the
> SNS on 12x/day, finds that it is drained and doesn't have the energy to
> refill it. We find that babies typically do their less effective feeding
at
> the end when they're tired and actually need MORE supply. Letting the baby
> tired out on the breast by ineffectively sucking, can lead to the baby
> waking up earlier.
>
> Now, I'm all for frequent feeding in more normal breastfeeding
> circumstances, but this woman needs all the help she can get to simplify
> her routine and cut out the unnecessary steps.  I would HIGHLY recommend
> that she put in MORE formula than she thinks the baby needs.  We typically
> find that limiting supplement in any way limits progress because the baby
> usually is less vigorous at the breast at the next feeding.
>

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