Old recap:
<<You'll recall that 5 June, I travelled from Atlanta to Birmingham, AL
> to help my dh's cousin with her new baby.....snip....BFAR......after going from 7#8 to 6#14,  Weekly
> gains week 3, 4, 5 and 6  were all appropriate at 9,6,8,4.5 oz.  Ped
> was very concerned about the 4.5 oz; parents called me.
>
>  Week 7 update:
> ~gained 5.5 oz
> ~continues to exceed developmental milestones
> ~appropriate gains in length and head circumference
> ~alert, aware, smiling
> Mom has supplemented an ounce of EBM occasionally in the afternooon -
> usually just once a day.  Other times, she doesn't supplement, just
> nurses and nurses for the better part of 11 hours from noon to 11 pm......snip........
>Because her supply is so incredibly abundant
> in the am, it's clear that the extremely low afternoon supply is
> normal physiology (lower prolactin levels) complicated by the days of
> the baby nurse (recall the strict four hour feed/nap schedule) and
> that the reduction, in this case, does seem to be the 'red herring'
> (as I think Rachel stated).
>
> She is continuning to let baby sleep 11 pm-5 am since baby is gaining
> well.   We have talked about working with physiology (ie nursing more
> at night and early am when prolactin levels and therefore milk
> production, are highest).  I do understand her position though that
> she's so grateful for the sleep.  At this point, she'd rather get up
> and pump, using that milk to supplement later in the day if needed.>>


AND for the new info:

~the teary call came;/, the worry, the fear
~the baby decided to sleep for an extra hour several nights in a row -
getting 7 hours of sleep.  8 weeks old.  no CIO.  in a crib 12 inches
from mom.  and mom with a tenuous supply anyway.
~as expected extra nighttime sleep didn't do anything good for overall
milk output, intake or growth
~3.5 oz gain, though still excl in all other areas
~working really really hard though for milk.  saw someone in b-ham to
do some test weights in the afternoon.  it wasn't good.... 7g in 35
minutes was the best of the lot.....  all others were lower.   Taken
in context with the the baby's behavior, it all fits.

Skipping the long drawn out details, I strongly encouraged her to feed
the baby at night. She asked if she could just pump, that she felt it
was selfish of her to wake the a baby who was sleeping so well.    We
talked about biological appropriateness and how that interacts with
baby's needs, moms needs, prolactin levels, night feeds etc and she
came away with a decision to go ahead and do it.

She also will supplement in the afternoon at the breast using the lact-aid.

At this point, I'm still unwilling to accept that she has reached
maximum production simply b/c that exceptionally long night is not
biologically appropriate and is likely impacting prolactin levels
overall.

Otoh, there is this little voice in the back of my head saying
'Katherine, she nurses that baby literally *nonstop* from noon until
11 pm, during which time the baby isn't  getting quite what she needs
and that hasn't improved in two weeks of skin to skin, excellent
latch, breast compression."  then the other voice replies 'yes, but
some mom's are exceptionally sensitive to lack of nighttime feeds and
with the reduction, and the early poor start and infrequent feeds,  an
interval of 5h, let alone 6 or 7 is just too much."  In the am, she's
had feeds with weights 90g-105g fairly regularly before noon.   Okay,
so she has good storage capacity- if not sufficient alveoli to for a
full supply now that baby is bigger?

At this point I'm still thinking that night feeds have the potential
to boost overall production which will have a positive effect on the
afternoons and that there is hope still.   Feedback?

She won't take domperidone.  She and her dh read the wikipedia and
that was that.  No further info has been able to allay the concerns
cemented by that article.

Interested in any additional thoughts on a timeline, when you know
it's still worth trying to improve, when it's worth accepting that a
mom has reached her own maximum supply?

Katherine

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