HI Kathy,
I wanted to add a few more observations and comments.  You state that the
baby only prefers the larger tube.  What happens if mom tries the smaller tube?
Where is the bottom of the SNS?  Is it at the level of the baby's mouth?
Have you tried to lower it?
I agree that using the SNS 12 times a day is more than she needs to do and
way too much work.  Some suggestions would be to not use it more than every 3-4
hours, so if the baby wants to nurse prior to that time to just go to the bare
breast.  Also if mom is feeling fuller to not open the SNS and note how well
the baby nurses.  If the baby shows active signs of swallowing, then leave SNS
off for that feeding.
If the baby is improving on milk transfer and mom is increasing her supply
then I would suggest she not pump or keep it at twice a day if that is
manageable.  Next, ask her how much longer she is willing to continue this care plan.
If a date is set  by her, then you both can meet just prior to the date and
evaluate where she is.  If she is close to her goal, she may extend this date
but now this is on her terms.  I find with the SNS if short term goals and dates
are set to reevaluate, that moms feel more willing to keep working with the
devise.  Having her use galactagogues would be a good idea.
She should be praised for all her hard work.
Ann Perry RN, IBCLC
Boston, MA

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