Jennifer Sokolow asks "Did I do enough?", but I would say she is asking the wrong question.  The more important question is "Is this mother really receptive?".  Jennifer herself already acknowledged that it is tricky to advise a friend. 

The baby is almost 10% below birth weight at a day shy of 2 weeks. At 4 or 5 days of age, I would make similar suggestion sto Jennifers such as keeping the baby in close proximity at all times, watching for and responding to the slightest signs of stirring, and lots of breast switching (provided the baby really perked up when switched).  And I'd wait a few days before reweighing this baby.  

In my experience in the New York City environment (not Australia or Norway!!), I RARELY see babies that have lost this much and stalled in their growth for a week pull out of this situation.  The moms who have managed to do it are the extremely dedicated first time moms who virtually feed all day.  Even most of these don't pull out of it well -- often the baby struggles for weeks.  With a fourth time mom -- with positional challenges and a potential tongue tie I am doubtful that this situation will be rectified without expressing extra milk for this baby.  4 ounces a week is not going to be enough to help this baby back to where this baby should have been.  The baby most likely needs to rebound.  And the baby is unlikely to rebound since the baby is took 1.5 oz WITH assistance and probably a lot more stimulation what appears to be reported about the mother reluctantly checking and allowing he baby to sleep long stretches.  From the description given, it doesn't seem likely that the feed observed was a poor feeding -- it seems more likely that this feed was probably a better feeding than usual.   So, being generous, the baby might get 15 oz a day (assuming the breasts magically jump up from an optimistic estimate of 9 to 12 oz a day).  Again, this is not really likely to assist the baby to rebound.

Yet, I don't think this baby is going to starve in a couple of days or suffer irreparable harm.  As much as I think that the supply needs to be aggressively stimulated, I don't think the supply will dry up in a couple of days either.  So, since this is a friend to friend situation which can lead to very uncomfortable relations -- there is an out.  One can adopt the good cop bad cop situation.  That would be to really push this mother to go to the pediatrician for another weight check.  Prep the mom and tell her that she can PUMP this time if the pediatrician feels the baby needs to be supplemented.  If not, that approach, then definitely go back and recheck this mother very soon, not just for weight gain (which can be the difference between an empty or full diaper or the difference between the weight before or after a feed) but for FEEDING VIGOR and intake.  Put the intake in context of whether it is a better or worse feed than the feedings the mother has observed between the two visits.  

Recording the pees and poops at 2 weeks of age is not going to help at all.  It is beyond the window when pees and poops have any meaning, so I would not burden the mother with record keeping that isn't relevant.  

Good luck with this case.  The only time I helped a friend, I found it simply too hard to be the bad cop (she had twins and a bad baby nurse) and I sent my friend to another lactation consultant.

Best regards, 

Susan Burger, MHS, PhD, IBCLC

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