Fio,

Like you, I would hope that someone can get to the bottom of the problem.
You are right, a full evaluation should be done.  

Sometimes, nursing for 5 minutes and following with a bottle of milk can be
a good option.  Recently I had a 5 week infant come in with some severe
micrognathia (a short lower jaw.)  Baby was 3 or 4 oz over birth weight at 4
weeks and looked terrible.  Mom reported 8 wet diapers & 2 stools in 24h.
Mom really wanted to breastfeed and babe did not transfer well at the bare
breast so we started with using an SNS at the breast.  Formula was needed
because by this time poor transfer had dropped supply.  Mom did not want to
give bottles and, with the SNS, we were able to transfer 83-cc milk in 30
minutes at the first feeding.  Mom did not have as much luck at home
although baby did start to grow.  Baby gained 8-oz in 8 days at the next
weight check.  To make this gain with the SNS, mom would spend 1 - 1½h to
feed 2-oz from the SNS 8 - 10 times per day.  Mom and baby were both
exhausted.  We talked and decided that mom should pump and bottle-feed for a
few days so that she could get rest and baby could get well fed.  In 2 days
mom sounded much better.  She went back to the pediatrician.  Baby was still
gaining an ounce or more per day since intervention but, was so far behind,
that pediatrician told mom that formula was just fine and do not worry about
breastfeeding since obviously that did not work.  Mom has now given up on
breastfeeding and will nurse for comfort only, pump occasionally and will
wean soon.

Why this story?  To illustrate that one can keep baby at breast too long to
keep baby breastfeeding.  The care plan I gave her appeared to be the
"breastfeeding friendly" thing to do.  If I had done a less "breastfeeding
friendly" care plan, we might have had more success.  Had I encouraged mom
to pump and bottle-feed immediately and breastfeed for comfort only, I might
have been able to save the breastfeeding.  Baby did need to grow faster.
The pediatrician had a report from our office w/in 24h of the initial visit
but I suspect did not read them since he would have seen that baby's growth
had improved significantly with 12-oz gain in 10 days.  He only saw the
scrawny baby that was one pound over birth weight at 6 weeks.

Sometime the less breastfeeding friendly plan keeps baby breastfeeding
longer.

Good luck to this mom & I hope she sees someone soon.

Linda Pohl, IBCLC

Fio wrote:
I agree that any baby who needs food should be fed!  I don't know enough 
about whether the milk transfer in this case is sufficient (after asking 
her to clarify, she said the number of wet diapers was ok both with or 
without supplements) and I certainly did not tell her to not supplement 
the baby.  I *did* tell her that there were more breastfeeding friendly 
ways of doing so (since the baby is nursing well) like the SNS and I 
also said that pumping or just nursing 5 minutes when she could be 
nursing longer (assuming the baby is actually transferring the milk 
well...but given his wet diaper count I assume probably he was) would 
just diminish her production long-term.

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