I certainly share the concerns of whether a little hunger is preferable to
giving formula. If you check the archives over the years, you will see that
I have raised this question on multiple occasions. Please do not think that
I take this situation lightly. In every one of these situations, the mother
should be advised and assisted to increase her milk supply as much as
possible, and the baby should be assisted to increase his consumption of
milk and milk transfer abilities - this is an ongoing thing and the goal is
for mother/baby to be fully breastfeeding at breast at the soonest point in
the future. This does not always work out.

At this point in time, and I have stated this several times in the archives,
I personally am deciding to give the formula if there is no way to increase
the supply to the point needed, increase the milk transfer to the point
needed, or use donor milk. As I mentioned in a recent post, a situation in
which a baby had not lost alot of weight, and was gaining slowly but
steadily would not automatically be a reason to supplement. Always each case
is a judgement call, of course. But some of these recent cases were more
stark than others.

The research is definitely needed, however, one must look at the ethical
implications of withholding nourishment and calories long term from a baby.
Until then I do appreciate when I see a baby improve dramatically in a day
or two with adequate nourishment, and also the baby's ability to breastfeed
often improves along with his strength.

Laurie Wheeler, RN, MN, IBCLC
Mississippi USA

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