Dear Pat:

I have several questions regarding the case that you posted:

What would happen if this mother responded to her baby's nursing cues instead of nursing/pumping every four hours? What would happen if this mother covered the pump container with a towel so that she did not see whether or how or when her milk was flowing? When her milk does first let down, does the baby seem able to manage the flow comfortably? Does this mother have physiological reasons to continue pumping with this regularity? Does this baby ever appear to "nurse for comfort" (I recognize that breastfeeding is always a combination of nutrition, immunology, comfort, physiological and psychological development, ...) or, to put it another way, leisurely nurse with obvious enjoyment? Is the baby still taking bottles with fortifier? If so, why? Has the baby been evaluated for thrush (popping on and off the breast unhappily suggests this possibility)?

For good reason, this mother has been very focused on the quantification of her breastfeeding experience. While I am not saying that something else isn't going on, I just am noticing that cue-based nursing does not seem to be happening and does not seem to have been happening. It is possible that her baby has changed a nursing pattern due to development, a growth spurt, etc. which is changing the breast's response which the mother then finds confusing and concerning. If mother and baby spent a few days just nursing based on cues from the baby (switching breasts whenever the baby seemed to indicate the desire to do so and pumping with container covered if physiologically or psychologically necessary) and she and baby were able to experience cue-based nursing, what would happen? If the mother has never nursed based on the baby's cues, she may need education as well as emotional support before she is able to do so with confidence.

Cynthia 

Cynthia Good Mojab, MS, IBCLC
Ammawell
Email: [log in to unmask] 
Web site: http://home.attbi.com/~ammawell 

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