An IBCLC and I are both working with a first-time mom of a newborn.  Baby was
born 4/18 and weighed 8lb 11oz.  By 4/22 baby had lost 1lb 1oz.  No stool
from 4/21-4/24.  LC supplied mom with an SNS and Medela pump and told her to
supplement with glucose water and EBM.  I saw mom on 4/24.  Mom's breasts
were soft.  She said she didn't have time to use the pump because baby nursed
all the time.  She said that she'd put the baby to the breast, baby would
suck and fall asleep within five minutes.  She'd let baby stay on the breast
asleep, for 45 minutes or more.  When she took the baby off the breast the
baby would scream and husband would walk the floor for an hour with the
screaming baby until "it was time"  for the next feeding.  Then the pattern
would repeat of baby sucking a short time with little or no swallowing and
then falling asllep at the breast.  When I observed the baby she would latch
well and suck, but she was sleepy and there was minimal swallowing.  I
discussed ways to increase milk supply, pumping and using SNS with glucose
water and expressed milk.  She had an appt with the ped 4/25.  She reported
that the baby had stooled and gained an ounce and a half and doctor was
satisfied.
LC called me today and said baby has only gained half an ounce since 4/25.
 In 24 hours of pumping mom only got 12 ccs of milk.  LC and I agreed it was
time to give baby formula in SNS.  Neither LC nor I have observed MER in this
mom.  Despite frequent pumping and nursing mom does not have breast fullness.
 She said she did not experience any breast changes during pregnancy.  No
breast trauma or surgery or infertility.  LC and I both wonder if she may
have insufficient breast tissue.  (She does have tubular breasts.)
I have two questions.  1)  How do we approach getting her breasts examined.
 Do we call OB and have him call her in or advise her to call OB and hope
that she does.  2) Is there still a synthetic oxytocin spray that is used to
encourage MER or is all that stuff off the market now?  Any other ideas?
 Anything we missed?
TIA!
Cynthia Dillon Payne, LLL Leader