Would pre/post feed weighs be appropriate in the following situation:  with 
day 3 infant weight loss approaching 10% and mothers milk not yet in 
physician ordered supplement after breastfeeds, volume not specified. At 3 
days 12 hrs (about midnight) mother noticed significant breast changes, d/c 
supp and fed through night, at morning weigh noted baby continued to lose, 
now>10%. Physician ordered to continue to offer supplement post breastfeed. 
Upon observation baby latches well, normal suck, visible audible signs of 
milk transfer.  Her nurse and I are exploring alternatives together to 
discuss with physician.
-Do nothing, observe/assist with effective breastfeeds, reassess at midnight 
weight check. Obviously, the physician has a concern with this approach...
-Have mother pump and offer expressed breastmilk after breastfeeds. The 
nurse's concern here is maternal exhaustion and overwhelming this mother who 
is post c-sec.
-Offer formula supplement post breastfeed. My concern is overwhelming baby 
with too much volume thereby delaying next breastfeed, impacting maternal 
supply, as well as possible risks to baby of artificial milk. As you may 
imagine nurse thinks I am overstating what is only a marginal, theoretical 
concern......
-What about test weights? Nurse fears that if we don't get the volume we are 
looking for (about 1.5 oz ballpark) we send a powerful, negative 
psychological message to mother....she may very well be right. On the other 
hand if there was good transfer we could d/c supplement and the bother of 
expressing.
thank you in advance for your help-
Kristen Panzer MS IBCLC

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