Mellanie, I would suggest that this mother is not listening well, which
is not uncommon. She also seems to have fairly strong ideas about what
she will and will not to support the situation that she so muchs wants
to work. Interesting.  I would suggest  Domperidone. Supplementing at
breast is best with a feeding tube device, as described by Jack Newman
MD at Cindy Curtis' website www.breastfeedingonline.com.  If she chooses
to do bottles as a way to provide calories, she can do so, but I would
makes sure she has full knowledge that this could slow the process of
increasing supply. Breast compression would also help.  Refer her to
Jack Newman MD's book, Dr. Jack Newman's Ultimate Breastfeeding Book of
Answers, avail at www.breastfeedingonline.com. Kathleen

Kathleen Bruce RN IBCLC
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I am working with a mom whose baby is slow to gain.  She was not back to
birthweight at 2wks, mom rented a baby scale to monitor weight & intake.
At 3wks, baby had only gained 2oz.  I advised mom to see an IBCLC, but
Mom did not want a consultation and was sure the baby was latching
properly.  I persuaded her to let me watch the baby nurse.  Mom had
thought the baby was supposed to have more of the upper aereola in the
mouth, so she had her latched too high and baby was basically just on
the nipple with the lower jaw.  I showed the mom a proper latch and how
to tell if baby is swallowing.  She watched baby nurse and stated that
she had never seen her actually swallow before.  Baby is very sleepy and
mom thought baby was just "a good baby".  As a result of babies poor
latch mom's milk supply has dropped significantly.  Since Monday when I
saw them mom is nursing baby every 2hrs, pumping with a double pump,
giving baby pumped milk and following up with formula.  The total amount
baby gets via bottle (mom does not want alternative to bottle) is 2oz
(usually 3/4oz ebm followed by 1.25oz formula).  She is taking fenugreek
3 capsules 3x per day.  Mom's supply has not shown much of an increase
in the 4 days since she began the protocol (she was getting 1/2oz
pumping every 2hrs and is now getting 3/4oz).  The mom is very
determined to make this work and get the baby nursing and on 100%
breastmilk.  Is there a better protocol to follow to get the baby
gaining and increase mom's milk supply?  How soon do you reasonably
think she may get a full supply?  Baby's current weight is 6lbs 11oz,
birth weight was 7lbs 5oz.  The mom is exhausted and was under the
impression that she would have a full supply back after just a few days.
I appreciate any input you can give.

Mellanie Sheppard - hoping to sit for IBCLC 2004

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