I agree with Nikki about how the SNS works and just want to add a couple
things.
For the mother's own increasing milk supply to overcome the pressure of the
milk in the SNS the bottom of the SNS has to be at the level of the baby's
chin or slightly below.  If it is too high the milk free flows.  The baby
should not be recieving any milk unless they are sucking.
Kitty Franz has done some wonderful work with the SNS and she made a guide on
how to estimate how much of the mother's milk the baby is getting.  The
mother writes down all feedings with how much the baby takes out of the SNS.
Then when the baby comes back in to be seen their weight is obtained.
Convert the weight into ounces and divide by 6 and you will get an estimate
of how many ounces the baby needed to consume to gain this weight.  Now add
up from each day how many ounces the baby consumed from the SNS and the
difference is how much the baby got from the breast.  I would bring a mother
back in for a visit twice a week if she could come.
I found with the introduction of using the SNS to a mother was to set a short
term goal (not including adoptive mothers).  I would asses if she would be
willing to use the SNS for 2 weeks.  If the mother sees there is an end time
sometimes using complicated interventions are more readily accepted and
tolerated.  Then I try to talk to them each day if possible.  When a mother
gives me feedback that she notes her breast seem fuller at a particular time
of day I suggest not using the SNS at that time and therefore start the
weaning process.
The SNS can be a great tool but not for all problems and they need close
monitoring and an end date to keep the mother motivated.
Ann Perry RN, IBCLC
Boston, MA

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