Mary,  Initial problems were probably from a very sleepy baby who was not 
actively sucking well enough to transfer plenty of colostrum. I say this 
because it is our typical pattern of babies induced a few weeks early, long 
epidurals, and c-sections with long epidurals. Perhaps it could be an overly 
active letdown or too much milk syndrome that is the cause of the later 
problems. If mom was having too much milk at first, she would have been very 
engorged at  your visit.

Many babies do shut down when they can't handle the too fast flow of milk. 
Then they are hungry quickly. The confusing thing is that too much foremilk 
usually makes a lot of runny bowel movements. Others take it in stride and 
eat a bunch all at once (3-4 ounces). Many are fussy at the breast, you see 
body language that is thrashing around at the breast, keeping mouth tight or 
sliding down to nipple, rather than getting more content as the feeding 
progresses.

Test weighing would have shown how much baby transferred at the feeding you 
observed. This knowledge allows the IBCLC to make a more accurate diagnosis 
if baby needs supplements or just a few more feedings per day. Also, knowing 
the weight at the time of the lactation consultation tells us if baby is 
starting to gain or continuing to slide downward.

For sleepy babies, I like to supplement at the breast with a periodontal 
syringe. (If you work in a hospital, you might get #5 French feeding tubes 
and 20 ml syringes. Put them together, cut off the tubing above the little 
side holes so you have one hole only, slide tube into baby's mouth at the 
breast, and squirt to get baby actively sucking.) This teaches them to 
actively suck in nice long repetitions.

If supplementing with a bottle is mom's choice, I encourage her to give 
about 1/2 ounce before nursing to wake the baby up and to limit how much is 
given by bottle.

Also, most moms with overly abundant milk supply can pump huge amounts, like 
3-4 ounces out of each breast.

Finally, this mom made her own choice. It could be that she finds pumping 
and bottle feeding more to her liking, no matter how you helped her.

Kathy Eng, BSW, IBCLC 

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