These babies that stall under their birth weight and stay there for several
weeks can't suck their way out of a paper bag.  I saw one today.  This 9 day
old, 8 oz (228g) under birth wt baby was using an SNS and couldn't drain it
in an hour.  Their sucking isn't robust enough to stimulate any increase in
milk supply no matter how long they stay on the breast, and these moms would
be better served to switch tactics.  They can jump start the baby with about
an oz. by bottle, then put the baby to a full breast for about 10 min. per
side (well-positioned and using breast massage).  Breastfeed until the baby
switches from nutritive (NS) to non-nutritive sucking (NNS) and when that
happens, stop and pump 10 min.  Teach the mom how to identify NS:  Look for
open eyes, slow, wide, rhythmic jaw excursions, sounds of swallowing.  When
the eyes close, the suck gets shallow and rapid, and swallowing ceases, baby
is non-nutritively sucking.  Top off the baby some more milk by bottle so
the baby gets a really generous feed.  Make sure mom pumps at least 8 times
a day.  She'll only be able to do this if she isn't spending so much time
nursing.  Tell her this is an intervention.  Interventions are supposed to
be intense, effective and brief.  Within a few days the birth weight will be
regained and hopefully the milk supply more stimulated.  Then she reverses
the process and offers a full breast first and only tops off with bottle if
the baby obviously switches to NNS too early.  See if her MD will prescribe
metoclopramide or domperidone to give her milk supply a boost.  Her health
insurance will prob. only pay for metoclopramide (Reglan).

It might help the nurse practitioner feel more comfortable about LCs if she
were receiving regular reports from local LCs.  This lack of trust might be
remedied if the LCs knew there was a problem.  Perhaps there is a way you
might inform them so that they can build some bridges.  BUILD, not burn:)

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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