Michelle,
 
You wrote, *Mom only gets 1/4 to 1/2 oz per pumping after a feed, and has  
been offering 1 oz or so after feeds at the breast, but says baby usually won't  
take it.*
 
As others have stated, this baby needs to eat and his not getting  supplement 
following feeds because of sleepiness is likely because baby has no  energy 
to continue feeding.  I recently worked with a similar case and had  mom 
sometimes breastfeed both breasts for only 10-15 min first, then give  supplement 
and if baby wasn't swallowing most of those minutes, then had her  supplement 
first (feeding tube at breast, open, first would be best)and then  breastfeed, 
using lots of breast compression and switching frequently.   Also, I'd increase 
the frequency of feeds to every 1-2 hr and when feeds aren't  going on for an 
hour or more, this is doable. Feeding weights would be important  here to 
ascertain what baby is actually getting at breast so mom can see the  need for 
the above mentioned plan.  
 
The baby I worked with was only transferring about 8 ml and when I did the  
math with mom, calculating what baby needed in 24 hr, it was very obvious how  
underfed this baby was.  It took a few days to wake this little guy up and  
longer to be able to bring mom's supply up with some power pumping, use of hosp  
grade pump, right flange use, and galactagogues.  This mom had to use  
formula because number one rule is to feed the baby.  Baby is now  exclusively 
breastfeeding and mom even has some milk to freeze for work  eventually.
 
There also was a recent thread here about feeding supplement first and  using 
the breast as "dessert" until baby is strong enough to breastfeed with  vigor 
and effectively.  Hope this helps and things turn around, which they  
certainly can, which I always let moms know.  Daily, or twice daily  contact, to 
follow closely and change plan as needed is vital in these  situations.
 
Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
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