Julie,
I apologize for not adding anything of value in my reply to you, as i hadn't 
time to search out your original post until just now.  Obviously, you have 
already done so much.
Two thoughts came to mind however - is mom NOW at the point where she 
might cope better with the thought of supplementing at the breast?  
Sometimes, one week can make a real difference in their energy and 
commitment level, for good or bad.  I still favor a simple feeding tube that is 
easy to clean and assemble and use.  And, if little one would actually latch on 
enough to get a decent feed, she would be well reminded that it could cut 
down on her pumping time.  
Also, do we know for a fact that she fits well into the breast pump flanges?  
She doesn't complain of constriction, etc while pumping?  I'm surprised, over 
the years, at how many moms have a need for a larger flange, and i never 
would have guessed to look at them.  Plus, can you instruct her to hand 
express right after pumping, citing the newer research on that?  Oh well, 
random thought.
Lastly, when i mentioned herbs before, i meant something more stout than the 
tea.  I'm lucky to have an herbalist at my disposal for moms in need locally.

With all that you've offered, what more can you do than ensure that she is 
getting the deepest, best latch w/each feed, with a feeding tube (ABM or 
not), and reinforcing the need for frequency?  Oh, I know - guilt her into 
making the drive for frequent weight checks!  :)  If she won't come to you, 
can she promise to go somewhere else for a weight check, and preferrably, 
have another adult with her?  I sometimes find that i can get to the heart of 
the matter if another adult is with mom, who can verify what she (thinks) is 
seeing, or can give a completely different take on the diapers, etc.

Certainly, this sounds like a baby who needs watching for awhile.
Good luck to you,

Alicia Burgett, IBCLC, private practice

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