In a message dated 5.8.03 10:31:31 PM, Mellanie writes:


> working with a mom whose baby is slow to gain
>  mom is nursing baby every 2hrs, pumping with a double pump, =
giving baby pumped milk and following up with formula.  The total amount =
baby gets via bottle (mom does not want alternative to bottle) is 2oz =
(usually 3/4oz ebm followed by 1.25oz formula).
I showed the mom a proper latch and how =
to tell if baby is swallowing. 

Hi Mellanie,
A few important ideas come to mind here.
 I think your positioning suggestions are great. You don't mention but did 
you speak to Mom about compression? The use of this is vitally important at 
this point and should, perhaps dramatically, increase the amount taken at 
breast. She should concentrate its use towards the end of each position at 
each breast. If doing effectively, she should notice baby start to swallow 
much more frequently (as typically the swallowing frequency has slowed down 
dramatically at this point). When she notes that the swallowing again has 
diminished DESPITE compression, she should remove baby, invigorate him if 
necessary and change breasts. She should repeat this to allow for 4 different 
feeding positions, 2 on each breast (eg/ f-ball and xcradle) per feeding 
(changing breast between each position). This will allow for the most 
complete emptying of each breast and make the time spent as efficient as 
possible, a vital factor in managing the fatigue inherent to this frequency 
of feeds.   
The fact that this Mom is able to pump 3/4oz after each feed every 2 hours 
and the fact that this baby takes an additional 2 oz, THEN is willing to feed 
again in 2 hrs., suggests strongly to me that this baby is NOT feeding 
anywhere near as effectively as is necessary to dramatically increase the 
production!!
 I also think that every 2 hrs, particularly if this frequency is maintained 
throughout the night, may be a little TOO frequent. Assuming that the above 
routine takes 45 min (this would be very efficient!), I might suggest 2.5 hr 
intervals. I also would not maintain this frequeny at night and would give 
more supplement, if needed, to allow for more sleep.   I say "if needed" 
because these changes should give more milk.   Over the next few days, as she 
notices her supply increasing, I would try to cut out the supplement during 
the day but continue the pumping to offer the accumulated amts at night. A 
few more days and she may be ready to give up the nighttime as well.   Feel 
free to give her a copy of this and if you are unsure of any of my (less than 
perfectly explained!)   instructions, she should see an LC.
As for the supposed negative comments by the NP, these need to be addressed.  
 

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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