Hi Julie
I agree that sorting out the attachment is the high priority.  However, I
would be reluctant to add expressing and comping to this mother's already
overfull schedule.  How would you/she feel about breast compressions to
encourage active feeding, then instead of expressing and comping, simply
switching sides and using compressions until the baby stops actively sucking
and then switching again - and again.  I usually encourage mothers to feed
both sides at least twice and more often if the baby is still interested.
The whole process shouldn't take as long as she is taking to feed now - but
I tend to discourage clock watching and I see no need for bottles in this
equation (no disrespect to Cathy, we just don't use them so much here)
because the baby is showing signs of getting *just* enough.  The aim now is
to increase supply and transfer to enable catch-up growth.  I think this can
be done without the gadgets, given that you have observed a well organised
suck. You might even find that if you try some baby led attachment with S2S
you might achieve a more effective latch.  
I also suggest showing the mother the jack Newman video clips that so
beautifully demonstrate active suckling and the effect of breast
compressions.  
Regards
Nina Berry
Australia 
-----Original Message-----

Does this sound like a good plan?:

-Work on getting latch more asymmetric and absolutely as much areola as baby
can take.

-Nurse and compress only while baby is actively sucking, them pump
(immediately after feeding?  one hour after?)

-Spoon or cup feed EBM to supplement (we really hope to avoid formula since
dad has many food allergies)

-Discuss exclusion diet; I think mom is open to making changes

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