Deborah,
I knew I would open a can of worms by recommending supplementing with a
bottle.  I agree with you that bottle feeding will not increase a mother's
supply. Pumping with a hospital grade pump is necessary when mother's supply
is low and infant is not breastfeeding effectively. I never recommend bottle
feeding cavalierly.  And I always have mother do the least bottle feeding and
the most breastfeeding possible.
When a baby is weak from dehydration, though, and mother is exhausted and
overwrought we need to get the baby fed and we need to have a plan that works
for the family.  With these starving little babies I find that often  they
don't have the stamina to use a supplementer at the breast and, even  more
importantly, for some of our mothers it's the straw that breaks the camel's
back.  If I assess that a baby has the stamina and mother can handle it then
the supplementer is the way to go.  I always tell the mother what it will
entail though and she is involved in making the decision.

I used to feel that nipple confusion resulted just because baby recieved
bottles but I now think differently about this. In cases where babies prefer
bottles, so often I believe it is because they are unable to breastfeed
effectively.  Certainly when we give bottles inappropriately and too early,
supply can be interfered with and babies may not learn to breastfeed.  With
our dehydrated babies who have lost too much wt. this is not the case
however. As others have mentioned, correcting dehydration can turn baby's
behavior around quickly. And then no more bottles!

The one month old  I wrote about yesterday who was 6 ounces below birth wt.
returned to our lactation center today. He had gained 10 oz. in 5 days,
mother's supply increased from 15 to 21 oz. and with compression and massage,
infant was transferring milk well in 40 minutes. There was such a difference
in his nursing behavior...no more flutter suck...and this baby finally
believed he was going to get enough to eat. He now demanded to be fed whereas
before he had just given up and had to be awakened to feed.  The plan now is
no more ABM, supplement several times per day with EBM and follow up for wt.
check on Friday.  Hopefully at this point he can go on once again to
exculusively BF.

Your personal situation is heartbreaking. It sounds like you did not receive
the support and help you needed at a critical time and this is why all of us,
I think agonize so over supplementing. I don't say there is no such thing as
nipple confusion. and in most cases I won't risk it .  But with a starving,
dehydrated baby and exhausted mother I weigh the risk benefit of short term
correction with a bottle.  A more complicated plan for some families can be
the end of BF.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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