Hi mary belle,
Welcome!
You write about your 5-6day old mother/baby pair with history of latch issues
and poor wt. gain. On consult you note that Mom is "slightly engorged" but
despite assist w/ good latch you hear swallows only for first minute or two.
This description (sl. engorgement) is certainly consistent with the day 5-6
but I must say that I haven't run into this particular scenario before...ie.
engorgement to any degree is NOT consistent with a supply issue.
Now the supply may be plentiful but the baby may have issues getting to it.
Thus I have had instances where the Mom is *very* engorged and besides
impacting the babe's ability to latch ,and even when latched well, they
occassionally have difficulty initiating flow requiring many minutes of
compression etc. to finally *break the dam*, so to speak.
Also, the lack of pumped milk doesn't point to a supply issue as the ability
to extract milk from an engorged breast with a pump is limited.
On the other hand, I have also had instances where the Mom had very little
supply resulting in a very brief period of swallowing followed by frustration
on the babe's part or a long period of nonnutritive fdng BUT the breast
always *appears* to be empty as well, no *slight* engorgement as you've
described.
Unless....has the Mom had a breast augmentation?

I would, of course, concur and reemphasize the value of skin/skin (as
mentioned by a previous poster) for any baby and especially for any baby who
falls asleep so quickly (!) at the breast. This behavior is much more nl in
the immediate newborn period and I would be alarmed by a gaining, 6day old
who persists with this despite being naked at the breast....Perhaps this
problem is more the baby's than the mother's??!
At any rate, if the issue has not resolved by now, I might try an oxytocin
nasal spray.
They are still used (or so I've heard!). If you search the archives you will
find somewhat recent postings on availability, dosage etc.
Lynn Shea Rn,Bsn,Ibclc
Franklin, Massachusetts

>>My question - finally:  From what I describe, and I'm afraid quite poorly at
that - would you say there is a milk supply problem or a problem with MER?
Or both at this time? I'm leaning towards MER, but oxytocin intranasal spray
is no longer available - is that right?  What else would I suggest for MER
problem?  Would you take measures to at the same time increase milk supply
(domperidome or Reglan - fenugreek?) or wait and first resolve MER problem -
 if there is one and then see how supply is - which I'm worried about with
little to no emptying of the breast taking place at this time.,,

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