I'm so sorry I have not had a chance to respond.  I so appreciate all of your input.  Several of you had suggested some things that I had not thought of.  I did have the mom doing compression, which seemed to help a bit.  The baby was tiring too easily to do all of the position changes at first, but she has now gained well over a pound and mom reports that baby seems stronger and is nursing a little longer, so I suggested the position changes to her.  I'm not sure how well her supply is increasing though.  I can't get a straight answer from her on anything.  She first stated that she was still getting about 3/4 oz, but then she told me that she had been pumping every 2hrs and feeding baby every 3-3.5hrs, so it is hard to tell exactly what is going on.  I advised her to stay on the baby's "schedule".  Follow baby's lead and nurse, supplement then pump.  (I did have her do the supplement prior to nursing for a few days until baby was stronger and that seemed to help baby nurse better - thanks Barbara!).  Mom had been taking fenugreek (3 3x/day) with little effect and has now added in blessed thistle (3 3x/day).  She is going to reassess tomorrow and if there is no change in her supply she will get a rx for Reglan.  She wants to try the reglan before the domperidone because her insurance covers the reglan, but not domperidone.  As for phasing out the ABM supplement, mom is having a very hard time with this.  She is afraid the baby will stop gaining if she decreases the amount of ABM supplement.  The baby was just taking 1oz of ABM and about 3/4oz EBM, then began refusing the ABM.  Now, just a few days later, baby is taking 3/4-1oz EBM plus 2-3oz ABM post nursing.  I suspect a growth spurt.  I advised mom to stop watching the clock and put baby to breast everytime she showed hunger cues.  I will follow up with her again tonight or tomorrow.  

I'm sure I have forgotten some important piece of information here, as I have had to stop writing 4 times now and it has taken me almost 2 hours to do this post. : )  If you see that I am missing some important info that mom needs please let me know.  

Thanks!
Mellanie Sheppard future IBCLC (2004)
Arlington, TX USA

P.S. regarding the NP's comments, the mom is going to express her dissatisfaction to the dr, as he is the one that referred her to me to begin with.  I have also let the LC's in the area know what was said so that they may write a letter if they would like.  I have decided not to write because I don't believe a letter from me would be taken seriously without any credentials after my name. 

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