Hello, Mellanie.
       I have just gotten to read my mail from the past three days, so I am
sorry for the slow response.  Some of my thoughts, not necessarily in any
order other than how they come to mind.
       Yes, sometimes if a mom can't pump any more after 3-4 days, it means
she isn't making any more milk.  But sometimes, it means the baby is
swallowing the extra she is making.  She won't necessarily see more milk in
the bottle when she's pumping *if* the interventions with the baby are
helping him to nurse more efficiently.  One thing to watch is if baby takes
less supplement after the feeding.  Or, if he's grown a pound (I realize the
baby you're working with hasn't done this yet, but keep it in mind for the
future), but hasn't increased how much supplement he's taking--then he's
getting more breastmilk to maintain that higher weight.
       I don't think you mentioned how long the mom is pumping.  Sometimes
moms only pump until they don't see milk coming out steadily.  If the milk
flow stops in three or four minutes, mom stops then.  Be sure she understands
she needs to pump for 10-15 minutes, even if she only sees milk for 5-6, so
that her body gets the message that she wants *more* milk.
       Also, be sure she is using a hospital-grade pump.  There are quite a
few "double pumps" on the market that are not appropriate for this situation.
 (Some may not be appropriate for pumping--period--but that's a different
topic!)
       A feeding tube device can be helpful, if the baby has the proper suck
for breastfeeding and just needs bigger mouthfuls as a reward, to encourage
him to keep using that correct suck.  But I have also been contacted by
mothers who have been using a nursing supplementer but the baby still didn't
take any milk from the breast.  The mothers were able to pump all the milk
the baby needed and baby got no formula.  Mothers didn't pump until after the
feeding, so the breastmilk was actually in the breast while the baby was
there.  Pre- and post-feed weights indicated that the only change in the
baby's weight after the feeding was exactly the amount that had been in the
nursing supplementer.  These devices reward *any* suck, not just a suck
that's proper for breastfeeding.  In these cases, the supplementer had done
such a wonderful job of rewarding baby's improper suck that baby was able to
drain the supplementer and didn't get a drop from the breast!  So
supplementers can be useful, but do be cautious with their use.
       If mom is adamant about bottle-feeding, you might suggest she try my
method of bottle-feeding, which appears in the February 2002 JOURNAL OF HUMAN
LACTATION.  This type of bottle-feeding can often help baby learn the correct
style of sucking.  And if baby can't manage this type of bottle-feeding at
all, it can be a red flag that perhaps the baby has a *feeding* problem (not
just a *breastfeeding* problem) that hasn't been recognized and needs to be
addressed.  Perhaps the jaw cannot move freely and baby would benefit from a
few visits to a cranial-sacral therapist.  Perhaps a speech therapist (they
deal with feeding issues) might be able to help.
       Good luck to you and this mom and baby.
       Dee Kassing

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