Dear Karen, you already caught some of the red flags here, like

 "Current baby's birth weight was 6 pounds 1 ounce. Now, at six
weeks, baby weighs 5 pounds, 9 ounces. Baby has always had at least 5-6
wet diapers and 1 bowel movement/day. Baby breastfeeds every 3 hours --
sometimes staying latched for up to an hour."

These are signs of poor intake and probably a poor milk supply. The test
weight of one ounce are also a huge problem. She might need to bump up her
fenugreek to 5 capsules three times a day and add blessed thistle. But the
real trick to increasing her milk supply is to remove more milk more often.
Pumping after nursing with a rental or hospital quality breastpump can also
be helpful.

You wrote, "So far I have suggested: more frequent breastfeeding for shorter
duration, pumping between feeds, using a nursing supplementer to give
supplements, having thyroid levels checked, checking with midwife about
the possibility of any remaining placental fragments, getting an Rx for
Domperidone."

My guess is that she did have her period back because of her low milk supply
and the baby's ineffective sucking.

My suggestion is for mom to start monitoring intake and make sure she is
feeding this baby more. A six pound baby needs 15 oz a day (check this
information in the Breastfeeding Answer Book). This little one might need
more to regain his weight. If she is nursing 8 times in 24 hours, that is an
intake of only 8 ounces, or half what baby needs.

I would also suggest she watch the baby's breastfeeding and use breast
compression to help him suck actively. He needs to actively suck, which is
lots of repetitions in a row, not just 3-4 and pausing. He should be able to
get busy and do it in a more timely manner. A supplement at the breast can
be very helpful to teach him to suck. The bottle given after nursing is
teaching him to comfort suck at the breast and wait for the bottle (but at
least he is getting more calories). Get the baby to nurse twice at each
breast for better intake. Switch him when he is no longer actively sucking.
She can also use a periodontal syringe at the breast, or a medicine dropper.
I would hope she could get him to nurse 10 times a day, but 8 might be more
realistic for now. That would mean a total of 2 or more ounces at each
feeding (what he can remove from the breast plus supplement).

It might take 2-3 days of intensive feeding with enough calories to have him
start to wake up more and strengthen his sucking. If she is also pumping on
a rental pump, her milk supply should start to increase as baby gains
strength.

Premies often have weaker sucks and self limit their intake. If no one is
encouraging them to nurse actively and take in enough calories they may not
learn it on their own. Plus, weight loss will make him weaker and less
effective at sucking. His weight should be monitored twice a week for a
while. Another test weight should be done after a week to see if there is
improvement. Perhaps mom could rent a Baby Weigh Scale and do some test
weights herself. Bowel movements will probably increase as caloric intake
increases (yes, he is getting older and may not have as many BMs per day).

It also wouldn't hurt to have the pedi check him out.

Good luck to this mom! Kathy Eng, BSW, IBCLC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html