I would do a full lactation history. Find out about breast changes (history 
or breast surgery?), medical problems during pregnancy, etc. Find out diaper 
counts and weight loss during the time mom was breastfeeding (birth weight, 
discharge weight, low weight, current weight naked). I would want to know 
what kind of pump she is using and how many times each 24 hours she is/was 
using it. When did bottles start and how much was baby given from day one to 
currently. Did mom get engorged?

If mom breastfed only a couple of times per day in the first 2-3 days at the 
hospital, she may have never gotten started on an abundant milk supply. If 
mom was fully breastfeeding, no bottles at all, and the weight loss was 
large, this points to a milk supply problem. If baby was latching poorly to 
the nipple shield, she may not have had good stimulation. I see alot of 
people using nipple shields incorrectly with the baby tip sucking (lips not 
on the flat base part rather on the tip or nipple area). I see alot of 
people giving bottles after every nursing session right from the beginning.

If mom hasn't been able to remove any milk, don't bet that just latching 
baby on will be enough to feed the baby (at least not for a while). Some 
kind of supplementing for enough calories per day will need to be done.

These cases are hard. There is no magic cure.

Best to you both, Kathy Eng, BSW, IBCLC 

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