Jennifer, I calculate that the baby is about 15 wks old and has gained an
average of 5 ounces per week. Excellent.
It seems mother has had a good supply, so I would first encourage her
continued expressing. I would ask her what changes to her current plan can
be done to make her life easier. Hands free pumping, decreasing the number
of pumping sessions (can often be done successfully once supply is firmly
established), etc.

The second thing is to see what could be done to help the baby transition to
direct bf. It seems the baby is still not latching and/or removing milk
effectively, as evidenced by lengthy feeds and still hungry afterwards. Has
the baby been checked for tongue tie or other anatomical issues? Is the baby
low tone? Mother might again revisit the use of a nipple shield or
supplementer device. A home-made device could be tried or a different
system? There are several brands and sizes of shields and perhaps a
different one could be tried. Have you or someone else watched mother
breastfeed? Often the positioning is not optimal and the baby and/or breast
is not well supported at all. I am often amazed at some of the contortions
women get their bodies and babies in, trying to breastfeed, and simple
positioning is all that is needed. Good luck and congrats to her on her
great efforts with a very challenging situation.
Laurie Wheeler, RN, MN, IBCLC
northeast Mississippi USA

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