Anne,
First take a deep breath. I'm sorry I'm a day late answering you.
This is what we call a "train wreck" because there are so many factors going
on at once to negatively affect a good lactation course.
There are some good basic rules to follow in any case like this one, or even
in much less complicated cases. Take each rule one at a time. There are many
options within each "rule." Discuss with the parents and the involved
primary healthcare providers. Make a decision and evaluate the outcome. Make
changes as you need to.
Here are the basic rules as I see them.
1. Feed the baby
2. Protect the milk supply
3. Establish effective "at breast" feeding.
Let's take one at a time. 1. Feed the baby - I do the birthweight in pounds
x 75 mls for a 24 hour total of what baby needs. The first 24-48 hrs are not
so critical to get in this amount but baby should be receiving some
alternate nourishment if not getting any colostrum from mom. Your
breastmilk, while different from what a new mother would make, will be much
closer to what baby needs than infant formula. So I would go with that if
mother wants to use it. Choose any method to feed the baby. The best method
in my opinion is to use a supplementer at the breast if baby can and will
latch effectively. Bottle feeding is the most familiar to most people, but
cup, syring, finger could be used. In my opinion there is no compelling
evidence for either alternate method. If supplementation will be short term
like 1 or 2 days, I generally try NOT to use an artificial nipple. If
supplementaiton will be long term, then I usually teach paced bottle feeding
if mom not using a supplementer.
2. Next is supply - if baby is latching and suckling at breast with
supplementer then that may be all that is needed. Pumping can also be used,
also galactagogues. If there is any question I would use the larger flange
size. STS alot.
3. The third one will follow, if baby is on breast with supplementer then
you have reached goal #3 already. Whatever mom's supply is, she is
breastfeeding successfully at that point. If baby is imprinted on bottle, a
nipple shield can be tried.
The mother needs ALOT of emotional support and encouragement to keep going
with this. Give her lots of positive reinforcement and ask how she is
managing and let her vent. Let her know this may take some time, but baby
needs her milk and mothering thru bf even more since it was a difficult
birth and early hospital course for both.
Laurie Wheeler, RN, MN, IBCLC
Mississippi USA

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