Something is not quite right with this mom and baby who I am helping and I can't put my finger on it. I am hoping someone has a thought or suggestion.  

This baby has short tongue, high palate and mom has short shank nipples. Which is usually fixed by tweaking position.  ON day 4 when I saw this mom, she was quite engorged. Baby had never been officially breastfeeding. Mom thought she was breastfeeding but baby was just licking and swallow latched. No transfer because there were no voids and stools. This baby was getting supplemented with ABM 5-6 times a day. Mom was trying to wait for baby to wake up and she hardly did ever wake up on her own. She would sleep at the breast or cry at the breast. So at this home visit. We got the baby on the breast and heard swallows but they were not frequent enough for my liking. We did supplement at the breast with a PD syringe to keep infant interested and hopefully kill two birds with one stone, drain the breast and teach baby to latch onto a "working breast". It only helped a little.   Baby would not suck without supplementation. Mom was too overwhelmed to do supplementation at the breast to keep baby interested.  I encouraged skin to skin. And frequent and adequate breast stimulation at least 8 times a day. I discussed how often to wake this sleepy baby. If baby will not wake up to breastfeed then I instructed her to continue with the ABM in the bottle. Baby has never had bili checked because ped thought she looked ok, I thought differently.   

We are on day 9 and mom said today that baby has one poop and 4 pees. Baby is getting supplemented with ABM on an average of 2 ounces, sometimes 3 ounces a feed with bottle.  Mom is pumping 8 times a day and only getting on average 5 cc of milk each time. She just started stimulating her breasts properly 3 days ago and no volume increase. She was using a pump in style (used and "serviced") and I told her to rent a hospital grade instead. Which she is going to rent. I am worried about the dirty and wet diapers even though this baby is 99% fed via bottle with ABM. I have never had a situation where nothing is working and nothing is adding up. Yet she is looking at me all the time for the answers. 

I don't know if this mom is over working herself and me and making it more complicated then it has to be.
 
Thanks for listening. 
Julie

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