I recently saw a mother with 3 days old baby (36 wk). The mother thought that breastfeeding was going great, milk came in and she was feeding every 3 h ( she was instructed to do this way in a hospital by lactation consultant).
The baby was jaundiced, sleepy and lost 9.5 % from birth weight. Guess, what I saw when mother started breastfeeding? Hypoplasia, probably one of the worst cases I ever saw. I understand, that there were other factors as prematurity. But this mother was never told anything. She was sure they are doing great, baby nursed and did not cry. It was a long visit... And I needed to explain to them what was going on. We started to supplement at the breast and baby needed bili blanket. Mother rented a pump and started herbs. 
I work for pediatric office, where we (IBCLCs) see every breastfeeding mother a day or two after discharge from a hospital. We saw this mother and baby 4 times. She continue to breastfeed with supplement.

My question is: what is the right thing to do? Should a mother have this information right away? Should we develop plan A and B, and maybe even plan C? And I strongly believe that breastfeeding is not simply transferring milk. It is so much more. We can help mothers with hypoplasia to breastfeed. However, we need to look at the whole picture.

Kindly,

Maya Bolman, IBCLC

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