Hi Carol,
Mostly from personal experience and anecdotes over the last few years. Reducing some supply on the side will help some with pressure/engorgement after procedure. Her emptying breast as close to the procedure will help also. Fistulas are messy, but manageable and the best milk movement through feeding or pumping will help.
Obviously it will also help to know why baby isn't gaining well. Poor intake or low supply?
Janet Dombro, IBCLC
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