First of all I will say that I am the most pro-breastfeeding advocate you
will find on this earth, BUT I am VERY concerned about the recent posts of
slow weight gaining babies and lactation counselors that try different
approaches, wait weeks or months between weight checks on these babies and
essentially don't know what to do.

FEED THESE BABIES!!!!   IMMEDIATELY!!!!!!

It is NOT appropriate for a baby to be allowed to stand still or gain small
amounts such as a few ounces per month.  The babies become weak and do not
have the strenght to stimulate their mothers milk supply.   That's why even
with more nursing they may not gain.  Their suck is often terribly
ineffectual until they are back on the growth charts where they need to be.
 These babies need to be gaining weight within 1 to 2 DAYS of seeing you,
 NOT standing still for weeks or months.  They need to gain QUICKLY,
sometimes as much as 2 to 3 ounces per day to play "catch up".  Babies need
to have gained 1 to 2 pounds per month in the first 6 months and be caught up
to that amount if they are behind

You MUST find a method that gets the baby fed (of course use methods that
preserve breastfeeding as the 1st choice, such as a tube device, cup, spoon,
dropper, etc.) AND formula is the choice IF mother's milk is not immediately
available. It is not the worst thing in the world.

Long term under feeding / semi-starving  the baby is much worse.

  Sometimes using appropriate amounts (often as much as the baby wants which
may be a surprising amount) of supplement (of course every drop of mother's
milk should be used and stimulated)  will perk the baby up and then with
better suckling and pumping the mother's milk supply should be up to full (if
there are no medical problems)  within a couple of weeks.(it should not take
months if she is healthy and following the plan correctly)

 Letting these situations drag on and on and on and on is the surest way that
I know to loose the confidence of the doctors and others who refer to a
lactation consultant or counselor.   They will see you as a fanatic that
holds breastfeeding higher that the actual health and nutrition of the baby.
  It also discourages and worries the mother.  If we want the confidence of
our colleagues in the health care field, we need to sharpen our skills and
use them.

All of us need to have someone with more knowledge and skill to refer to if
we are stumpted. (Someone who is immediately available) If you cannot help
the mother and baby resolve their low milk supply / low weigh gain problem
and have positive results obviously occuring within JUST A FEW DAYS, please
refer her to someone who can,(someone who can follow them closely/almost
daily) and learn how to help these mothers and babies effectively.  You will
be doing more to rescue breastfeeding than by "piddling around".   Use your
resources;  The Breastfeeding Answer Book, Breastfeeding and Human Lactatin,
Breastfeeding a Guide for the Medical Profession.  Find local expertise.
 Apprentice/intern yourself to an experienced LC. Learn, learn, learn, before
you let yourself be called upon as a breastfeeding specialist/counselor and
then get immediate help when you don't know what to do.  Lactnet is
wonderful, but should not be the main teaching tool to become an effective
LC.

Sincerely,
Jane Bradshaw RN, BSN, IBCLC
Lynchburg,VA