Hi,

I am working with this mother via email and telephone, and just want to make
sure I'm covering all bases...

Baby girls born 5 1/2 months ago at 37 weeks, assessed to be more like 35
weekers. Mother supplemented on occasion from the beginning with Avent
newborn nipples.  Went back to work full-time - 5 days a week, about 8 hours
a day using Medela Pump In Style. Changed to Avent Isis Manual pump shortly
thereafter because she did not like the feel of the PIS and felt she had
better control with the Isis.

Was advised by pediatrician around the 4 month checkup to take babies off
breast completely for one week due to unexplained diarrhea - trying to rule
out lactose intolerance - Ugh!  Mother quickly learned from her own research
that this was NOT what should be done and put the babies back on the breast.
Since this time, babies have been difficult to nurse, often refusing
entirely.

First spoke with mom 2 weeks ago.  Advised measures to increase supply as
she felt it was definitely below par; ie. Fenugreek, returning to
simultaneous double pumping, etc.  Discussed increasing skin-to-skin contact
and offering breast when babies were sleepy. Also advised avoiding bottles
at all during evenings, nights, and weekends, and suggested using cup for
supplemental feedings instead of bottle.  Mother not open to using nursing
supplementer at this point.

Spoke with mother today.  Supply is greatly increased, but babies still
routinely refuse to latch on even to a full breast in the morning hours.
The only time they will nurse without any fuss is when mother gets them out
of bed and puts them to breast in the middle of the night.  Once the babies
DO finally latch on - if they do - at least one breastfeeds well all the
time.  The other does fairly well once she gets going.  It's like the babies
are averted to the breast, as though they do not associate it with comfort
or nourishment. Mother is mostly offering the breast at every feed when she
is home, but if after 5 or so minutes, the babies are still fussing, she
gives into the bottle and pumps instead.  First attempts with a cup for
feedings were only messy and not successful.

Mother is *extremely* committed, but TIRED, and wishing for this to be less
work and more reward.  I encouraged co-sleeping.  Mother will consider
sleeping with one baby one night and the other on the next night.  At any
rate, she WILL continue putting babies to breast during night as this is the
ONLY time they will feed well, and it gives her much satisfaction.
Continued pumping  will also be done to maintain supply. Mother cannot
pinpoint any other causes, other than the low supply (which seems much
improved) and the constant use of bottles since birth for the baby's
"strike".

Any thoughts ladies?  Any other ideas for getting these babies back on the
breast, or at least getting them to a point where they will *consider* the
breast during their waking hours??  Do you think the supplementer should
would even be a help seeing as the supply seems to be adequate at this
point?

All answers are greatly appreciated by both me and this mother.  She is
anxiously awaiting any more insight.

THANKS!

Becky Flora
Kingsport, TN (hopefully an IBCLC in Oct.)

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