Hello, Fiona.

I had some thoughts about this baby.  The supply and strong MER are obvious
lines to pursue, but all the gasping and choking and refusal to continue
nursing may also be related to a baby with some pulmonary issues (maybe
secondary to the heart problems?)  The work of feeding may produce a kind of
cumulative hypoxia.  Feeds go well -- sort of-- until baby begins to be
deprived of oxygen, when it becomes more important to prioritize breathing
than feeding.  A suggestion would be to get mom on a better pump and after
baby nurses let-down, do post-feed pumping for the hind-milk and deliver it
after a while when baby recovers from the areobics of nursing.  Try using
various modes of delivery, but pace the delivery of fluids, allowing baby
time to breathe.  All this aversive behavior indicates that feeds must be
very scary for this little one.

BTW, I was so interested in Carlos Gonzales's remarks (attributed to Chloe
Fisher) that the breasts perceive that the baby is weak or impaired and
over-compensate with these copious supplies in an attempt to get enough milk
into the baby.  I would love to hear more about this insight.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract
Austin, Tx