I found myself reflecting a little further about this situation because of
the various responses to Janna's post on this list.

How was this mother's birth and most importantly how much access did this
mother have to her infant?  Weight loss seems to be the norm for many babies
born within the hospital setting.  Are we dealing with what I call iatrogenic
weight loss--due to a traumatic birth, the amount of separation that is
imposed upon mothers and babies in the hospital setting, or because of
parental misunderstanding of how breastfeeding works or a combination of all
these factors?  Is this woman truly incapable of producing enough milk? I
don't believe that minimal breast changes during adolescence and during
pregnancy is an absolute indication that someone is incapable of producing
enough milk.  It is one factor among many to think about.

How do we know that this infant didn't drop even more weight at home? She had
dropped to 8% below weight on day 2 of discharge and was seen on day 8--still
at 8% below weight.  This infant might have actually lost more weight from
day 2 to day 8.  Which would mean that this infant actually was starting to
gain back the weight she had lost.

The reason I believe that 8 ozs is alot of formula for this young infant is
that it is considered normal for the exclusively formula-fed infant (first
month) to take in between 26-32 ozs of formula in 24 hours.  This means that
this infant was getting somewhere between 1/3 to 1/4 of what a totally
formula-fed infant ingests.  Often mothers are recalling how much formula
they are giving and are guessing.  Mothers who are giving 1-2 ounces after
every nursing and nursing 12 times in a 24 hour could be giving almost 24 ozs
of formula--meaning that the infant is getting very little breastmilk and a
heck of alot of formula.  So once we introduce formula we may be introducing
another factor that rather than encouraging a milk supply actually
discourages a milk supply [meaning its a fine line we walk when introducing
formula--and this is assuming we are not dealing with a baby in a crisis]
Mothers need to be told that the introduction of infant formula can be life
saving for infants in a crisis situation but if the infant is not in a crisis
situation then that introduction can be detrimental.  And of course knowing
when we are truly dealing with a crisis and when we aren't is a fine art.
And, I recognize that one cannot determine from a distance what is really
going on in the situation you presented to this list other than in general
terms.  I don't think it is giving false hope to present to mothers the facts
that it is truly a small percentage of women that cannot fully breastfeed
their infants.  The odds are with her that she can do it.  But then I think
we need to simplify things for this woman.  I would encourage the woman to
breastfeed and keep an accurate count of how much formula she is giving and
not pump.  As Heather mentioned the "babymoon" idea is worth doing-- even if
all it does is take the pressure off and give this mom time to enjoy her
baby.  Formula can be gradually decreased overtime while watching carefully
that the baby is still thriving.

Determining that a mother is one of those rare women that cannot produce
enough milk for her infant in the early weeks maybe premature.  Hospital
births and the amount of mother/infant separation may cause alot of the
weight loss problems we see in that first week.  Sometimes standing back and
keeping a watchful eye akin to being like a midwife at a birth is a
worthwhile game plan.  And yes,  sometimes it is time to jump in and
intervene. But in most cases we are seeing the norm and the normal
consequence of interventions. Valerie W. McClain, IBCLC

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