Rob
Wow that's an interesting case history you've presented us with.  I'm not an
MD so will leave the exclusion of pathology to you in my suggestions.
Firstly the weight:  when you say no weight gain in 4 days - is it the same
scale each time?  Could the initial weight (post d/c from hosp) reflect a
baby a bit overloaded with fluid from the IV?
I will reveal my bias upfront - I hate and have no faith in test weights,
but seeing you are using them 30ml doesn't seem like much at 16 days.  I
guess you are using the one-sided feeding to increase the exposure to fat
rich milk, but if she is still expressing 120ml after each feed, then bub
isn't getting to much of it anyway.  My suggestion would be to offer both
sides every feed - only go back to one sided feeding when you get the signs
of lactose overload (you know, frothy stools, great weight gain etc).
Her supply seems good, so I wouldn't pump at all - let the baby regulate the
production and then he is more likely to receive that fat enriched milk.
Also, how good a history giver is this mum?  I've had mothers tell me the
baby is wetting plenty of nappies, then I get to see one with a 6" patch of
yellow urine and a spot of urates and the mother says, yes I get about 6 of
them a day... :-(   I'd be concerned about only seeing one small green dirty
nappy - maybe baby really isn't getting enough milk, in which case the feed
management of swapping from side to side frequently during a feed will help.
Good luck with this one.
Denise Fisher, IBCLC, midwife
Brisbane, Australia

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