First of all, one hour for an average feeding is way too long, especially if mom is pumping afterwards. In cases of baby not getting enough milk, one must first get to the crux of the problem - is it mom or is it baby?  My thoughts on poor milk supply is, if mom is willing, to go all out to try to stimulate a supply and see what response you get.  This would involve pumping as much as possible for a week, at least 8X a day, more when she can squeeze it in, with a hospital grade pump.  If double pumping, pump for 10-15 minutes every 2-3 hours (2 hours is better) with at least one or two pumpings at night.  I would also explain the possibility of boosting supply with herbs and mom can add this if she wishes. During this time, baby can be fed by any number of means, but feedings by mom, either at breast or otherwise, must be kept within a time limit that will also allow her to maintain maximum pumping and also have time to eat and get needed rest, not to mention maintaining her sanity.

 If mom is emptying breasts this frequently, there should be a response by the end of a week of this routine.  If she sees a big jump in supply, the problem is very likely baby-related - poor milk removal due to any number of reasons.  If baby has a very poor suck, using a supplementer will keep baby at breast, but will not adequately stimulate the milk supply.  So one has to be realistic about how much time will be spent at breast, how much will be spent pumping in order to protect the supply and how much will be spend getting milk into the baby by other means, if using the supplementer at the breast is not doing the trick in a reasonable length of time.  Some babies with big problems will take as long using a bottle as at breast, but with someone else feeding baby, at least some of the time, mom can use that time to pump and get a little break, instead of doing all of the feeding plus the pumping 24/7.  In the meantime, the baby problems need to be addressed and hopefully, in time, baby will be able to efficiently remove milk and supplementing/pumping can be cut way back or discontinued entirely.

If very frequent pumping has little or no effect on supply, then it is likely that problem lies with mom (although could be a combo of mom and baby.)  Mom can continue her efforts to boost her supply, may want to add drugs and we all know that, in time, she may develop an adequate supply.  In the meantime, a plan must be formulated by which mom can combine feeding her baby with her efforts to boost her supply.  She may need to use a supplementer throughout the feed, instead of nursing first and then adding the supplementer.  She may choose to let others do some of the feeding so that she can continue to maximize her pumping.

Care plans need to be realistic and reevaluated frequently in order to be ultimately successful.  If this is going to be a long haul, mom needs to be able to work towards her goal without burning out (goals need to be realistic as well and can change over time.)  Present ideas, watch and listen to the mom and help her to make decisions that she is comfortable with and can live with in the real world, which may include other children as well as a partner and perhaps even extended family.  Every case will be different.

I realize this is not very specific.  There is a lot of info in the archives about managing supplementing and pumping and low milk supply.  It is a complicated subject. But my early goals in these types of cases is trying figure out the major source of the problem as quickly as possible, feeding the baby, protecting the milk supply and keeping the mom on track with continuing towards helping her baby to breastfeed.  If you can keep mom comfortable and on board, you will hopefully get the time you need to figure out exactly what is going on and what might be the best way to resolve the problem.

Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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