I hope it doesn't seem as if I am beating a dead horse on the test weight
issue, but I want to share another story about the usefulness of having the
ability to check pre-and post-feed weights.

I saw a mother last week for a complicated situation.  Briefly, 1st baby,
born 5 weeks preterm (weighing 5.4 oz), on oxygen for a week, in NICU for
total of 3 weeks, released home bottle feeding expressed breast milk.
Mother discontinued pumping by the 4th week, very discouraged because baby
wouldn't go to breast.  No follow-up care for bfg support.  By the 5th week
baby weaned to cow milk based formula, and began passing blood in the stool.
By the 6th week, MD changed baby to hypoallergenic formula and advised mom
to consider re-lactation.  She called me when baby was 7.5 weeks old,
(adjusted age 3 weeks) and I saw them in their home.  Baby has rough skin,
weighs 9.7oz, and totally resists being put near the breast.  Mom has only
drops of milk expressible from very flaccid breasts.

Plan:  Initiate breast pumping with hospt. grade pump 15 min q3 hrs.
Contacte MD for prescript. for metoclopromide (10 day course)  Use nipple
shield to help coax baby to breast.  We were able to get baby to take breast
briefly with shield and dripped formula, but during the next 7 days, baby
only went back to breast 3-4 times.  Mom ready to give up again when I saw
her yest.

This time mom reports she is consistently pumping 29-35 ml each time she
pumps, and breasts are fuller and nipples much more everted.  We undressed
mom so baby got a lot of skin to skin contact, and put mom in side-lying (my
favorite position to coax reluctant babies back on.)  Baby was not really
hungry, but wasn't full either, and was in quiet alert.  Infant State is an
important consideration -- you have to capitalize on catching them at the
right moment!  We didn't use the shield because there was more nipple to
work with and some milk we could express onto the nipple tip.  Got baby
really lined up great, way down mom's torso so she was looking up into mom's
eyes as she went to breast.  We wedged up the nipple so she could sense it.
Baby latched right on, nursed like a champ for 15 min.  Every so often she
gave a great shuddering sigh -- as if weeks of tension were melting away
from her soul.  Her mother began to smile,  and milk immed. began to drip
from the other nipple.  Grandma got teary, and I had a huge rush of
gratitude for 20 years of experience which gains me the privilege of
assisting in this healing.  Baby was test weighed between breasts and after
both.  Total feed intake was 38 ml (1.3 oz).  Mother was so affirmed that
her hard work had paid off and that there was proof.  We pumped another 20
ml total, so milk supply is really up.  Mom has decided to cont. with the
plan, and I have hopes this  couple will be spared allergic disease,
expensive formula, and the huge loss the failure of this lactation would
have meant to them both.

I say again:  There is always a chance that a baby can be brought to breast
if the mother has milk and the positioning is right and you work sensitively
with the baby.
Babies WANT to breastfeed, but sometimes they CAN'T.  More expert support,
given in a much more timely manner would have prevented this whole debacle.
No offense to peer counselors -- they are great support for normal
situations, but that's all this mom ever saw, and she needed more.  But even
late support may salvage this.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html