Janna Zempsky  and all,

Janna asks about how to help a mom with 2 week old who is getting
supplemental formula and transfering .5 to 1oz  of milk (per test weights)
with each breasffeeding.

I rent the scales and find it to be a mixed blessing.   When a mom is
measuring the breastfeedings she will supplement to compensate for what is
not received at the breast.  As long as she continues to do this there is no
demand placed on the breasts to make more unless of course she is pumping but
as we have all seen, many moms don't respond as well to pumps at they do the
baby, especailly with regard to increasing low supply.    Moms seem to have a
very difficult time with this concept when they have the scale and
understandably are reluctant to reduce the supplements because they view it
as withholding food from their hungry baby since they can see the baby will
not get enough from the breast.    Certainly she should be pumping and making
as much of the supplement breast milk as possible but frequently only small
amounts of the supplement is breast milk due to the mom's unresponsiveness to
the pump.........sigh.......... a big catch 22.

What I have had some success with is to suggest to the mom that instead of
doing pre and post feeding weights she should only weigh the baby in the nude
once a day in the AM and gradually and systematically reduce the formula.  I
ask her to start slowly to reassure the mom and protect the baby.  If the
baby is getting for example, 8oz each 24 hours, I tell her only give 7oz
formula for a few days, watch the weight and output and call my voice mail
each day with her 24 hour totals of breastfeedings, output, and daily am
weight  and any other improtant info so I can monitor.   Mom leaves the
message on my voice mail  and indicates whether I should call her back or
not.   I record the information on a flow sheet on her chart.   I also
reassure her that if any of the numbers sound concerning I will call her
anyway.  If the baby gains appropriately at the reduced supplement amount we
bump it down again by one ounce of the daily total for the next few days, and
so on until the mom is totally breastfeeding OR until I can actually see
mom's supply is not likely to respond appropriately and then of course we
look at other options.    If all is going well the supplements amounts can
often be taken down more rapidly depending on mom's comfort level as the
supplement amounts get smaller.   I find this very slow, very monitored
process works to calm the  fears of most moms with regard to reducing formula
supplement.    Of course some of the moms are giving some formula and some
expressed breast milk.   I have them reduce the formula first and when the
baby is getting only breast milk supplement we decrease the supplements much
more quickly and mom is usually very reassured to see her baby is gaining on
her milk alone.   If we try this and the supply does not respond we have not
placed the baby at risk (usually mom's biggest concern) because we only
reduce the formula as long as appropriate gains are achieved.   If the supply
is not coming up with this added demand, the baby usually doesn't lose
because the drops in supplement are so small, the baby usually just fails to
maintain the appropriate gain so we discontinue the reduction of  the
supplement past that point or we hold at that spot  a few more days or even
increase and try to reduce again but maybe only in 1/2 ounce increments of
the daily total.   I usually find that a drop of 1oz of the daily total per
every 2 to 3 days is a good starting point for most.

I am sure many of you have done this or something very similar, but just
wanted to share the specifics of how I monitor it.  I have found this to be a
great use of my voice mail system that will take up to a five minute message.
 It allows me to monitor many patients each day easily, without time
consuming phone calls when they aren't needed.   Most of the moms have liked
this system because they can also leave the messages quickly at their own
convience ( my voice mail is only voice mail and is available 24/7) and felt
comforted by the knowledge that I am looking at their chart daily as they
call in the weights, etc.    As the process proceeds I often "wean" mom from
daily phone messages and we drop to every other day, every few days, weekly
and so on.

Hope this helps in your situation.

Kathy Kuhn
Private Practice LC
ParentsPlace.com LC
mom of 4 sons
Eastern PA
(snowing like crazy here today 6-8" and much more expected)

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