>Another thing to think about in terms of lactation management for these
women is--at some point--to cut >your losses and encourage exclusive pumping
and bottle-feeding, especially if the whole experience is >>miserable for
the woman and you sense she is going to quit completely.  I have had two
women with >hypoplasia get to nearly full supply (one was put on Metformin
and Dom Peridone), but only with pumping >(maybe produced 25-30 oz a day and
the baby needed about 35 
>oz).   As Lisa pointed out, a flow-dependent baby is going to (most likely)

>stop driving the supply when the initial let-downs pass.   It is incredibly
and 
>erosively demoralising for a mother to breastfeed and then watch her baby 
>down four ounces of formula.   And then get on a pump and yield a trickle.


Might this be a time when either using a LactAid or giving the bottle first,
then satisfying at the breast might be in order?  I've had several women who
have done just that.  They knew they weren't going to exclusively provide
human milk.  One opted to use the LactAid at every feed, the other to give
the bottle first then let the baby suckle after. Both were quite satisfied.


A side note for the first mother--she was in good company at a local LLL
Group.  The other members of her "subculture" were women who were
breastfeeding after breast reduction surgery.  They helped develop one of
the most accepting and encouraging group of women I have ever had the
pleasure to be associated with.  It was their cultural norm to assume good
intent, to think that whoever was using whatever breastfeeding aid, be that
a nipple shield, SNS, bottle or ??, that individual was doing what was best
for her baby, herself, and her family.  They gave and got tremendous support
for their mothering and breastfeeding; a truly delightful group.

Mary Wagner-Davis, MS, MFT, IBCLC, LLLL
Mother of four, new mother-in-law to one

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