I think even without weighing it was obvious that there was not enough milk. Red flags I see:
  Feeding at 3 hour intervals in early postpartum, weight loss of 10% on day 3, early high bilirubin and supplementing with formula and no pumping to try and increase an apparent lack of milk. 
  In my opinion 3 hourly feedings in the early postpartum is the best way to opt for not enough milk. Then baby starts getting yellow and thus even less reaching out for food and loosing weight which adds to decreased alertness. Then the added formula pops in and no milk from mom is needed to work for. I don't need to know how small exactly the amount is to know it is way too small for the baby needs.
   
  I'm still not convinced that I need to start doing test weighing from now on in my practice (I see moms in their own homes, mostly)
   
  Warmly greeting,
   
  Gonneke, IBCLC, LLLL, MOM
  

Kathy Boggs <[log in to unmask]> wrote:
  
At the risk of really beating a dead horse, here's a real life test wt. 
situation I've been involved in over the last couple of days. Baby, full term, 
birth wt. 7-12, first baby, born by vaginal delivery at a different hospital 
than the one where I work. Readmitted to our hospital on day 3 with 10% wt. 
loss and bilirubin of 17. Mother had been exclusively breastfeeding since birth. 
Baby 0+, Coombs negative, no bruising, no other risk factors for jaundice. 
Baby admitted late Saturday and not seen by LC until Monday. Infant breastfed 
every three hours in hospital and then supplemented with formula per MD 
order. Mom and baby were never separated. The baby was readmitted to pedi and mom 
stayed in room with him. No one started mom pumping until she was seen by LC 
on Monday.

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