Yael Wyshogrod wrote:
>Pat's comments make sense, so now I am really confused about this.   Maybe I
>am wrong, but it still seems to me that if the mother does not have a rapid
>and strong MER, the baby would get milk from the SNS first.

My experience correlates with what Pat said. When less disappears
from the bottle at a feed, it means that more is coming from the
breast and it indicates to the mother that she can put less into it
next time. I tell the mother that's how she will know her supply is
increasing. Also, her *noticing* the let-down can be an important
'milestone' in the process.

I have only had experience with Supply Line (not SNS brand as such,
so I am not sure if it is entirely equivalent) but have always set it
up from the beginning of the feed (with the single long tubing, not
the two short ones, so you have more of a chance to vary the bottle
position). If the mother has significant flow from the breast, I
suggest she pinch the tubing temporarily while plenty is coming from
the breast and let it flow when this slows or stops (so I guess this
is similar to what has already been suggested by Yael and Jack).

One of the reasons for placing the tubing from the start of the feed,
is that I have had trouble trying to get the very soft flexible
tubing into the baby's mouth while he is attached, unless he is
detached and then reattached, and I prefer not to have to do this.
(Do you others have trouble with this??)

Also, altering the level of the bottle makes a big difference - to
get a reluctant baby to suck when there is virtually nothing in the
breast (or before let-down), hold the bottle up high so milk flows by
gravity into baby's mouth, to give the baby the idea of where the
milk is coming from. With low supply, let-down can be quite delayed,
so getting an immediate reward can keep baby interested so he stays
attached until this happens.

Once he gets the idea and sucks efficiently, you can lower the bottle
to about the same level as the nipple (or pinch the tubing if flow
from the breast is really good), so that anything available in the
breast under the positive pressure of a let-down will come out in
preference to the milk from the bottle (that's the theory anyway). If
you want to make it even harder for the baby to get milk from the
bottle, lower the bottle further (but you risk it going backwards in
the tubing when baby pauses) or pinch the tubing.

I hope this makes sense!
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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