OK, I have a question that I hope someone can shed some light on.  I have had a few mothers call recently with babies who were not gaining up to par (not meeting minimum acceptable weight gain).  One is a PCOS mom and another is a mom who had a breast reduction.  Now this mom had stitches all the
way around her nipple, but the way it was explained to me, the nipple was not removed, just tissue all the way around it, thus the stitches.  Both moms did ok in the hospital, (the PCOS mom had above average amount of colostrum!) but babies are doing marginal now due to the weight gain issue.  When
questioned, both moms state their babies are peeing and pooping just as we would expect them to.  The one baby I saw (reduction mom) was alert and awake and vigorous at the breast, no obvious signs of FTT other than he wasn't well filled out yet, but he was only 3 weeks old!  All other signs were
good.  Good latch.  Audible gulping.   My question is, is it possible to not be getting enough milk and still have the wet and dirty diapers that indicate sufficiency?  My feeling is no, their body isn't going to get rid of waste if it is not getting enough nutrition to meet needs.  Then, why the
weight issue, which is more worrisome because of the history of these 2 moms, who are at risk of this very thing?  Can anyone shed some light on this?  I have told both moms to keep tracking the pees and poops and, of course, their peds are bringing them in more often for weight checks.  At this
point, we don't have a scales I would feel comfortable doing a pre- and post-feed weight with.  I have suggested adding some pumpings after feeds to boost supply and gave info on galactogogues to a mom who asked me specifically about Blessed Thistle and Fenugreek, though I am not supposed to suggest
that patients use these.  ;-(  Both of these babies are giving all the cues we tell moms to watch for regarding sufficiency.  Am I missing something?

Marsha, who is glad that the general public is becoming more knowledgeable about breastfeeding, so that patients ask me about things I am not supposed to bring up!

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Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations as all other earthly causes combined.
John S. C. Abbot
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