I agree strongly with Diana and Marianne. 

I always let the Mother know that her baby is smart for knowing where his milk 
comes from, and for certainly preferring that method of obtaining milk.

I also let her know that a baby who is happy to take the breast and simply 
doesn't want a bottle is a better situation than a baby who takes the bottle 
and refuses or "doesn't want" the breast! That can help moms realize that the 
normal way of feeding is always preferable to the baby, and that not "wanting" 
a bottle is simply a normal and healthy survival strategy for the baby.

I need to add that the OP suggested perhaps using a nipple shield for the 
mother so that it would be "easier" for the baby to "take" the bottle? IMO, 
perhaps causing a problem in an otherwise great breastfeeding relationship is 
not worth the outcome in any case! Nipple shields have their uses, but most 
women do not need them, and I have not seen any evidence that proper 
protocol for the use of these appliances includes changing the normal course 
of breastfeeding, to make it "easier" for Mom or someone who is not Mom to 
give milk in a way she considers more expedient. The risk of sabotaging a good 
latch, intake, skin to skin contact with the breast, possibly altering flow from 
the breast, eliminating contact with Glands of Mongomery and maybe even 
setting a premature weaning into motion is, at least in my opinion, not worth 
the risk. 

The bottle here is the artificial and less perferred feeding method, and this 
baby HAS the ability to transfer milk from the breast properly and obviously 
does a good job. I think making a change in what is already working on the 
breastfeeding arena in order to help yet an other artificial method "work" 
should be reconsidered.

There are other ways to get milk into a baby whose mother chooses/needs to 
be away from him for longer than the time between two feedings. A small 
feeding cup, a "soft cup feeder," a spoon, a small flexible bowl (like the kind 
Tupperware used to make, you can still find them) a syringe, etc all should be 
brought to the table when a mother makes the choice to have someone else 
feed the baby, and there seems to be no way for her to not miss a feeding. 

Also, many breastfeeding mothers choose to either go home to feed the child 
during lunch breaks, have the child brought to her, or make some other 
changes in her time management so that breastfeeding will not be interrupted. 
Choices such as these reduce the reliance on artificial nipples, and containers, 
as well as reduce the choice to pump, store and transport milk, and the 
worries which accompany those. 

The clients I have worked with who have been the most successful at 
combining being away from baby, and continuing breastfeeding have a certain 
series of things in common they commit to. 

1)Nurse the baby the last thing out the door before leaving. (this may 
eliminate or reduce morning feedings by Day Care providers.) 

2)Nurse the baby the FIRST thing in the door as soon as she gets home. 
(before grocery shopping, before Mom changing out of "work" clothes, before 
starting dinner, etc.)

3) Completely eliminate the use of artificial feeding methods on days and times 
when Mom IS at home. If Mom is not at work, baby gets the breast. There is 
usually no reason to pump, and certainly usually *no* reason to use bottles or 
other feeding methods other than the breast after Mom gets home from work, 
in the morning before she leaves, or on weekends. 

4) Make sure the Day Care provider knows when Mom is coming home, so baby 
will be ready to nurse. That means everything from having baby in a clean 
diaper, and hopefully awake, to, if possible, holding a not TOO hungry baby off 
for a few minutes, to wait for Mom, who has "the good stuff, from the Good 
source" to get home. This also requires that Mom be prompt in her returning 
home at the time she is expected. 

5) If possible, Night Nursing (always easier if baby is near Mom at night. Babies 
KNOW that Mom is gone most of the day, night nursing is usually a given for 
babies whose Moms are gone all day. If she isn't there in the daytime, baby 
knows she is there at night and, again, most likely due to survival tactics, will 
take advantage of WHEN she is home, regardless of whether the sun is up or 
not. Babies don't care about the position of the sun in the sky when it comes 
to either getting their milk, or BEING with Mom.) and of course, LOTS of 
holding and skin to skin when Mom is there. 

I usually suggest to these Moms that they try to use a Sling and *leave the 
car seat IN the car!*...bringing the thing into the house, or carrying the child 
around IN it, from what I see, only promotes Detachment. (Had a Mom call the 
other day, who was worried about nursing her baby to sleep, because 
she "didn't know if the day care provider would rock the baby to sleep, and 
didn't want to get the baby in a bad habit that couldn't be taken care of when 
Mom wasn't home." *SIGH* We discussed choosing Day Care workers who 
parent the way YOU do. And, also her right to insist the baby be cared for the 
way SHE chose, and to make occasional unannounced "visits" during work 
days, to make sure things are being done the way Mom intended them to. I 
think we worked it out by the end of the conversation. I hope so.) 

These tactics can work for most women and their babies to promote not only 
a healthy supply, but help Mom and baby nursing as long as possible. 

I hope the Mom and Baby in the original post will do well. 

Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 

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