I agree there are way too many interventions here. I agree that 7% wt loss
is not necessarily an indication for supplementation. But rather, continued
support and monitoring would be required. I think this baby has been drawn
away from the breast by the cup and finger feeding and any other "away from
the breast" alternate methods. I would recommend mom decide on the homemade
#5 vs the SNS unit and use as needed based on baby's cues and output and
weights. I would babymoon with STS the next few days and clear the calendar
of most other activities and interventions. Mom needs to get used to using
the device and have alot of at-breast time. The device may not be needed at
all. I would definitely advise against a bottle, although the mother still
has the right to make that choice. I think it would make the breast refusal
more likely.

You may have to have a conversation with mom about her goals and plans. It
may be that she wants to express to provide as much ebm as possible in the
early weeks/months and that is more important to her than the breastfeeding
process or relationship. In my opinion, this tactic leads to earlier weaning
so the baby does not necessarily get "the most breastmilk." Other mothers
want to be breastfeeding at the breast and if time is spent nurturting this
activity, even while supplementing at breast, I think the chances are better
that  baby will be bf long term and so get more breastmilk in the long run.
And be nurtured as was intended, at the breast.

Galactagogues could be introduced, however, if you will continue to follow
this mom, I think I would wait a couple days to bring that up.
At this point I think doing away with the pumping would be indicated, so
that mom and baby can just feed and get used to the device. Pumping can help
the supply and provide ebm for the supplementer, but I am feeling it is all
getting too technical and focused on the milk and not the breastfeeding
process, which we hope will be long-term.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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