I agree with Heather, this is not unexplained to me! I often find that 
when women start nursing or pumping late usually have low milk supply. 
When did she start stimulating her breasts (meaning milk removal) at 
least 8-10 times in 24 hours? Sounds like never.

Babies who get bottles this early learn to swallow, not to suck. If baby 
is going to town with 10+ sucks in a row before a short pause, then 
starting up again with long repetitions of sucking, they will usually 
remove or transfer milk. Baby also needs to suck this actively for 10 
minutes then slow down for another 5-10 minutes on the first side. 
Similar pattern on second side but maybe shorter time. The bottle fed 
babies I try to get to breastfeed often will not suck but only swallow, 
or suck just a few minutes.

Thank goodness you are doing test weights!!!!!

I always keep the suction lower than maximum -- too high on the Lactina 
with the maximum setting on the piston. I test this at over 220 mgh.

If mom is willing, you need to figure out how much baby needs to eat in 
24 hours (in the BAB), and compare that to how much he is able to remove 
from the breast. Mom will need to nurse with some way of supplement at 
least 8 times per 24 hours and then do maybe 10 minutes of pumping on a 
med. suction after each nursing. Do this for 2-3 days and see what 
happens. This is not always an easy course to follow as mom is 
constantly busy. If mom will use an SNS type device, she may not need to 
do so much pumping but I still would suggest it after every feeding for 
2 days, or at least 4 times in 24 hours.

Best, Kathy Eng, BSW, IBCLC

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