I have well-documented cases where using the SNS alone is not enough to
drive the supply up, even with the use of domperidone.  And I have also
seen cases where, over the long term it does.

Both pumping and the SNS can be seen by some mothers as difficult to
manage.  I find more cases of mothers viewing the SNS as difficult than
pumping, BUT - it is usually very individual how mothers react.

Advantages of pumping:
1) Discrete time interval involved
2) If mother lets down to the pump, we know we're getting efficient milk
removal
3) More breastmilk gets into baby than using the SNS without pumping - or
to put it another way - LESS FORMULA gets into the baby
4) A copious supply can compensate for sucking problems

Advantages of SNS:
1) Baby has more time on breast learning how to suck in a way that removes
milk from the breast vs. other feeding devices
2) Mother may enjoy having baby at the breast vs. using a mechanical pump

The cases where a tube at the breast has not worked include:
1) Primary lactational insufficiency, where mother NEVER achieves a full
supply and the tube becomes a symbol of "failure" in her mind
2) Baby does not compress, so milk is really just coming from the tube
3) Mother's supply does not increase using the tube
4) The flow from the tube is inappropriately slow so baby does not gain
5) The flow from the tube is inappropraitely fast so baby learns to retract
the tongue, back off onto the nipple and/or clamp on the breast

I think it is very important to monitor these cases closely AND use test
weighing to determine whether or not the SNS is really stimulating release
of milk from the breast or not.  I still do use it in some cases where the
baby is NOT releasing milk from the breast - but I make it very clear that
the sole purpose is to feed the baby comfortably at the breast and talk
about the fact that pumping would help to bring up the supply.

I just had a case this week where the mother had delayed lactogenesis, used
the tube on the breast because the baby did not feed well from the cup, or
bottle and didn't make enough of a seal to finger feed.  I made it clear to
the mom and the pediatrician that the baby really was getting milk JUST
FROM THE TUBE.  The mom still wasn't getting much milk from pumping after a
couple of days, called in a panic about getting the right dosage for
domperidone (I made her call the breastfeeding medicine specialist since I
am NOT an MD to get the dosages). About 2 hours after she called me - her
supply was fully in and she went completely to breast alone with no
problem.

You MUST look at the dyad to figure out what is the best approach, not pick
one way that you THINK is best.

Susan Burger, MHS, PhD, IBCLC

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