Hello, Jean.
       I am wondering if perhaps baby just wasn't ready for the change in
firmness in the breast when the milk came in, and couldn't initially figure out
how to handle it.  Then the mother, understandably worried that her baby wasn't
eating, resorted to a bottle.  If the bottle was a regular-flow (fast-flow)
nipple and the baby was held in the traditional bottle-feeding position, then
baby might have quickly gotten used to how the milk just flows into his mouth
without any effort on his part.  Now, he is not happy when he has to work to
produce a let-down.  If this might be the situation, you can suggest that mom
alter her bottle-feeding style to one that will make baby suck in a style closer
to what he needs to do at breast.  For more info, you can go to
www.ilca.org/pubs/jhl/j18h1|10.pdf.
       There is another possibility.  If mom is still engorged on day 7 even
though she has been pumping, then maybe the milk flow is just too strong for
the baby.  If mom seems to have more milk than baby needs (she can let quite a
bit flow into a towel and yet baby still can get easily filled up OR baby
finishes the feed and yet there are areas that feel rather firm to the touch as
though the milk did not completely drain), then measures to tamp down the supply
may make the baby more comfortable at breast.
       If you refer this mother to an IBCLC because you don't feel confident
to work with this situation, ask the mother and the IBCLC if you can come
along to observe the consultation.  If both are agreeable, you can learn a lot
that way.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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