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Subject:
From:
Laurie Wheeler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 24 Aug 2014 00:51:03 -0500
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Hi Annette,

I am not exactly sure what you are asking. It seems the baby is term and
well, you did not give the birthweight but in my experience typical weight
loss is 6 or 7% between birthday and day of discharge around day 2. And
then babies typically are back to birthweight by 10 days to 2 wks, although
2 wks to me is pretty late. When things are going very well babies are
often back to birthweight by day 4 or 5 in my experience.

If the baby is still 13 oz under birthweight at 16 days old this does
indicate the baby is not getting enough to eat. If the baby is taking in
sufficient volumes and is still not gaining, further workup is needed
looking for infection, cardiac, or metabolic.

If I am reading you right, the Mom is resistant to giving formula, but is
willing to provide bf, own ebm, and donor ebm. If sufficient volumes are
provided, this will put weight on the baby and formula will not do so any
better (if that is what the doctor is thinking, which some do). So there
should be no argument as far as the ability of human milk to provide the
volume/calories. The baby may be feeding poorly at this point, and often
will need milk provided by alternate method, syringe, dropper, cup, bottle,
or lactation aid at breast.

The baby will have catch-up growth, once provided sufficient
volume/calories, in my experience 4 to 8 oz overnight once fed generously
by alternate method, and recently had one gain 10 oz! Then the typical
weight gain is often 1 oz per day for those early months.

For this mom it seems that she would explore with you how to provide
sufficient volumes of human milk in the most comfortable, enjoyable, and
also efficient manner (meaning I wouldn't think feedings should last
hours), ways to increase milk production (expressing after feeds, herbs,
reglan/domperidone). If feeds are lengthy then sometimes baby is getting a
good volume at a feed but only gets 6 or 7 feeds/24 hrs  and total 24 hr
volumes are too low. I do, personally, like the lactation aid method, but
mom may not. Are you familiar with the book Making More Milk by Marasco and
West, that is a very good reference for Mom.

Laurie Wheeler, RN MN IBCLC
MISSISSIPPI USA

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