Hi Susan,
Thankyou for sharing your experiences with the use of the SNS
I'll just interject a little here and there with some more questions!

How do you see the flow working with supplemental systems? Some mothers I've
spoken to have believed that milk is only removed from the supplementer if
their milk supply is not sufficient but I can't understand how that could be
the case. Presumably if a woman with an abundant milk supply used one the
baby would still get milk from it so....if you are not restricting
supplement and the baby is not breastfeeding at any time without the
supplementer how can the amount of supplement required decrease over time??

> I think it absolutely key to monitor progress in a breastfeeding support
> group or small group clinic to make sure that the baby is starting to
> transfer more milk from the breast and not relying on the SNS.

So are you saying that the SNS in these cases worked purely as a way of
providing supplement to babies (ie avoiding bottles or cups etc) and did not
assist in increasing milk supply?

 I have at least 4 clearcut
> examples of mothers who I have seen recently who spent at least three
> months trying that approach and it only worked when they stopped limiting
> supplement, let the baby actually get as much food as he or she needed,
and
> worked on getting the supply up with a combination of pumping and/or
> domperidone.


I often wonder about the usefulness of breastfeeding supplementers. The
places where we have the most studies on relactation (and the most
women...the Indian study frm last year with 1000 women for eg!) have not had
any gadgets at all, no pumps no supplementer and have just concentrated on
breastfeeding and supplement after breastfeeds. It's not that I can't see
that supplementers can be useful because they clearly are, especially in
cases where long term supplementation is required but just how useful are
they in cases where mothers are concentrating on increasing milk supply??


 I have not seen any of the
> women who were supplementing AND had low supply who just kept the baby on
> the breast without pumping get up to full supply.


Please do!!

> Now, this is really going to push me to demonstrate this in a solidly
> designed study because there is nothing worse than dealing with an
exhaused
> mom, underfeeding baby, and low supply after months of work.

I'm not an LC and have never used a breastfeeding supplementer myself so my
comments/questions are based on talking to mothers and research. That's why
I'm interested in getting a different view from you.

> So, I'm wondering if this might account for the differences in my and
> Karleen's experiences.
>

But what about when breastfeeding isn't so much about nutrition, what about
the 2yo who will not breastfeed without the supplementer. I think that that
is mostly about being used to the supplementer, prefering it that way, not
having had the opportunity to breastfeed without it (JP care to comment??)

>
> "Nipple confused" and/or "Addicted to the breast, bottle, finger, etc"
> really seems to be composing of one or more the following:
>
> * tongue retraction
> * tongue thrusting
> * mouth insufficiently opened
> * inadequate compression of the breast
> * flow confusion
> * stimuli confused (as in hardness, softness, compressibility of finger,
> nipples, breast)

All mothers know that breastfeeding is good for "bonding" but don't know
what that means. I think that going into the nitty gritty of what is
actually happening when a child suckles at the breast can be really helpful
to mothers in understanding that providing nutrition is only a proportion of
what breastfeeding is about, going into the physiological and emotional
interdependence of breastfeeding, stress relieving stuff etc, calming effect
of bf on mum and babe etc. These are things that mums can give themselves
and their babies regardless of how much milk they make.

> My thanks to Karleen for bringing up the bonding issue.  It really is
> important when working with the SNS to think about how to bring this into
> the picture.  It really is such a technogadget and all too easy to get
> caught up in the intricacies of tube sizes and supplement amounts and time
> schedules for breast alone and breast with tube!  Most women consider the
> SNS a necessary evil to help them attain their goals that they want to
drop
> as soon as possible. I completely empathize with the women who go through
> setbacks when their babies haven't gained adequate weight because they
> withdrew supplement too quickly.

Karleen Gribble
Australia

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