Diane, Heather, and all,

What I meant to say was that the mother expressed only enough to fill
less than half *of the bottom of * the 2-cup measuring pitcher, looked
like maybe 2-3 ml.  The baby's behavior told me that she was VERY
hungry.  At the breast she was doing almost exlusive non-nutritive
sucking.  The weight didn't say she wasn't getting enough milk, but her
behavior did.  I didn't ask about wet diapers.  I didn't need to.  Mom
is pumping every 4 hours and getting only one-fourth ounce each
session.  She pumped every four hours last night, but went 10-hours
without pumping today.  We talked about prioritizing pumping over the
baby's bath.  We talked about how important REGULAR pumping is for
increasing supply.  Mom is also now on antibiotics for a respiratory
infection.

Mom is not using the SNS during the day because she can't juggle (so to
speak) baby (who VERY quickly latches to nipple if mom isn't VERY fast
getting her close enough to get well-latched), large breast (she is
using rolled cloth for support), and SNS.  She is also not using the SNS
because she is worried about the tape sensitivity.  She also seemed to
have some concerns about the tube hurting the baby's mouth (think we
calmed those concerns).  She did report better success today sitting on
the couch with lots of pillows so she could concentrate on holding
baby's shoulders and supporting neck with one hand and holding breast
with the other.

I would much prefer mom use the SNS and will pass on the new suggestions
for securing it.  By now, I'm sure you all understand why the baby needs
supplementing.

Mom is tired, sick, and, trying to learn to consistently keep baby
well-latched while dealing with a an unhappy baby.  She seems hesitant
to ask for the help which appears to be available, and I am not sure
why.   I told her to bottle feed before the feeding so baby would have
the energy and will to keep sucking when she only gets an occasional
swallow of milk, but not to give the entire feeding before nursing so
that she is a little hungry and will be willing to suck.

I'm hoping that once mom is more comfortable with getting and keeping
baby correctly positioned and latched, when baby is calmer, and when mom
feels better she will feel able to supplement totally or at least
primarily with the SNS.

Plan to call mom tomorrow and suggest sliding SNS through bra and/or
small bandaids.  I'll need to see if I can locate the hydrogel tape
before suggesting that.

Thanks for all the suggestions.  Sorry my original story didn't make
sense and thanks for pointing out the inconsistencies.

--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
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