Dear Mary,
I am a little confused with your client's story.  You stated that at the
visit when the baby was 3 weeks old, she took 3.5 oz at that nursing.  For a 3
week old, that is a good average intake.  Then you said that at that point the
baby had been gaining an average of 10 oz/week since the lowest weight after
birth.  That would be just under 1.5 oz/day, better than the average which is
0.5-1.0 oz/day even with 6 oz of supplement a day.
I want to make another observation from your story.  This mother came to you
at 3 weeks with the complaint of not making enough milk.  You stated that she
was very distracted by the toddler.  You set up a care plan but she did not
follow through with it and it has taken many phone calls on your part to get
even part of the plans fulfilled.
I don't know if you get the JHL but in the latest issue the editor wrote a
great paper on listening to the client.  As I read this I could see where in the
past I may not have fully listened to the client and why some of  them never
followed through with my plans or called back.
Is her problem 'a poor milk supply' or is there some other underlying issues?
 I personally would bring her in, get the weight but not introduce any
gadgets or discuss the frenulum.  I would encourage her to tell you her days, what
is she experiencing since the birth of this baby.  Many times when a mother
does not comply with a care plan may be because they feel it is too overwhelming
and this was really not the issue they wanted resolved.
She has sought you out, let her know you are someone who wants to take the
time to listen to her.
I hope this is of some help.
Ann Perry RN, IBCLC
Boston, MA

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