I would definitely do test weights, you will only know if intake is good 
by doing test weights. The baby probably needs a maximum of 32 ounces 
per day. Probably more like 2.5 ounces times the baby's weight as a 
better judge of what baby needs to be eating. So a 10 lb baby needs 
about 25 ounces per day. This is in the BAB on intake amounts under 
weight gain.

I find that pumping 7 times in 24 hours is usually not enough and most 
moms need bigger flanges and a rental pump. We are now telling moms to 
do 10X in 24 hours for the first week after birth and then 8X and at 
least once per night. The hormones are highest in making milk from 1-5 
AM so we push moms to pump at least once then. I see their milk supply 
dropping when they stop pumping in the night and sleep all night 
through. So it could be that by nursing the baby, mom is actually 
stimulating more often and better than with the pump.

And remember that bottles flow fast and babies are frequently over fed. 
They get a huge amount of formula flowing into their mouths so they have 
to learn to swallow quickly and suck less. This makes them act "hungry" 
after bottles but what they really want is more real sucking. Bottles 
take only about 5-10 minutes and this is a pretty short feeding session 
for a baby. So baby fusses, and then mom feeds them another ounce of two 
and baby becomes over fed and fat.

I would watch the baby for normal breastfeeding weight gain, which is 6 
ounces per week in the first 3-4 months. We don't really know about 
weight gain when baby is overly fat from bottle feeding and then goes to 
breastfeeding only. I have seen them gain less per week, say 3-4 ounces, 
yet in these situations but I am not comfortable saying this is okay. 
While baby was too fat to begin with, we have to make sure their intake 
is adequate from just breastfeeding when relactating or inducing lactation.

I have never had anyone relactate from a zero milk supply or no 
breastfeeding or pumping in the first week to having a full milk supply 
months later. So I am perhaps a bit cautious. I have heard that it can 
happen.

Kathy Eng, BSW, IBCLC

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