"However, the problem with this is - the very first supplementation - I have mom pump, she feeds baby whatever she has pumped.  Great, baby gets breastmilk, hopefully no formula, and life is good!
However, at the next feeding, there is no breastmilk available to use for supplement (because it was given at the last feed)."

Hi Casey
I am thinking that you have misunderstood how milk is made. Breasts are NOT like bladders.  They don't fill, store, empty and then take time to refill.  They are never truly empty - a bit like a bottomless cup of coffee.  They are more like sweat glands, replacing the fluid that is removed almost as quickly as it is taken - so that there is a 'full feed' available to the baby as little as 20-40mins after the last feed ... for most newborns this means that just as soon as they have finished the second side, the first side is ready to offer a top up.

So, here's what I suggest.  For that first supplement, put baby to breast and express milk from the other side.  Then swap. Offer the EBM.  If the baby hasn't had quite enough to eat, repeat the process (reassuring mum that it doesn't matter how much is expressed, she is just maximising nipple stimulation to let her body know that baby needs more milk) adding breast compression for good measure.  When the baby next starts wriggling, grunting or mouthing, repeat the process ... even if it is only 40 mins or an hour later.  If there is some worry that the mother's milk is going to be slow to come in, then whether baby is hungry or not, express an hour after the last feed and don't allow the baby to go for more than two hours between feeds at breast during the day and 3 overnight. Frequent feeding/milk reduction will trigger onset of copious milk production.  Keeping baby skin to skin with mum between feeds will help baby to conserve energy and increase mum's prolactin levels, too ...

Cheers
n

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