pat asks "Now the dilemma.  Can she increase her supply to make enough for
"at least 2 feedings at breast per day" or does she need to work on
increasing supply in general, get the supply up, and then sort of wean down
to the feedings she wants to keep?"

hi pat,
in my experience this mother will not be successful only doing 2 bf/day. the
baby is quite young at 4wks, and the mother has been doing quite alot of
supplementing, so she has never really established a good supply it seems.
she gives alot of supplement after bf and one day even skipped bf altogether
and i guess did not get engorged. the milk transfer was .5 oz and baby
sometimes takes 5 oz!
i guess anything is possible but i think this baby will very soon be
refusing to bf altogether and be completely on formula. i would be honest w/
the mom, saying that while the antibodies are being rec'd by baby thru any
bf, the dose baby is getting is very small and will not likely have a very
big impact on baby's health. i would ask mom what her bf goals were. if she
wants to bf for several months or a year or more, i would advise her that in
my experience babies are usually fully formula fed by 1-2 mos, w/ this
scenario. i would explore w/ her acceptable strategies for increasing her
supply. ultimately of course it is her decision but i would not give her
false hope but, as you are doing, encourage her to resume bf or expressing
regularly for the baby.
as you know older babies/children can continue bf and keep some supply going
for months and months. a new baby generally does not do this, in my
experience.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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