Hi - I've been working for about 2 weeks with a mom who was referred to me from her physician because of failure to gain weight.  The baby was eight days old on the day of this referral - and had stayed at her 8% below birth weight level since discharge on day of life 2.  Latch was perfect.  Maternal history was significant for "minimal breast changes during adolescence and during pregnancy" but felt her milk come in on day 3.  I did a test weigh on her and during a 30 minute feeding baby transferred 0.3mL - this was with breast compression.  To me, low supply explained the weight problems.  I felt she needed to pump to empty - both breasts for 15minutes - after each feeding (at least 8-9times/per day)  She could put the baby to breast as often as she wanted - but pumping after feeding needed to be at least 8x/day.  I suggested starting some formula, which she did - to make the baby calm and help her get strong enough to suck well.  Two days later, she was pumping only 8x/day, putting baby to breast 12, and giving baby about 8 oz of formula with an Avent bottle.  She declined an SNS or syringe or pump - thought of it as too much work in addition to all the other work she was doing with breastfeeding.  Baby gained nicely, but a test weight showed only 0.5 oz transferred.  She started Reglan and 5 days into it, no change.  I added fenugreek and blessed thistle - last test weights (I gave her my scale for the weekend) were 0.5 for one feeding, 0.6 for another, and 1.0 for another.  I have tried to seem optimistic and encouraging, but have never said that I'm sure it will work.  I did say 'you're doing a great job, things are coming together, keep it up - your test weighs are increasing".  I've tried for her to cut back on formula but she now knows how little the baby gets from her and feels when she cries, she needs some.  QUESTION:  should I stop encouraging her to keep up this level of work - seems like it's not working and she's totally frustrated and exhausted; should I encourage her to breastfeed on demand and follow up w/formula as needed?  At some point, I start to feel like I'm giving her false hope.  Any advice would be appreciated!
Janna in CT where we're supposed to get 12 inches today!

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