Dear Fellow Lactnetters:
        We have had 4 different moms contact us in the past 2 weeks with babies
who are not gaining weight ( some have lost weight). All had to be put on
supplemental feedings of abm by their pediatricians. We have evaluated
latch and suckling patterns, listened for swallowing, recommended the use
of SNS or cup feeding rather than bottles, suggested Fenugreek and Blessed
Thistle, and none of the four has been able to get her supply up to the
needed levels.
        My question to you all has to do with one of these, a mom who has a 2 week
old baby, approximately 9 lbs at birth, now down to 8 1/2 lbs. The pedi
told her to stop putting baby to breast and to pump (she purchased a PNS)
and bottlefeed both ebm and abm. The reason he gave is so that he will have
an accurate calorie count of the baby's intake and can evaluate to see if
there might be a metabolic problem. I spoke to the MD this morning,
expressed my concern that the supply might drop even more if the baby can't
nurse, and got rather grudging permission to suggest she use the SNS for
some feedings. (She BF with SNS last week, but the baby's wgt dropped when
she stopped supplementing.)  He said he really wants an accurate record of
all intake over the next few days, and of course can't get this if the baby
nurses.  We have no scales available for loan or rental, so test weights
are out.  The mom does not want to take any herbs.  She has not breastfed
since yesterday.  She pumps her breasts (gets about 1/2 oz), then BF for 5
min on each side "to give the baby hindmilk and stimulate milk production",
and then feeds abm with an orthodontic nipple. She says she is tired of the
SNS, so does not want to use it even though I told her I ok'd occasional
use with the MD.
        At this point, the mom seems to be doubting what I tell her; she contacted
another IBCLE by phone (got basically the same info I gave her) and is
still saying she wants to BF. She just wants me to tell her how long it
will take to increase her supply and how to do it.  The pedi is with the
group in our area that probably supports BF best. I am at a loss to think
of anything else to suggest. I would appreciate your input.
Thanks!  Anne