Elishiva, I had hoped I explained this well enough, but realize I did not. Please see below: In a message dated 3/24/00 1:23:37 AM, [log in to unmask] writes: << Jennifer, since you say that the mother is "able to pump enough milk for her baby," why is it "clear" that the mom doesn't have enough of a milk supply? It sounds like she has it, the pump is getting it out, but for some reason the baby still isn't >> While mom *can* pump enough, it is a rather long and arduous process for her. It takes her 20 minutes of double-pumping, often *after* an attempted feeding where the baby has stimulated the breast but not exhibited any swallowing or effective suckling, just to get perhaps 2 or 3 ounces. While this is certainly sufficient to feed a baby of 4 weeks, most mothers would find themselves either pumping more in 20 minutes or decreasing to about 10 minutes to pump this amount. Now, in and of itself, this would still not concern me, except that when I watch the baby nurse, I do not see *any* signs of effective transfer. <<-- that's why she's supplementing with milk pumped after (and doesn't need to 'after a good feeding'). >> I have never seen one of these "good feedings", BTW. The mother has described them as happening about once per day, in the morning. << If that milk is in the breast now waiting to be pumped out after a "not-so-good feeding" by the baby, why do you feel "the baby would do well if mom's supply came up" even further?>> Partly b/c the baby has been finger fed for almost 4 weeks and bottlefed once per day for several weeks. Partly b/c the baby does show increased interest w/ alternate massage. But, she never opens her eyes at the breast, there are only brief moments of audible swallowing, she continues to be extremely sleepy and fussy at the breast, while alert at other times. It reminds me of the thread re: the study of cup vs bottlefeeding and "no" nipple confusion--this baby, as Jack replied, would fit into the category of the baby who did well despite the bottles or cup (or in this case finger feeds) if her mother had a really abundant supply. Unfortunately, the mother will not try a supplementer again and does not have an abundant supply. <<All of this tends to suggest to me that the problem is still the baby's job of getting the milk transferred better (thereby both feeding herself and stimulating her mother), rather than the Reglan-related job of getting mom's breasts to produce more.>> I agree that problem still lies with the baby, but without a supplementer and w/o the proper stimulation, the mother is losing the ground she gained w/ the Reglan. She finds she is pumping somewhat less milk and her breasts have not changed much in appearance from when she first started using the Reglan (at which time the most she could pump was about 1/2 oz). Since the baby was not latching at all when the mother started the Reglan and has only been latching correctly for a few days, I think this is the worst time to go off the Reglan. I thought that if we could keep the drug therapy in place now that the baby knows how to latch, she may get some reward for her efforts and begin to suckle better. If you have any other ideas about how to approach this, mom is very open. <<Jennifer - this seems to me to be a situation where a spot of weighing might come in useful! Not test weighing (!) but just weighing....like Elisheva, I don't know why you think there is not enough milk for the baby, unless it's because the baby seems unhappy at the breast (though as you say there may be other reasons for this).>> Heather, See above, but she is not only fussy, but falls asleep soon after latching and suckling for a brief time. She does have some brief gulping/swallowing, but only very brief. The weighing would be an unclear test, since mom has not gone more than about 18 hours w/o adding a supplement, as she sees immediate decrease in output. <<Chances are this baby and mother will gradually do better now the latch is improving, though if the breasts are only being stimulated 6-7 times a day she'll need more than that to build and maintain a supply.>> My big concern is that the baby decreases wet diapers and has no poops at all when mom just nurses. The 6-7X is pumping--mom is putting baby to breast every time the baby wakes (2-3, rarely 4 hour intervals). She is exhausted, as she has been doing this for 3 weeks and spends up to an hour working on nursing and then still has to pump. I would appreciate any help, as this mom has been very committed to this baby in spite of much family opposition. Jennifer Tow, IBCLC, CT, USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html