Thank you for your input, Teresa. Here is a reply similar to the one I sent Ann. I am trying to listen. She seems to have a hard time with relating a history in any order at all.. Also, after his 3.5 oz, he was still HUNGRY! (And that 10 oz a week was with the ABM supplementation, the amount of which she was vague about.) He seems to need a lot of milk, and I think if she were pumping more, her supply would increase, but she won't/ can't. I have discussed seeing her doctor for a thyroid assessment and hematocrit. I really feel she does not have "enough" milk at this moment. Have you ever been at a consult and just been pretty darn sure that baby was not satified? That was what was happening here. The problem is, I tried a low tec wait and see approach, only to have panic phone calls, and realize she was not complying with the treatment plan.(I personally don't have a problem with the word "compliant" it would take a dozen words to relate the same behavior an other way.) She also increased the ABM usage, when we had previously talked about decreasing it as she was making more milk. Her letdown is SLOW. It takes a long time to happen. Also the baby's latch is difficult for him to sustain. His swallowing is not as regular as I would like to hear. I am suspecting that, as she said he is "nipple feeding" more, his latch is actually getting worse. I listen to her. She wants instant answers, and doesn't want to do what needs to be done on her end. I am also seeing that if SOMETHING isn't done now, she will quit. She has already asked about "pumping and feeding in the bottle." We talked about the fact that her baby is very happy to nurse, and as it is difficult for her to pump often enough, AND he can nurse, this wouldn't be the best plan. She asks a million questions, seemingly sometimes with no point, at every call. I am trying to stay on topic and she is going off on tangents ect.The orignial consult was one of the longest I have ever done. I just couldn't seem to answer everything she wanted to hear. I DO feel that there is a supply issue, probably from the tongue as well as maybe the distraction. I didn't hear the amount of swallowing I would have liked to at the consult, and I think the only reason I saw a 3.5 oz intake was the combined Proper latch, Compression, lip flanging and encouraging her to continue nursiong when she thought "he was done." I don't think he was transfering this much at a regular feed, without these interventions. I have NO IDEA what is really going on in that house when I am not there. I used to be a post partum doula, and in moms in this situation what they *say* they are doing is often very different than what they are actually doing. I had to talk to her about Early Hunger Cues, as she ignored him, when I first got there, as he was putting hand to mouth, and fussing. She waited until a full out cry was in progress for a minute or two before getting him. I even asked if she wanted me to get him out of the crib, there was a gate across her bedroom door, where the baby was, and she almost jumped on me when I started across the gate. SHe also freaked out when the toddler tried to get over that gate "Not in Mommy's room!" she told the child. Lots of anxiety there. There are other issues here besides breastfeeding, I am quite aware of that. (Anxiety, PPD, OCD, who knows?) But I have to rely on what I am *seeing*, more than JUST what she is telling me. There are other issues, *but this baby has to be fed*. He does NOT latch properly, I had hoped an ENT would correct the frenulum, but it doesn't look like she is going to address that further. She wants to save her supply and we can't do that by just continuing to "wait and see." I am, obviously, really frustrated. Not anxious, as it isn't my baby, but frustrated, none the less. Sorry if I am all over the place, this is a complicated consult. Thank you for your input. I will continue to listen to her. I am hoping I can *rely* on what I hear. But that doesn't seem to be the case, in this case. Mary *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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