What kind of pump is mom using and how often does she use it? Every 2 hours means how many times in 24 hours? (Moms often tell me they pump every 3 hours but that really means 4-5 times in a whole 24 hour period.) Is she sleeping all night without nursing or pumping? Ideally, she is on a rental pump (or hospital grade) and someone has checked that her flanges are big enough.

How many times in 24 hours is she really nursing? Every 3 hours would be 8 times if she is doing it in the nighttime. If she is skipping feedings here and there or sleeping all night, this could be part of the problem.

What kind of childbirth? Induction? C-section? How long on the epidural? Long epidurals make for sleepy babies who usually don't suckle well and stimulate mom's supply. How many weeks was pregnancy at delivery?

Check her latch on for the chin smooshed into the breast and the nose going out. More chin and lower lip onto the breast with the nose out. More bottom areola into baby's mouth. Check for short tongue, tongue tie, etc. 

Was she given Mag. Sulfate before or after delivery?
Is mom on any kind of chemical birth control method? (the pill, shot, patch, ring, etc.)

What is baby's birth weight, lowest weight, and current weight? Hopefully all weighed naked or in just a dry diaper.

How much formula is baby getting in 24 hours? Depending on how poorly baby was doing weight wise before she started supplementing, too much in the bottles and not enough breastfeeding can result in poor milk supply.

Test weights done at the breast would be extremely helpful to see what amounts baby is taking in. Just because baby takes 2 ounces by bottle after nursing doesn't necessarily tell us what we need to know. After nursing, I would have mom pump on a hospital grade electric pump with large enough flanges and see what she gets out. 

I would like to see how baby takes an Avent bottle while sitting upright and the bottle horizontal rather than vertical so gravity pushes the liquid into his mouth. If he can not remove milk in this way, I would suspect something in the baby's suck that isn't right. I would look at if baby's lips grip the breast and bottle correctly, with wide open gape and flanged lips that have muscle tone. 

Good luck to this mom! Kathy Eng, BSW, IBCLC

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