Indeed, this is one tough case.
Here are my suggestions:
Pick one way to feed baby, mom's choice. I would do paced bottle feeding
with slow flow nipple. But whatever mom wants is best. Then I would
recommend galactagogues for mom. Herbal or prescription or both. I would
recommend mom be seen by an endocrinologist. If she is obese, she may
possibly have insulin resistance and/or polycystic ovary syndrome. She
should also have retained placenta ruled out by ultrasound or I think they
can do Hcg levels? Pick a pump and a flange that mom likes. If she believes
she is getting more milk with the 27 mm flange and the lactina select, I
would go with that. She can always change to larger size if she feels she
needs to. Of course I would recommend continuous kangaroo care if possible.
The mother will likely need a supplementer at breast, but first I would try
to take the pressure off of trying to breastfeed, but allow baby exploration
and self attachment to whatever level he can accomplish.
She may also need some testing or scanning done to check her pituitary if
there is a history of a problem with that, but the endocrinologist can guide
her there too.
I would want the mother to make it clear and get a firm commitment from the
endocrinologist that he/she will support the mother's breastfeeding efforts.
Best of luck to this dyad.
Laurie Wheeler RN MN IBCLC
Mississippi USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome