Hi Laura,
You asked what would I do. There are several ways of approaching this
situation, as you noted. I generally "err on the side of caution" and I
don't think I would yet leave baby to his own devices. There are still too
many "red flags" to wit: initial wt loss of 20 percent, which is huge; he
gained with supplements, however lost again as soon as supplements were
weaned; feeds are still long, lasting over an hour and still needing
encouragement; he is around 17 days old and not quite back to birthweight,
i.e. still very behind what his curve should be; even after a good feed he
does not empty breast; he is still sleepy and has a poor suck. The mom is
still very concerned and does not feel baby will take enough milk on his
own. For all of these reasons, I would continue a program of
supplementation, with mom's own milk, which I would be very keen to preserve
with all the strategies we know. This mother needs alot of emotional
support, and it sounds like this baby "may" have hypotonia, or some syndrome
or something that needs to be looked into further.
That is the route I would take. In fact, I would not encourage those very
lengthy feeds at breast, but rather give the ebm bottle after a shorter
breastfeed, preserving baby's energy and mom's time and energy for milk
expression.
It might be possible to supplement with a supply line (nursing supplementer)
at breast, but if baby is sleepy, with poor suck, it might not work. Also,
mother may not be ready for that new technique.
It goes without saying, this baby needs very close monitoring.
Hope this is helpful to you.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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