Yes, Jennifer, you did!  If I am interpreting data correctly, baby has been gaining an ounce per day (both scales are recording the same weight change per day) so she is moving forward but not at a great clip...plus she needs to catch up.  Giving EBM in a bottle after every feeding will help to get her there so that is great advice.  
It is a lot of extra work to breastfeed, bottle feed and pump with 3 other kids.  Since she gave up with the others, she may find it easier to nurse once baby gets back to where she wants to be on the growth curve.  So temporarily giving baby extra milk (more than she can probably pump) may be the key now.  Remember that banked breast milk can be used before formula if mom is adamant against using it.  You need a prescription and it is expensive but it is the next best alternative.  If not then formula will help baby catch up sooner and make breastfeeding much easier.  
Keeping mom pumping after each feed will maintain or grow her supply...which may have already slipped down because of the slow weight gain.  Hand expression can help too.  Once baby is caught up with weight, mom will likely have boosted her supply enough by pumping/hand expressing for baby to take over at the breast, although there is always some transition.
Keep up the good work!
Annie Brown, FNP, IBCLC
Greenwich CT

On Jul 18, 2011, at 4:05 PM, LACTNET automatic digest system wrote:

> Thank you so much for all the responses I got to my original post! I have been away from my computer for a few days so couldn't respond sooner, but was so grateful for all the input into this case.
> 
> Here is the update: I spoke to mom Thursday night and suggested that she pump and give baby extra EMB until weight catches up. Mom has a pump but doesn't know how to use it, so wanted me show her. I arranged to see her Friday, two days after first seeing the baby.
> 
> The good news: latch is hugely improved, baby takes a big mouthful and doesn't slip off. Saw lots of swallowing. Baby drank 2 oz in 1/2 the time that she took 1.5 oz during the previous visit. Baby had two large bowel movements while I was present. Mother is feeding a lot more frequently.
> 
> I was originally scheduled to visit at 4 p.m., mainly to work on pumping, but mother postponed until 5:30, and baby was hungry when I got there, so once the feed was finished I had only 10 minutes to show mom how to pump (she purchased an Ameda Purely Yours with a previous child but never opened it) before needing to get back to my own family, who were waiting dinner on me. I set up the pump and gave mom the general idea but have no idea if she's been pumping regularly--I was away for the weekend visiting my daughter in sleepaway camp. I plan to call her this evening.
> 
> My main concern now is about the baby's weight: the pediatrician saw the baby Friday morning. On the dr's scale, she weighed 7# 3 oz (naked). On my scale Friday afternoon, she weighed 6# 12 oz (also naked). The dr has a mechanical baby scale; I have a brand new Tanita BD-815U digital scale. Which is more likely to be accurate? 7 oz is a huge discrepancy! If it is my scale that is so inaccurate, I will have to send it back! The doctor isn't too concerned about the weight. I am quite concerned. The dr also told mom to pump, mainly because he believes that whatever amount mom pumps will tell him how much the baby is getting at each feeding. I know that's not the case, but I am glad he told her to pump b/c it reinforces what I told her. As you can tell, mom is very passive and needs lots of handholding. I don't want to have to go every day to help her pump. I hope I am underestimating her. She did take to heart my latching and feeding frequency advice.
> 
> I feel very over-involved but am not sure how to disentangle myself. I am actually wondering if the baby should be supplemented with formula (unless mother has EBM for her). But the doctor didn't suggest it. What is my responsibility here? I find myself worrying about this baby several times a day.
> 
> Certainly, I will be a lot more cautious the next time someone tells me "everything's fine but could you just come and check the latch"!
> 
> Jennifer Sokolow, IBCLC
> 
> PS Someone mentioned about other ways to support this mother. She has biweekly cleaning help, dinners delivered by synagogue members every night, her older children are in day camp and her husband is home for the foreseeable future. So I think she has a pretty good support system. Depression was also mentioned. I'm pretty familiar with depression and I don't think she's depressed. I've known her for two years and she's always been passive and cheerful, just as she is now.
> 
> On Jul 13, 2011, at 11:28 PM, Jennifer Sokolow wrote:
> 
>> Hello Wise Ones,
>> 
>> I am helping a friend with breastfeeding, always a tricky proposition. I just saw her today and would like some feedback about the advice I gave her.
>> 
>> Background: This is baby #4. With first three, mom never felt baby was getting enough at breast, so she supplemented with formula after every feed and stopped bf within the first 2-3 months. This time mom said that she really wanted to bf and make it work. Induced at 38 weeks due to low amniotic fluid. Typical US hospital medicated vaginal birth. Mom was offered to have baby on chest immediately after birth but refused until after baby was bathed & swaddled. We made plans for me to visit twice in the first weeks, but each time mom cancelled. She said baby was doing well. Last night, however, mom told me she had nipple soreness and asked if I could see her today.
>> 
>> I visited this afternoon. Baby is now 13 days old, but only one day adjusted, as her due date was yesterday. Birth weight was 7# 4 oz. At 1 week old, her weight at the ped's office was 6# 12 oz. Mom informed me that baby had regained her birthweight as of today (according to the bathroom scale trick: mom weighed herself with and without baby and subtracted). We know how accurate that is! On my Tanita neonatal scale, baby was 6# 10.4 oz. So in fact, baby had lost slightly or just maintained her weight for the last week and is NOT back to birthweight. This was concerning to me.
> 

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