Hi Tricia,
Sorry I do not have the original post to look at, but I would have to say
that lecithin is not the culprit. The first thing we will look for are
horses, not zebras, as they say. Sometimes a mother with many children will
be unable to devote the time for lengthy feedings or extra feedings and may
also fail to wake a sleepy baby or may use a pacifier when busy with other
children. Please don't take that as any accusation of her love for her
baby. However, you describe a "babymoon" period with 14+ feeds a day but
still a very "dramatic" wt loss (7#6 to 5#12). This is a wt loss of 780
grams or 22%!  I do not agree that pumping 30 mls after 30 min of bf is a
sign of an adequate milk supply. My guess is that the baby was only getting
a few mls, if any, and the 30 mls was all that was there. I also do not
agree that this is a "too much foremilk" problem, but that this is a "not
enough milk" problem. Sometimes there is milk there in the early days, but
it downregulates due to poor milk removal on the baby's part; but I think
you said this happened in the first 5 days, so the milk supply never was
adequate.
I am thinking this mother was assumed to be quite knowledgeable and
experienced with bf, as I would assume, and possibly did not receive a
lengthy and focused discharge discussion, as I might not have given her
either. Or she may very well have gotten a thorough discharge discussion,
but overlooked the signs of ineffective feeding. It is imperative for us
to make a renewed committment today, to emphasize to every mother the signs
of effective vs ineffective feeding and when to contact a skilled bf
helper. I am sure if we questioned, very specifically, the character of the
voids and stools, we would find that the voids were very small (for new LCs
you can ask: "with your eyes closed, can you easily tell the difference in
heaviness of a clean vs wet diaper? do you have to pull apart the
disposable diaper to see if it is wet? are the voids almost clear or do
they appear dark yellow, brownish or (especially I see this) pink, orange,
or reddish?"). Also when asking about the stools, ask about the size of the
stools (a teaspoon size? a smear?), the color? any dark at all by 3 full
days old? and emphasize to mothers that the wet and dirty diaper volumes
(not just frequency) should increase significantly and the baby should not
have less number of wets or poops in successive days (early days) and never
go a day w/o stooling. I am just mentioning this as I find it is very
important in triage, to ask detailed descriptors of the diaper output. Also
inquire about jaundice, saying words like "does the baby's white part of
the eyes look yellow, and the baby's chest or tummy look yellow, peachy, or
pumpkin-y?). I don't know if you got to help her later, or in person or by
phone, but everyone should know this particular baby should be referred
directly to hospital ER or doctor's office stat, and should not be managed
alone by the LC. I will comment more in next post re the management of the
mother's breasts.

<<The baby looked emaciated and hadn't stooled for 36 hours, but it was
voiding. Another sign to me that we have too more foremilk and not enough
hindmilk. This baby looked like it was starving to death. Plus mom is able
to pump milk. If we have a production problem, why is she able to pump 30
ml after breastfeeding for 30 min? >>

Laurie Wheeler RN MN IBCLC
Mississippi USA

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