Jennifer Tow always gives us a reality check. Many good points have been
made in this discussion by her and other lactnetters. We have seen that
donor milk is not often available to "regular" babies. I am at least lucky
that mother's own milk is the go-to milk when supplementation is needed,
but sometimes the mother or the LC cannot get enough or any milk from her.
That is when formula is used (and I wouldn't use 5% weight loss as the
criteria, but look at a plethora of s/s).
I definitely think that teaching that the formula was a temporary measure,
small amounts should be used (depending on day of life and kg weight), and
a bf-friendly feeding device should be used (I like spoons or lactation
aids, and we also use syringes). The mom should have followup of course, in
person.
I just want to share 2 recent success stories.

Baby wouldn't latch but no significant risk factors. Skin to skin and
regular expression of colostrum, spoonfed by my "protocol" which is "shoot
for 5 to 10 puddles of colostrum (the center of a plastic spoon found in
our kitchen) from each breast every 2 or 3 hrs and STS between feeds". Baby
bf robustly at  24 hrs old. Left hospital bf well (altho mother on her own
began bottlefeeding formula). In another case mom had long labor, meconium;
baby wouldn't latch, virtually continuous STS from birth until discharge.
Fed spoons of ebm as above (of course attempting to bf when cues seen), mom
requested a pump but couldn't get milk out so continued hand expressing.
Baby began bf robustly at 36 hrs, first feed about 50 min long. Went home
about 39 hrs old, had lost 2.5%.
The mothers had fairly easy time expressing by hand, but this is not always
the case.  The mothers had supportive nurses and doctors. One nurse
commented the second baby always had a nice warm temp and heart rate around
100-110 very calm. These cases go a long way convincing other doctors and
nurses that this "protocol" can work.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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