Sue Wirth's client: " She was only breastfeeding the baby 5 times each day
and the baby was sleeping
8 hours at night. "

No wonder she had a fall off of supply. This is simply *not enough* for
many babies to stimulate and sustain adequate milk production for exclusive
bf in the early weeks and months. Some babies manage it, of course, but the
majority don't.

"Starting on 2/25 she breastfed 9x/day immediately followed
by supplements of formula (19oz./24hrs total). "

9 times a day is better,  hope it included waking the baby at night.  But
heavens, that's a lot of top ups of formula. Depending on the baby's
condition, some top ups may have been indicated, but I would be concerned
that giving top ups as frequently as this *is bound to reduce the milk
supply further* and, worse, work against the positive change of feeding
more frequently.

" Since 3/1 (this is where I came into the picture) she has been pumping 6+
x/day, BF 5x/day (and inbetween
feeds) and supplementing 5x/day with as much as 28oz. "

Why is she only bf 5 times a day again? Why not bf as much as possible,
give lots of skin to skin, and pump as well if there is time?  There is no
point in pumping *instead* of feeding. 28 ounces of formula is a truly huge
amount - probably as much as 75 per cent of the baby's calorie needs. If
she wants to top up, why not use the pumped EBM?  Has anyone seen the baby
feed?

Truly, from the sound of it, I think this may be a situation where the
simplest explanation and solution  has not yet been properly tried.

Keep us posted!

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK