Tricia,
I have many times seen situations where the mother reported "plenty" of
wet diapers, but no bowel movements. (Note: what first time mothers
think is wet enough often is not, only they don't know the difference
until they've seen their first really wet diaper after a good, full
feed)  It is quite possible for a baby to take in enough to stay barely
hydrated but not enough to gain weight and thrive. While there is the
occasional baby who will space out from the very start, most should be
stooling often from the onset of mother's milk supply. My starting place
for assessing this situation is to see what's happening with baby's
weight; if baby is gaining normally, then it probably is not a
transfer/supply issue. But if baby is losing weight or just not gaining,
and especially if this is accompanied by a lot of gassiness, falling
asleep at the breast frequently, or the opposite, fussing frequently and
not acting content, then I am very suspicious of milk transfer. How did
baby's next weight check come out?

From there, you ask the question, "why is there a problem with milk
transfer? Is there enough milk, or is baby having difficulty getting
milk out of the breast, or does baby not have adequate access to the
breast?"

While any one "symptom" can be normal in a baby, a combination of yellow
flag symptoms equals a red flag, something that should be reviewed
closely. A good starting place would be to document the baby's intake at
breast via test weights, if at all possible. At this point I would be
suspicious of mom's supply, given that she did not experience much
postpartum change and her milk came in late. The history of infertility
is also an additional red flag in the context of all that is going on;
my experience and research suggests that women with infertility problems
have a higher rate of milk supply problems than average, most likely due
to unknown hormonal imbalances. This mom and babe definitely need to be
followed closely, and baby needs to be supplemented appropriately if mom
she is unable to get enough milk. Pumping after feeds for extra milk is
first choice, formula is second. It is important NOT to starve the baby
out in this process; a weak baby does not do well at breast.

If milk supply is determined to be the issue, there is the possibility
of delayed lactogenesis as opposed to primary failure. Did mother have
mag sulfate therapy, or did she experience severe edema that lasted into
the postpartum? Tincture of time with lots of good stimulation would be
the answer in such a case.

I would encourage you to stay on top of this case-- make sure baby gets
enough to grow, and then if applicable, start addressing supply.

Regards,
Lisa Marasco MA IBCLC

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