Thank you for your input, Teresa.

Here is a reply similar to the one I sent Ann.

I am trying to listen. She seems to have a hard time with relating a
history in any order  at all.. Also, after his 3.5 oz, he was still HUNGRY!
(And that 10 oz a week was with the ABM supplementation, the amount of
which she was vague about.) He seems to need a lot of milk, and I think if
she were pumping more, her supply would increase, but she won't/ can't. I
have discussed seeing  her doctor for a thyroid assessment and hematocrit.
I really feel she does not have "enough" milk at this moment. Have you ever
been at a consult and just been pretty darn sure that baby was not
satified? That was what was happening here.

The problem is, I tried a low tec wait and see approach, only to have panic
phone calls, and realize she was not complying with the treatment plan.(I
personally don't have a problem with the word "compliant" it would take a
dozen words to relate the same behavior an other way.) She also increased
the ABM usage, when we had previously talked about decreasing it as she was
making more milk.

Her letdown is SLOW. It takes a long time to happen.  Also the baby's latch
is difficult for him to sustain. His swallowing is not as regular as I
would like to hear. I am suspecting that, as she said he is "nipple
feeding" more, his latch is actually getting worse. I listen to her. She
wants instant answers, and doesn't want to do what needs to be done on her
end.

I am also seeing that if SOMETHING isn't done now, she will quit. She has
already asked about "pumping and feeding in the bottle." We talked about
the fact that her baby is very happy to nurse, and as it is difficult for
her to pump often enough, AND he can nurse, this wouldn't be the best plan.
She asks a million questions, seemingly sometimes with no point, at every
call. I am trying to stay on topic and she is going off on tangents ect.The
orignial consult was one of the longest I have ever done. I just couldn't
seem to answer everything she wanted to hear.

I DO feel that there is a supply issue, probably from the tongue as well as
maybe the distraction. I didn't hear the amount of swallowing I would have
liked to at the consult, and I think the only reason I saw a 3.5 oz intake
was the combined Proper latch, Compression, lip flanging and encouraging
her to continue nursiong when she thought "he was done." I don't think he
was transfering this much at a regular feed, without these interventions.

I have NO IDEA what is really going on in that house when I am not there. I
used to be a post partum doula, and in moms in this situation what they
*say* they are doing is often very different than what they are actually
doing. I had to talk to her about Early Hunger Cues, as she ignored him,
when I first got there, as he was putting hand to mouth, and fussing. She
waited until a full out cry was in progress for a minute or two before
getting him. I even asked if she wanted me to get him out of the crib,
there was a gate across her bedroom door, where the baby was, and she
almost jumped on me when I started across the gate. SHe also freaked out
when the toddler tried to get over that gate "Not in Mommy's room!" she
told the child. Lots of anxiety there.

There are other issues here besides breastfeeding, I am quite aware of
that. (Anxiety, PPD, OCD, who knows?) But I have to rely on what I am
*seeing*, more than JUST what she is telling me. There are other issues,
*but this baby has to be fed*. He does NOT latch properly, I had hoped an
ENT would correct the frenulum, but it doesn't look like she is going to
address that further. She wants to save her supply and we can't do that by
just continuing to "wait and see."

I am, obviously, really frustrated. Not anxious, as it isn't my baby, but
frustrated, none the less.

Sorry if I am all over the place, this is a complicated consult.

Thank you for your input. I will continue to listen to her. I am hoping I
can *rely* on what I hear. But that doesn't seem to be the case, in this
case.

Mary

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