If the infant is 13 ounces down at 16 days that baby isn't getting enough to eat. He should have been back up to birth weight by 10 days, 14 days at the max. Unless there has been some early difficulty with stimulating milk supply - i.e. mother not feeding frequently enough, separation from infant, infant not transferring milk well, etc. (which doesn't sound like this has been the case), your most likely cause is primary lactation failure given her history of infertility and hypoplastic breasts. She may not be physically able to produce a full supply of milk. This infant needs food immediately. I'm guessing that this baby is not have 6 to 8 wet diapers and at least 4 large, yellow bowel movements per day? We either need to get this baby some donor human milk or formula stat. Did this mother ever have any breast changes during pregnancy? After delivery? Did she notice her areola darkening during pregnancy? These are red flags when it comes to infertility
 and hypoplastic breasts.

I would get her pumping 8 to 10 times per day for 20 to 30 minutes with a hospital grade pump and see how much production we can stimulate. But given the history of infertility and hypoplastic breasts, she is at a higher risk of primary lactation failure and may not be able to produce a full supply of milk for this baby. But in my opinion, the number one rule is feed the baby! This is going to be very hard on her emotionally, but I would encourage you to accept her feelings and praise her for whatever production she can get, and support whatever decision she makes. Also discuss the possibility of using donor human milk, and talk about the benefits of even providing a partial supply of human milk. Focus on increasing milk production as much as possible and supplementing as much as needed to help that baby gain weight. Reglan, domperidone, or herbal supplements can increase production a little bit and possibly reduce the amount of supplement the mother
 needs to give. But frequent breast emptying is going to be the most important intervention to maximize milk production, and likely if her supply is this low, medications may increase production a little, but are likely not going to result in a full supply of milk. This is a person who could probably really use a referral to a human milk bank.

Here's an article from Marianne Neifert on lactation failure.
http://pediatrics.aappublications.org/content/76/5/823.short


I hope I'm wrong though and the pumping stimulates a full production of milk, but these all sound like big red flags to me. 

Sincerely,
Tricia Shamblin, RN, IBCLC

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