Carrie
What an ordeal for this woman. It seems the autoimmune issues are not 
causing direct problems except for the induction which led to early bf 
difficulty. Immediately upon reading the first part of her story I thought 
insufficient milk supply. It seems that is the crux of the problem. It seems 
it was not asked or noticed whether her milk came in. My plan would have 
been to have mother state her goals and then go for RPS, pumping with a 
medela classic or ameda elite 8-10x, supplementation per mom's choice, 
generally either slow flow bottle or tube supplementer at breast. I don't 
see how thumb feeding is helpful in any way??? Why the Haberman??
It does not seem to me, by her report, that there are any suck issues with 
the baby. I have seen unusual shaped breasts and areola, like described, and 
baby just does not have the fullness of the breast to get a good latch on 
to. This situation is difficult and one must be tactful yet honest, but I do 
not recommend giving predictions such as "you'll never make enough milk" or 
the like.

It sounds to me that mother should think about what *she* wants at this 
point and go from there. I would be thinking regular bottle feeding (sounds 
like mom figured that one out), continue the galactagogues (she may be going 
overboard with the teas - not saying she should stop it if she wants it, but 
does she ever just enjoy another beverage????), let the baby self-attach at 
will, baby needs pleasurable breast experiences not battles. I definitely 
feel the 9 oz is fabulous and definitely making a difference. Encourage mom 
to believe in that. I think what adoptive moms do would be helpful for this 
mother, and that she can totally bf at some point when baby's need is for 
less volume of milk. This can happen if mother makes the committment to bf 
long term. She can possibly maintain this level of milk production with less 
than 8x pumping. By the way, I don't feel the Lactina works as well as the 
other 2 I mentioned, so I would have preferred mother stay with the classic. 
I have no experience with the Symphony but studies I've seen seem to show no 
real advantage over the classic. I would offer a tube supplementer at breast 
*for later* once baby is interested in latching. Bringing this in now would 
be another battle, IMO.

Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA

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