Dear Amy, this is really great that you were able to help this mom latch on 
and have the baby nurse. I work with many moms who get a late start in 
either pumping or nursing. Some individuals will do just fine with such a 
late start but my professional experience is that it is more normal for moms 
to have a low supply in these situations. What I see with the moms of 
premature babies who get started pumping day 5 or later often make about 1 
ounces per pumping session (total extracted each time combined from both 
breasts).

You did right by showing her how to use a supplementer at the breast. I like 
to do test weights (I use a Tanita BLB 12, weights down to 1/10 of an ounce 
or 2 grams) just to be sure. I encourage 10 nursings in 24 hours. The more 
formula one has to use as a supplement, the longer it takes for baby to get 
hungry again, and this often drops down to 7-8 feedings in 24 hours.

Also, many moms have a larger reservoir of milk pooled in their breasts. The 
first pumping or nursing will be a decent quantity. BUT, the next pumping or 
nursing may be just drops because the breast isn't geared up to make milk 
(yet). My experience is that most moms need about 3 days to begin making 
larger amounts of milk. The key wording here is "to begin making more milk." 
And this is without galatagogues because the WIC population I work with 
usually will not try them or can not buy them.

Watch the weight gain, watch the number of bowel movements per day. 
Carefully monitor weight until baby is gaining 8 ounces a week just at the 
breast with no supplements. It would also be helpful if she could pump for 
5-10  minutes after each nursing with a hospital grade (rental) pump to 
super stimulate her supply.

All you can do is try, nothing ventured nothing gained.

Kathy Eng, BSW, IBCLC 

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