Hi there everyone,

I'd like to pick your brains please......if seems like a simple situation but we are not moving forward in the way the mom would like and though we have plans in place, we are still looking for answers.  Permission to post.  1st baby, no health history for mom that indicates any issues with milk supply.  Mom eats 'well', is educated and very willing to do lots to help improve BF situation.  She is taking herbs and domperidone (quite a lot if you ask me), she is pumpiing with a rental pump.  She has actually come a long way in terms of supply and has made peace with the fact that she won't exclusively breastfeed this baby (her decision).  Baby is big boy, now approaching 12wks and gaining well due to supplemental EBM and some formula.  He has good tongue mobility, latch is comfortable for mom (now) and he appears quite symetrical (jaw, ears, etc....).  Mom is able to pump 40 -70ml post feed though 40ml is more typical.  She had a sensitive scale at home for a week and has done test weights with me in a clinic and at her home.  Most baby has ever taken from her is ~58ml with switch nursing and lots of compressions (~1/2hr+) both times this happened was at the clinic.  Average amount taken is more like 18 - 22ml at the breast (both breasts with compressions) then mom supplements and pumps (40+ml).  You can see that this is quite frustrating for the mom.  It is like the baby has learned (and no doubt that he has) that there isn't enough milk or that flow is slow so he doesn't bother.  He falls asleep at the breast very very quickly.  We have tried an at breast supplementer which is better but not great - still sleepy.  We have tried giving supplement first and finishing at the breast, making the breast the reward.  We have tried reducing the amt of supplement and feeding very very frequently.  Baby has had 2 sessions of CST tho haven't heard from mom what the outcome has been yet.  What do you all think?  Encourage the at breast supplementer more? - that is my inclination.   Baby learns milk is at breast (if not in it) and supply is stimulated.  Just really want to know if I am missing anything.....for heavens sake I deal with much tougher situations but I promised the mom I'd write to you all and see what you say.  As I write this I think it seems clear that baby is just smart and knows where the flow is especially after having a tough start where latch was quite poor and flow much more compromised.  Agree or no?

thanks so much

beth mcmillan IBCLC LLLC leader
Ottawa, Ontario

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