I have a great doc here in Vegas that work very closely with especially on infant's that are not gaining well or FTTs in the deep dark whole..  MDs like everything to be quantitative and factual so deal in facts not feelings and you will develop a great relationship with the MD and they will respect you and your knowledge.

Here is what I do:

You want to deal in facts so with a consultation you want do a pre/post feed weight. You need to know how much baby is taking in with compressions (Dr. Newman videos rock!) and with encouragement/stimulation of baby midfeed.

Look in your Counseling the Nursing Mother book.. in the back is a chart for ounces required per weight. Or you can take the weight in lbs and ounces and multiply by 2.5 or you can use any tool on the internet. For a baby >5 days of age if you want to deal in cc/kg the baby should be getting 150-180 cc/kg. So take a 3kg baby on breastmilk. If baby takes in 75cc per feed 8 times a day for 24 hours you get= 75*8= 600 then 600/3kg=200 cc/kg so this baby would be exceeding the need.

Then take what the baby took in during your consultation and see how this relates to the ounce requirement. If it is dead on or over the ounce requirement then suspect something is up metabolically, physiologically, or milk wise (very very rare and usually shows on a newborn screening test). If it is less then you know baby is not getting enough. So say you have a baby who requires 32ounces every 24 hours, thats 4 ounces every 3 hours = 8 feeds in 24 hours. If your baby transferred only 2 ounces then each feed or 8 feeds in 24 hours will require a 2 ounce supplementation. How you supplement is up to mom...depends on her situation, patience, and what her desires are.

With this supplementation I also advise on a weight check every 3-4 days at the peds office to monitor things. That baby needs to gain (prior to 6 months) 5-8 ounces a week. Usually when you see the supply kick up you can catch it here as you see the weight gain jump to 10-12 ounces a week. 

The mom/baby will need a pre/post feed weight check with you once a week for about 2-6 weeks depending on how depleted the supply is and how responsive her hormones are. 

I also have mom pump with a hospital grade pump. At least 4 times in 24 hours, max 6. With 2 of those pumps being done in the night (one during baby's 4-5 hour sleep right before mom goes to bed, after a shower, and when she isn't feeding baby for 20 minutes). The other 3-5 are post feed for 10 minutes.  When you see that pump after the shower before going to bed double in ounces then you are ready to decrease supplementation, but you have to confirm with a pre/post feed transfer weight. I tell moms they have to meet and then exceed baby's need in order for me to decrease the supplementation significantly.

I also suggest anything with oatmeal or brewers yeast.. like lactation cookies.. check drmommas lactation cookies online. 

I also suggest ending the birth control if mom is already on it as this seems to help kick the hormonal cascade back into gear and increase the milk supply.

Hope this helps. Vegas is a tough crowd so the more I deal in facts and numbers the easier my conversations are with the docs here and the more respect I and lactation gains in the community. So far this protocol is working for my moms and it can take anywhere between 2-6 weeks depending on the mom's compliance, the baby, and the hormonal cascade in the mom.

Hope this helps.
Lisa Weinshenker, RN, IBCLC
Las Vegas, NV

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