Hi Andrea,
I can certainly relate to your observation of this infant's stressed
behavior.  If this mom came to me expecting to have the BF fixed by some
simple techniques, I would gently try to show her and explain to her that
her infant is not yet mature enough to transfer lots of breast milk.  The
arching, grunting, startles, sneezes, hiccups, etc that I am sure she sees a
lot of are signs of distress and immaturity.  I would focus on maximizing wt
gain and keeping feeds (however administered) friendly, quick and supportive
of a normal suck.  I find that Haberman feeders can be ideal for the non
breast feeds and allow mom time to pump and keep the supply up.  I usually
tell moms to expect full term feeding behavior when their premie is 2  weeks
either side of the due date and until then they should be focusing mostly on
building a huge supply to be ready when the baby is ready.

The other issue you bring up is very relevant to any outpatient service.
Part of the issue is to what extent any of us can "read" someone who just
came in for their first consultation.  Some days are better than others.
Also if this mom is trying "one more specialist" after a long line of
frustrating experiences, you may or may not know that.  She may already want
to stop and just needs to say "I tried Bf and even went to a specialist, but
they did nothing".  In spite of this, I do believe there are things we can
say or do that help the family keep going if that is what they truly desire.
I always say something like "I really want to support you in meeting your
goals.  Since we have just met, please tell me what those are."  And, " If I
say anything that sounds really odd to you, please speak up.  I want you to
leave here  with a  clear plan and a back up plan that works for you and
your baby."  This last little speech has led me to write up some plans that
are quite original, but that the family can work with and stick with.  I
remember several times writing plans that say "recreational nursing only
until weight check next week".  Since you are open to ideas, I would also
consider asking moms you have worked with for feedback.  The moms who are
several months out may be very helpful in tailoring the suggestions you give
moms this week.

Good luck and I really appreciate this topic being brought up.
tracy

Tracy Haines Throckmorton
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