Catherine W.G. writes:
"I would prefer something more active, like a syringe with a feeding
tube......
With the syringe and tube, mom or dad can push some milk to baby upon
each tiny sucking effort."

Had a frustrating case today where this was so true.  5 day old.  Birth
unremarkable.  Weight same as at d/c (just under 6 pounds). Mom had
increase in breast size in pg.  No hx of breast surgery or trauma.  Mom
felt her milk wasn't "in" yet.  I was able to express drops from her
breast, but no sprays.  I could feel some firmness in her
breast-probably a few "full" ducts-but not what I would have expected at
5 days.   Didn't think until after she left to ask about her bleeding
(r/o retained placenta) but will ask when I talk to her tomorrow.  Mom
obtaining less than an ounce with pumping in spite of using massage and
nipple stimulation before pumping.  Baby took over 2 hours to feed and
was "never satisfied".  Output in last 24 hours was 4 wet and 3 dirty.
Parents had tried Haberman, cup, syringe/tube at breast and bottle.
Baby usually screamed at whatever was used to try to feed him, but was
at the same time desparately rooting.  Digital oral assessment was
difficult as baby would not latch to my finger in spite of trying to
stimulate a response by stroking palate or tongue.  Didn't even try to
suck and them get frustrated because nothing came out of the finger.

I was wondering how we would even meet rule #! (Feed the Baby).  I was
finally able to get him to finger feed (syringe and tube) by pushing
some milk into his mouth even though he wouldn't latch to the finger at
first.  After getting a couple ccs with my taking the lead, he eagerly
guzzled more down on his own (with just a slight pressure to counter the
friction of syringe inside tube).  Mom then did it herself very well.
Dad seemed more to be saying "Why are you bothering, just bottle feed"
(in spite of the fact that baby wasn't accepting the bottle either.)  He
eventually took an ounce total before "zonking out".  Mom now felt she
was successfully feeding her baby.

My conclusion was that baby had become so frustrated at getting so
little at the breast that he just gave up on getting food from anything
in or near his mouth in spite of the fact that his instincts and
reflexes were urging him to eat.  He probably needed more than the ounce
he took, but was so exhausted from trying everything else that as soon
as he had enough to relieve the hunger pangs, he was ready to sleep.  I
fully expect he will take more the next feinge feeds.

Mom left with plan to finger feed through the weekend giving lots of
skin-to-skin without trying to get him to breast (some "happy time" at
breast with no pressure) unless he showed a strong instinct to try to
latch.  Meanwhile, mom will be taking galactagogue (MM+) and "super
pumping".  On Monday  I'll see her again and we'll decide where to go
from there.  Without the baby finally taking to finger feeding, my next
step would have been to track down the doc and see if baby needed to be
admitted for IVs or gavage feeding.

Winnie

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