Judy
I do sometimes recommend "switch nursing" when a baby is a sorta "sleepy
newborn" maybe jaundiced, but otherwise normal in my opinion. I advise the
mom to watch the baby and when the good open- pause-close or what I
sometimes call the "long strong" sucks cease, to do breast compression to
get more swallows then switch to the other breast. And keep doing this til
we get a good amt into the baby. As a general rule, though, I advise the
finish first breast first rule of thumb.
Now regards your client "10 week old infant, who MD feels is not gaining
well enough, gaining 1/2-3/4 oz. per day". Judy, on the face of it this
seems not very problematic becoz it works out to 3.5 to 5.5 oz per week,
which I think is normal or maybe low normal, but if consistant and all
devel. milestones intact, then I would advise to assess mom's bf and bf
practices and counsel to optimal bf practices.
"and MD has gradually increased suggested formula supplements to 12 oz /day.
I really am having a difficult time understanding the need for all this
formula". Yes, I agree. If the formula has been gradually added BUT THE MOM
HAS NOT COMPENSATED BY WORKING ON KEEPING UP or improving HER OWN SUPPLY and
bf management then this will lead to her supply going down the toilet. Also
the baby may come to prefer or respond better to the firmer or longer
artificial teat and/or the faster flow from the bottle. THIS IS A CLASSIC
CASE OF SUPPLEMENTATION LEADING TO BF FAILURE, IMO. Now I must add that you
have to carefully assess this bf dyad to see if the mother or baby has a
primary problem, a management problem, or reallly needs some
supplementation. However when supplementation is used, the mother should AT
THE SAME TIME be working hard to improve her supply to its optimum. [I use
the caps for emphasis only - not flaming of course].

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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