Morgan
I would be very concerned indeed for a baby whose mother seems to be making
very little milk, and mother is opposed to using formula. The baby really
needs milk, so can she get human milk from a donor or milk bank? If not, I
would really be urging the mother to give her baby the formula, or other
homemade artificial baby milk. My calculations show baby needs about 38 mls
every 2 hrs, not every 6 hours. If the mother is not producing much milk
(you didn't say how much, just that it is very little and dwindling still)
the baby will be at very high risk for dehydration and hyperbilirubinemia.
Of course, you will first try to see if mother can express milk by another
route, either hand expression or the use of a different pump or pump flange
size. Under these circumstances, I would not have  a problem with the mother
having a prescription for domperidone. It needs to be investigated what her
supply is, lactogenesis II etc. The baby may indeed have a tongue tie, or
maybe a dysfunctional suck due to a neurological condition. This would go
along with the baby being "unresponsive to breast and feeding." Is the baby
premature, you said he is just under 6 lbs? The baby does need nourishment,
I think the CST is a good idea, and lots of skin to skin holding (kangaroo
care) to get him feeling more integrated and coordinated.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA

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