The mom is anemic and baby is slow to gain weight but has now, at day 25
is back to birth weight with a borderline weight gain of 4 1/2 oz in a week.
All the other signs of adequate milk are there-an increase in stools which
are more substantial than in the beginning and plenty of wet diapers yet the
question remains whether this baby is getting "enough" and if formula is
indicated. And what type of role does maternal long-term anemia play?

  I will speak from personal experience here as I also have found no
reference dealing with maternal long-term anemia and it's effects on milk
supply. As a long standing vegetarian (since the age of 12) and at times,
not a very good one, I have battled with anemia over the past 25+ years.
Like this mother, I am lucky I can sit her and type as my hbg hovers around
7-9 during pregnancy.  BUT after 6 pregnancies (along with tandem nursing 5
babies) I have had absolutely no problems with milk supply issues. I cannot
speak for this current pregancy but I do not anticipate a problem.  Except
for the slow weight gain in the beginning, hasn't this mother's baby met all
the other parameters of "normal"  growth once he got going?

  In my mind I view this as more of an inadaquate milk removal  in the early
days. I may have missed the details of the birth and weight loss but  was
this mother really nursing frequently and effectively around the clock?
Unless we are there to witness this it is hard to say. How many times have
we heard mothers tell us all the things we want to hear but the pieces don't
add up. This baby has improved and I feel it gets better for many mothers
after the initial week or two of struggling to tend to a newborn and
everything else. She is anemic, she is tired from that. She has a new baby,
that is exhausting, too. Maybe she is just doing too much at home in
addition to tending to the baby, not eating properly and missing a feeding
here or there?  If the peds (at least one) feels ok with a take and see
attitude before giving formula, I woud run with it!

   If the mother is taking large doses of iron plus eating an iron rich diet
there has to be something wrong with the way she processes iron. If it is as
the result of an inadaquate diet, this mother really needs nutritional
counseling. She can take all the iron she wants but if she is taking it with
foods that block absorption, she'll get no where. I have found that when
iron is prescribed there is rarely any directions other than "take once a
day." Well, if you take it with dairy products your body just isn't going to
get it. It took research on my part to know how and when to take iron and
the difference between "heme" and "non-heme" iron. Fortunately I can bump my
iron levels between pregnancies to not need iron pills. But if I slack off
on proper diet, hgb drops. It takes months of iron supplementation to
rebuild an iron store so this mother, once she starts taking it properly if
that is the problem, won't see results for awhile.  My OB once joked with me
and said it was like I was shopping at 7-11(convenience store) getting just
what I needed instead of going to a full grocery store and stocking up!

  Forgive me if this sounds at all jumbled-my brain is lacking iron to think
all-together clear!

  ~Lorij, LLL Leader, AAPL
  mom to 6

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