<the baby was latching on every 2-21/2 hours deeply...so she's supplementing
with 1 oz
formula after....so that the baby gets 2 oz/feed 9x/day to = 18
ounces/24 hours (150cc/kg/day)...feeding 15 minutes each breast every 2 1/2
hours during the day and 1 (4) hour stretch at night to equal 9 feeds or
4 1/2 hours breast stimulation...>

My first question with this mom is "Why the scheduling/timing?" Does this
represent a big *increase* in nsg time for this mom/baby? Is this the *most*
mom is willing to do? I don't ask to be critical - I've worked with women
who just couldn't/wouldn't nurse any more than this. When that happens, they
have to be informed that for *their* baby, at *this* time, it might not be
enough to fully meet the baby's needs. If that's the case, the mom needs to
know that she may need to supplement (if not willing to nurse more), and she
needs to know the reasons why formula might not be the best choice for her
baby.

The first thing I would recommend, IF mom was willing/able, would be to head
straight to bed with the baby and stay there for a couple of days, nursing
at every little squeak or snuffle. When I hear moms able to give me such a
pat run-down on frequency/length of feeds per 24 hrs., I become very
suspicious that it is the *parents* who are driving the nursing, rather than
the baby. There are some babies who do nurse that regularly and predictably,
but I'd sure want to know. And I'm sure you've told her that more=better at
this point.

On the other hand, is this one of those sleepy babies who really *doesn't*
wake spontaneously & want to nurse more often? If that's the case, I'd be
worried that a 21/2 week old baby, esp. one who didn't get off to the
greatest start (mom's engorgement & pain inhibiting let-down), needs to be
prodded a bit more aggressively, that the baby might be becoming weak and
kind of lethargic. In which case, I'd also suggest mom & baby going to bed
together for a few days, and/or fdg. more frequently (at least 12
feeds/day), and/or mom pumping to build supply.

Rule #1 - Feed the Baby! If she can manage, she could pump on one side while
nsg on the other, then switch sides next time. Or if she's truly able to
give this her top-priority attention for a couple of days, pump between fdgs
(I know, hard to do, and reaches a point of diminishing returns!), still
with the baby snuggled right up with her. Or pump a little to get let-down,
then pop the baby on. And she may not need to supplement after every feed -
you could help her work out parameters for deciding this, based on baby's
output, wt. gain, and response.

Let us know how this turns out! As for predicting whether she will be able
to build her supply enough to meet the baby's needs (and see him flourish,
not just creep along), I dunno but I'd guess yes.

Cathy Bargar RN IBCLC Ithaca NY

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