Pam, These are actually the kinds of cases I like to work with. Not that I
would be happy with this outcome so far, but it will involve alot of
detective work, diplomacy, and supporting the mom and baby, which I love to
do.
I think there is more to this picture. If baby did in fact weigh 6#10 and
down to 6#7 at 42 hrs, that is no big deal. Perhaps the baby was weighed
again and went down to 6#2, again not necessarily a big deal, but more of a
concern. Perhaps one or more of the weights were  inaccurate. Perhaps the
mother had conveyed to the doctor that baby was starting not to latlch or
was acting very hungry, perhaps then the doctor recommended supplementation.
Any time supplementation is indicated, or ordered, the couple need followup
and investigation as to whether it is a baby not transferring the good
supply that is there, or a mother whose supply is not kicking in. Or a
combination. And of course measures need to be taken to get this referral to
the LC going and the interventions started quickly.
Why the milk didn't "come in" is a worry. Why the baby is not gaining well
on bf+supplemental bottles is worrisome. So I would schedule a nice long
consultation with mom/baby and try to get very detailed info about all these
circumstances and what exactly and how often baby is eating. Observe the
breasts and the breastfeeding. Contact the doctor and let him know that you
are working with this mother to enhance her supply and baby's weight gain
and could he shed some light on their condiiton at discharge and any
subseuent contacts. Afther this, develop a plan with mother and doctor if
the baby is in any bad shape, and at this point you could let him know that
you've had good success with early referrals and early use of hospital grade
pumps, or whatever, and ask what would be a good system to get the referrals
to you. Let him know that you will report to him and discuss with him any
interventions you would want to try.
I think you will find there is some hidden info in the story and that you
will develop a collegial relationship with the doc.
Let us know how it goes.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI/ USA

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