Hi Anne
Something odd going on here.
Your post seems to suggest that the quality of this mothers' milk is
inadequate to meet the nutritional needs of her infant (given that the
supply is adequate). I have never seen any evidence that this is possible
(wih the exception perhaps of post gastric-bypass surgery mothers but even
then, I suspect that the issue is poor supply as a result of severe
malnutrition in the mother).
My questions are
1. What is happening with baby's output? (won't know that til after birth"
2. How frequently is the mother feeding? (I suspect that the answer lies
here somewhere.) Is she using a dummy (pacifier) to buy her time to attend
to the older kids? (I would encourage this mother to prepare for the need to
feed *at least* 12 times in twenty four hours in the first month to 6 weeks
- including a cluster-feed period (usually in the evening at about dinner
prep time) in which baby feeds almost constantly for three to four hours.)
3. What growth charts is the paed using? If s/he is using the WHO/CDC
charts, it is likely that the 'required' gains are overestimated.
4. What kind of birth (intervention) does she have?  Does she practice BLA
and s2s immediately after birth and for at least the first 48hrs?
5. Co-sleeping is known to improve breastfeeding exclusivity and duration;
How does the mum feel about taking her baby to bed with her?
6. Is mum expressing unnecessarily (to give bottles when she goes out or in
the night or just so someone else can do the feeding)?

Lastly, don't blame the milk.  If a baby is not growing as expected, is
exclusively breastfed on cue, having 5 heavy wet one use nappies every 24
hours and three or four poos in the early weeks (beyond day five), then
there is likely something wrong with the baby and that needs to be checked
out.  The thyroid history is interesting (overactive thyroid will burn
calories, if I remember rightly).  

We have a deep suspicion of breastmilk in our culture.  It (the lack of it
or the inadequacy of it) is regularly blamed for every infant anomoly.  This
enables us to 'fix' so many problems with commerical non-human milks that
are viewed culturally as so much more reliable (measurable, predictable).
If a baby is not gaining well on human milk, the answer is invariably
formula. If a baby is not doing well on formula, everyone agrees that this
is a situation that warrants further investigation. We have our expectations
upside down on this.  

Hope this helps
Nina Berry
Breastfeeding Counsellor
PhD Candidate
Australia

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