Thanks for the update and additional info, Heather!

I think you have drawn a valid conclusion: "I do not think she's neglecting
the baby or other children. But I do think she needs more support in an
ongoing fashion."  You and others have told her about services that she is
eligible for, but that she cannot or will not access ... and I am guessing
cannot more than anything, given what else you told us:   "It seems that
she has multiple limitations in terms of follow through, as she has not
taken actions to increase supply since we discussed a plan together."

None of this rises to the level of neglect that is a reportable offense.
 What it tells us is that this a mother who needs a LOT of support.  The
care plans suggested aren't manageable for this mom.  I wonder if any of US
could follow through!

So you have to find a different plan, that *does* work for her.  Does she
have a phone? Does she have two hands?  This may be a mom who simply needs
you to call her frequently, much like a peer counselor, to cheer her on and
remind her of what she can do with the equipment she has (the hands....):
Breast massage briefly before nursing, and compressions during a feed.
All of that can be done within the considerable barriers she faces. and
during the times she is nursing.

She also deserves praise praise praise for sticking with BFg with this
child, given the history of short-term lactation with her other kids.  It
may well be that this kid *is* healthy as an ox, thanks to BFg, even if the
gain has been slow.

Do this for free, and write it off (as many of us PPLCs do) as one of those
moms who haunts us, and whom we end up giving way more help to than we ever
charge for.  *Do* continue to keep her HCPs updated (your ethical
obligation doesn't stop when the the work is pro bono).  I'd be pulling in
the OB on reports, given her IGT suspicion.  And also bringing up thought
(23): What kind of birth control is mom using?

And I agree with the suggestions about using introduction of solids (if the
MD concurs it is time ...) as a way to make this a bit less onerous.

You also said "I can't make her actually do any of the stuff that I'm
urging her to do, and I'm just not sure what else to do!"  That is true for
ALL of us IBCLCs, no matter what our work setting, and no matter what the
income or home life of the mother happens to be.  It is one of the great
frustrations of our profession.

 Good luck, and tell us how things progress!

-- 
Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA
IBCLCs empower women and save babies' lives!
Learn more <http://tinyurl.com/3nj2p3c> and visit www.ILCA.org

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