I know that this seems like an elementary question and for those that
work with SNS's daily I'm sure it is that is why I seek your collective
wisdom.  I thankfully don't often have the occasion to recommend it's use
often and when I do I find I stumble over the logistics of it's use.
I had a mom that wanted to get baby "back to breast" after one week of
using ABM and not being able to latch baby after grandma suggested she
use a bottle because the baby "wasn't getting anything".  Mom was very
upset and felt grandma (her mom) had sabotaged her efforts.  I suggested
the use of an SNS/electric pump as we were able to get baby to the breast
and latched without alot of distress on the baby's part.
Here is the logistics question:  If she pumps prior to a feed then the
baby will most likely use whatever she pumps, then there will be no
leftovers and no way for her to tell how much to reduce the amount in the
SNS by next time.  If she pumps after the feed, she will probably not get
much to put in the SNS the next time and will have to resort to using ABM
as the supplement.
As I am writing this (its amazing how much clearer things seem when your
not in the midst of chaos) I'm thinking probably best to recommend
pumping in between nursing sessions like an hour after/before nursing but
it seems like a lot to ask and there really is no way to predict when the
baby will want to nurse again anyway.
Can someone help me over this stumbling block?  I can't believe I'm
having this much difficulty with what seems like such a simple question.

Ilene Fabisch, IBCLC, LLLL, WIC Bf Co and NE Rep
Brockton, MA

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