You asked ...

"How do you keep baby 2 from going the same way as baby 1. What kind of
hospital policies do you have to preserve breastfeeding in situations like
these."

First of all, mom has to want to breastfeed and put some effort into it. 
Some women give lip service to the notion that they really want to 
breastfeed but if you look at their behavior what they are really doing is 
bottle feeding.

I find that women who want to nurse are usually pumping at least 4 times in 
24 hours and actively soliciting BF help. Those ladies that are pumping once 
a day, at that point her supply is so low that a lot of intervention will be 
needed to get baby to breast. A milk supply of 2 ounces is extremely 
difficult to work with for most mothers and babies. Meaning some kind of 
supplementation, and the SNS is not that easy to use (moms don't always find 
it easy or like it). Using an SNS with a nipple shield makes it harder for 
the mother to do by herself. And it will take her a couple of weeks to even 
see what kind of success she will have.

The other consideration is that if mom didn't get off to a good start in the 
first week, her milk production may not come back up much. She may have 
missed her window of opportunity. She will most likely have to continue to 
supplement.

Other people has answered about hospital practices so I will share a little 
bit of my experience with you. When I have mothers like this, I ask them if 
they want to learn to put baby to breast OR, are they happy giving bottles 
like they are now? I also ask them how do they feel when their baby cries 
because I have found the majority of mothers won't "make" their baby nurse 
if he resists and cries. They feel baby has chosen the bottle and they want 
to "support baby's choice." (Yes, I actually hear it said that way.)

For those moms who choose to bottlefeed, I at least try to get them pumping 
more -- even a manual pump is better than nothing.

I wish you were here in my part of Houston. It would be great to have a 
physician who cares as much as you do.

Kathy Eng, BSW, IBCLC 

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