I can't recall if I sent this update, but I didn't see it in my 'sent'
folder so here it is.

You'll recall that 5 June, I travelled from Atlanta to Birmingham, AL
to help my dh's cousin with her new baby.    10% weight loss following
birth and only 1 oz gained by end of second week.  Temporary live in
baby nurse; baby on four hour feed schedule.   Baby slept from 11 pm
to 4 or 5 am from day four on then fed q 4h during the rest of the
day. [**thud** sound of Katherine hitting the floor in a faint]

For parents, this seemed fine as discharge instructions from hospital
were 'feed her every two to four hours on cue'.  Baby didn't seem to
be asking for more, so they thought it was fine.  Towards the end of
the second week, intervention from the ped changed the feeding
frequency and sent the mom for lactation help.
Through it all, baby 'seemed' fine.  Alert.  Enough output.   Weekly
gains week 3, 4, 5 and 6  were all appropriate at 9,6,8,4.5 oz.  Ped
was very concerned about the 4.5 oz; parents called me.

[skip fun weekend in Birmingham with great new parents, confident,
competent, not easily rattled, fabulous baby - easy going, not easily
frustrated]

 Week 7 update:
~gained 5.5 oz
~continues to exceed developmental milestones
~grow appropriately in length and head circumference
~alert, aware, smiling

Week 8 update will likely come on Monday.

Mom has supplemented an ounce of EBM occasionally in the afternooon -
usually just once a day.  Other times, she doesn't supplement, just
nurses and nurses for the better part of 11 hours from noon to 11 pm.
Supplementation is done at the breast using a Lact-Aid and EBM that
mom easily pumps first thing in the am when she wakes.  While she'd
rather not use it, she, like most other moms I see, finds that an at
breast supplementer makes the most sense and has used it with ease
since we introduced it. Because her supply is so incredibly abundant
in the am, it's clear that the extremely low afternoon supply is
normal physiology (lower prolactin levels) complicated by the days of
the baby nurse (recall the strict four hour feed/nap schedule) and
that the reduction, in this case, does seem to be the 'red herring'
(as I think Rachel stated).

She is continuning to let baby sleep 11 pm-5 am since baby is gaining
well.   We have talked about working with physiology (ie nursing more
at night and early am when prolactin levels and therefore milk
production, are highest).  I do understand her position though that
she's so grateful for the sleep.  At this point, she'd rather get up
and pump, using that milk to supplement later in the day if needed.

On a different but tangentially related note, generally I find that
moms needing to supplement respond very well to using supplementer.
Especially in that group that finds pumping overwhelming, difficult or
not productive, using ABM in a supplementer at breast is a very
appealing and workable solution.   Along with breast compression,
appropriate tweaks to latch and hold (critical front line issues for
any mom with supply issue), dietary adjustments, and galatoguges,
breastfeeding with supplementer as indicated seems to provide a
comprhensive plan that puts moms firmly back on the path of increasing
supply.

Thanks everyone for your help and feedback.  It was very much needed
and appreciated.

Katherine Morrison
Atlanta, GA

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