Hi all,

Saw a case the other day that has me puzzled.  G1Pl mom 43 yrs. old.
Difficult pregnancy and difficult birth. C-Sec 35 wks gestation.  Mom
began pumping 3 days postpartum.  Called me for a consult as baby now 2
days shy of 3wks.  I was having difficulty with my scale so I couldn't
get an accurate wt.  I saw the baby breastfeed.  Shallow latch.
Reajusting position and latch I heard intermitten swallows.  Showed mom
how to keep the baby sucking as baby was happy to just hold breast in
its mouth.  Mom only pumping 2x a day and breastfeeding 2x a day.
Supplementing with bottle 2x a day.  Total supplement 4 oz of breastmilk
and 5 1/2 oz of formula.  Baby sleeps 6 hr. stretches.  Only feeds 4x a
day.  Baby look ok.  She had a peds appt. scheduled two days after my
consult. Peds visit showed baby to be only 1 oz. below birth wt. Birth
wt. for this 35 weeker was 7#9oz.  Of course I had talked to mom on
increasing feeds and pumping after feeds.  But if this baby is gaining
well, which has me puzzled based on my assessment, I don't know if the
baby does need to increase feeds.  Now, the plan would be to increase
moms supply so she doesn't have to supplement with formula and then mom
and baby can make the transition for all feeds at breast.  SNS did not
interest her.

Is it possible for babies to gain so well when they are only feeding 4x
a day at this age?  Anyone else seen this?

Feeling like I need to go back to school,
Assunta Osterholt, IBCLC