Thanks to all who privately posted me with consolation.  The dad of Baby #1
(the mom with gest. diabetes) came in this AM to return the feeding tube
device and to let me know they decided to wean.  I validated his feelings
about what a nightmare the past 2 weeks have been, and told him when they
feel stronger to complain.  I also phoned the MD.  He was out of the office,
but I spoke to the nurse and told her that 2 weeks was too long to wait to
begin intervention on such a seriously off-the-track baby.  I mentioned (very
nicely) how impt. early stim. of breasts is if baby is non-nurser. A sad
attempt at hand expression every few days will not get it, and in fact, this
mom was involuting. Dad says that this AM he looked at her breasts as she was
dressing.  He described them to me as deflated balloons.  I told nurse that
we could relactate a mom who had established a supply and then weaned, but
that I had my doubts about how well we could do on someone who was involuting
and never established supply.  I put the info about the insur. clerk
comparing the medical grade pump to a diaper bag in the report I faxed to the
doc.  I also spoke to a medical director of the larger group with whom the
doc is affiliated to urge him to try to speak to the insur. people about this
issue.

The good news is that Baby # 2 (the 7 day old ) is looking more promising.
 Mom is pumping 2 oz milk per session and is really hanging in with freq.
feeds/pumps.  Baby woke up just a bit today after generous bottle feeds.  Mom
got baby to do a little nippling, and in general doesn't sound as panicked.
 Baby is producing some mustard stools (about 3 small ones) and urine is
picking up.  We'll keep having happy mouth experiences at breast and feed her
up to a stonger status and then move the bottle out and get her going.
 Luckily this mom has fabulous nipples.  Nice and erect and just the right
size for this baby's mouth.

Just thought you'd like to hear the next chapter.  I have appreciated
Denise's updates on her slow gaining baby.  The best part of clinical
practice is gathering experience of how things turn out and using results of
interventions to hone how you use your skills next time.

Some of the mothers we see are truly heroic, aren't they?.
Barbara Wilson-Clay, BSE, IBCLC
Austin, Tx priv. pract.