You've gotten some good responses. Here's my thoughts:
1. If an experienced mom or LC-type did not assess her milk supply on day 3
or 4, I would wonder about how good her supply really was. I have had many
moms in my office who assess their supplies as good or their breasts as
full, when to me they are not. She may have some hypoplasia? Breasts with
few milk glands just feel very soft and "flaccid" to me.
2. This next point to me is more important: the baby likely has some
suck/swallow/breathe issues, as evidenced by what you have seen and the
admission to the nicu, if even for a short period of time. During the
critical first days of breastfeeding, it is likely baby was bf ineffectively
with little milk transfer. Mom was not expressing during that time, and has
since been possibly under-expressing.
3. I would be working on supply, as you are doing. I like feeding tubes at
breast, but this baby may not be a candidate due to ineffective milk removal
and possibly at risk to aspirate. It may be that, at this time, baby needs
to be paced bottle fed, paying close attention to what he does during feeds
and after. And get him evaluated by speech pathologist, OT, whomever can see
what's going on.
Laurie
Laurie Wheeler RN MN IBCLC
Mississippi USA

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