Hi Halle,
I think your approach to this problem with the SNS is a good start.  What is
not clear in your note is whether the baby was ever effective at taking the
milk from the breast.
Inevitably when babies do not gain well the first thought is that the mother
cannot make enough milk.  But the problem did not start at the breast.  There
can be many factors that will end up with the mother not making enough milk;
lack of stimulation, lack of frequent emptying, unrelieved engorgement (LInda
Smith has addressed these problems in her literature and talks), just to name
a few.
In your note I think a very important point was on day five when the baby was
not stooling and decrease urine output. Then would have been a great time to
intervene and save this baby and mother from the trouble they ended up
having. (SIGH)
Maybe with the SNS, herbs and or medications this mother can get her supply
up.  At least she should be able to restore some of it.  I would have her use
the SNS at all feedings, record intakes and weights and then reevaluate after
one week.  I find Moms are more receptive to using the SNS if they can see
progress and should be followed closely for support.
Keep us posted.
Ann Perry RN, IBCLC
Boston, MA

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