I have been working with a mother for about 6 weeks. She had a very difficult delivery and a slow recovery. Initially she called me telling me she couldn't handle baby being latch-on all the time, she was exhausted. Baby was literally latched constantly. She couldn't come see me because she had gone to her mother's to recover and the father runs a business 16 hours a day. Baby sounded dehydrated and like he was getting into trouble. I said feed the baby in no uncertain terms. Finally at about 10 days the mother made it in to see me. Baby was below birth weight and the ABM mother was giving was causing diarrhea. Mom insisted that baby didn't like the ABM and preferred the breast. Mom never became engorged after the delivery. Little swallowing at breast and a terrible latch. I corrected the latch. Sent mom home with a pump and instructions on how much to supplement. Mom was so stressed and was going home w/o any help or support so I put off moving baby from bottles to alternate feeding methods until the next visit. Next visit baby was having more trouble with diarrhea. Dr had suggested a hypo allergenic ABM which baby refused so Dr said put baby back on Soy. I gave mom an alternate hypo allergenic ABM to the one the Dr had suggested and we discussed allergies at length. Mom has quite an allergy history. Mom was only pumping 2-3 x per day. No time, she said, baby was constantly at breast. Recorrected L-O at this point and tried finger feeding baby or syringing at breast. Baby would not stay at breast when ABM was introduced, w/o ABM baby latched-and relatched constantly and did not do well w/ finger feeding, kept breaking suction an pulling away. Mother was very uncomfortable with the thought and still completely stressed. I decided not to push it. Mom went home promising to try to pump more but the Jewish holidays prevented this. She kept giving the breast very frequently, and giving supplemental ABM. Friday she called me in a panic. Baby was refusing ABM altogether. On questioning her baby was having 6-8 wet diapers and 4-5 stools after 2 days off ABM. Monday she called me first thing. Saturday her breasts had engorged and she didn't know what was wrong. She took baby off breast for 24 hours because they were so painful. I told her it sounded like normal postpartum engorgement and get the baby back to breast. She came to see me Wednesday and baby is back at breast and engorgement is subsiding. Baby looks great! Weight is up 1#1 oz in 19 days. After 5 weeks her milk finally came in! Lucky for this baby because he seems very allergic. Mother reported to me during the visit, as an aside, that she is still bleeding heavily (soaking maxi pads). She has a postpartum appointment tomarrow so I told her to be sure and discuss the possibility of retained placental fragments with her HCP. I also called ahead to let them know what I have seen. Denise Parker, BA, IBCLC