I also think that this...
I also think that this...
When it appears a baby is not getting enough milk/not gaining as baby should, a few things "should" happen right away. They often do not, unfortunately.
1) It should be ascertained that baby is really not getting enough/not gaining. So weight checks need to be very carefully done on the same scale under the same exact conditions (baby naked or in a dry diaper.) Different scales, even when accurate, are calibrated differently and throw weight checks off, even by several ounces or more.
2) IF baby is really not gaining: Breastfeeding should be assessed by someone trained to do so. This is vital, because there are several reasons a baby might not be getting enough milk. It could be that mom has low milk production. This is usually what everyone assumes. BUt WHY does mom have low milk production? That is important to figure out. But it could also very well be that mom has plenty of milk but baby has difficulty extracting enough milk. (Milk transfer issues.) again, WHY baby has difficulty extracting enough milk must be ascertained. And very often it is as simple an issue of baby being sleepy and not nursing enough or not being allowed/encouraged to nurse frequently enough. It could also be a combination of any of these. Mom can attempt to figure this out herself or with the support of a breastfeeding knowledgeable doctor, but typically, especially when it is clear baby is not getting enough milk for some reason, this is when an experienced lactation consultant, preferably an IBCLC or one who has the same education/clinical training hours as an IBCLC should have, should be brought into it. LLL Leaders offer volunteer peer support, not trained professional lactation assistance. When there are newborn weight gain issues or anything else that serious, we can certainly talk the situation through with mom and offer information and support, but it would be stepping waaaaay outside our expertise to examine the mom, baby, or breastfeeding and attempt a diagnoses of the issues. The cost of a IBCLC consultation will vary from area to area, some areas/govt. programs have low cost or free options, some insurance carriers pay for it. Unfortunately, however, amny moms do find they must pay out of pocket. In the case of having to pay out of pocket, the cost of even several LC appts. (usually no more than one is needed) would typically be far less than the cost of formula feeding over many months. Also, sometimes an LC will be happy to offer a low cost option or payment plan etc. Private practice LCs are usually very passionate about helping moms. They have to make a living, but for what they do and the amount of training they must have, IBCLCs (particularly private practiec LCs) do not make much at all.
3) If it is ascertained that baby needs to have supplemental feedings, efforts should be made to have the supplement be moms own pumped milk as much as possible. This is not only healthier for baby, but mom should be pumping anyway to maintain and bring in appropriate milk production supply when supplementing.
4) Even if baby is supplemented with formula, mom needs to pump. Even if the initial issue had nothing to do with low supply, a mom will begin to lose her milk production ability when supplements are given. This can be helped (although not always completely solved) by regular pumping. Frequent, effective removal of milk from the breasts, by baby if possible and by a pump if needed, is always needed to improve/maintain appropriate milk production. In the absence of this, galactagogues are not going to do much. If this is happening, galactagogues may help, even quite a bit, but every mom responds differently to galactagogues.
5) Pumping should be done with a hospital grade rented pump if at all possible. This is the only pump designed for around the clock pumping and/or pumping that is meant to help bring in an appropriate milk production as opposed to simply extracting milk a couple times a day from a mom with an already established supply, which is what personal use double sided electric pumps are for.
6) Baby should be encouraged to nurse as much as possible, every feeding session if possible, even when getting supplements.
7) Supplements should be given in an as breastfeeding supportive way as possible. An at the breast supplementer (lactation aid) is a good tool if baby is able to latch and nurse, if that does not work or is not possible, cup feeding or paced bottled feeding techniques could be tried. And yes it often helps quite a bit if the supplement is given first and baby is allowed to finish the feeding at the breast.
8) As soon as it is possible, proactive steps can be made to wean baby off the supplements as much as possible, hopefully moving to exclusive breastfeeding-if possible. This can be done very slowly and carefully.
All of this is important because we KNOW that supplementing reduces breastfeeding duration/leads to the early cessation of nursing. And that happens because 1) Supplementing causes a mom to lose milk supply and 2) supplementing causes a baby to lose interest in breastfeeding over time due to various issues.
I do not know how much of the above you are already doing or have done. But going forward, I think even at this point, you could consider doing any of the above that makes sense to you, and it may very well help.