Carol called on me to explain a statement I made to Lacnet some time ago.
Basically it was that a mother of a preemie should continue to express at
approximately the frequency she expects the baby to go to the breast for
feeding when that becomes possible, but specifically not to drop the middle
of the night expression (despite a good milk supply) because baby will need
night feeds.  My rationale is that the breasts still need to be 'primed' at
particular times to be producing milk for that particular time - not well
explained, but I hope you understand what I mean.

Carol has quite correctly reminded me that breasts make milk at a rate
depending on degree of emptiness, and how does my rationale fit into this
fact.

Now my rationale goes something like - when baby first drops that middle of
the night feed (I know there are a lot of you out there who haven't
experienced this :-)  ) the breasts are very full and uncomfortable until
baby finally wakes and feeds (or gets woken to relieve the discomfort).
Similarly when baby starts to drop feeds when weaning commences.  Soon
afterwards the breasts remain soft and comfortable at that 'usual time'
that the feed/expression was dropped.

BUT, I can see Carol's point that in those cases baby may be reducing milk
volume produced, but in the case of the expressing for prems the volume is
not an issue (in this case).  Back to thinking while I type... but the prem
when he starts to breastfeed will not be able to take the larger volumes
the mother has been (over)expressing each time so that she doesn't have to
wake at night.

Sandra Lang in her book 'Breastfeeding Special Care Babies' states that
expressing should occur "at least 6 - 8 times in 24 hours..." and "During
the night".  I know about prolactin levels being higher at night, so
definitely good for a woman with low supply - but that's not the issue in
this particular case.

Questions:
Will the mother have difficulty/inconvenience/discomfort adjusting her milk
production (not volume, but timing of production) when baby starts going to
the breast?
When baby starts taking those nighttime breastfeeds will there be an
adequate supply in her breasts at that time?  (I can see that the answer
should be yes here, but would like to hear other comments)
Can some of the NICU LCs please respond as well with even just anecdotal
comments. Thanks.

Denise
Brisbane, Australia
(Don't you just hate it when someone questions what you've held to be near
and dear and when you do an evaluation on it yourself it doesn't look too
good?  Is this called 'personal growth'?)
Catherine, I've cc'd this to you because I felt it may be in your area of
expertise, too.  Thanks.
****************************************************
Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Course
http://www.breasted.com.au
mailto:[log in to unmask]
****************************************************

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