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Sent: Monday, January 05, 2004 12:02 AM
Subject: LACTNET Digest - 4 Jan 2004 (#2004-26)

It has been an interesting conversation about pumping and points out that
there is a great deal we have no hard answers for. A lot depends on our
evaluation of what is really going on. Is this a primary supply problem from
a hormonal cause or a latching problem etc. Different causes I suspect will
benefit from different pumping approaches. I do like Dee Kassing's Approach
to pumping right after latches.( Especially if the baby's latch is not
draining the breast.) Babies who are not thriving at the breast are often
poorly feeding and need supplementing. I have the mother feed at the breast
with as good a latch as possible for as long as the baby is actively sucking
with added breast compressions to assist. She does both breasts as long as
the baby is vigorous enough to continue. ( I see some very weak ,lethargic
babies who have been at the breast 24/7 not thriving, who can only maintain
sucking for  10 min or less.) Then, if possible, a helper (Dad,
Grandma,)supplements the baby (using any previously pumped milk if available
first) while the mother pumps. This way everthing is done in about 1 hour.
The mother is  less overwhelmed that before when she was feeding constantly
or when the baby was crying constantly from hunger, or sleeping constantly
from lack of calories. I have seen babies and supplies turn around quickly
when the baby's caloric needs improve. The baby is more vigorous at the
breast and the extra pumping has increased flow along with supply. Fenugreek
or domperidone might also be added to this approach.
But each situation is different that no one obsolute approach works for all.
When a mom asks me at the beginning of the visit what my plan will be, I can
honestly say that until closser to the end of the visit, I do not yet know.
That is what makes what wwe do do difficult and so challanging and so
rewarding. Good luck to us all! Ann Anderson, RN,IBCLC,Neew Jersey

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