I think it was two years ago that Dr. Jane Morton, a pediatrician from
Stanford, CA, came East while on sabbatical and donated copies of her two-part
video, "A Premie Needs His Mother" to our hospital and the big teaching hospital
nearby.
In this video mothers of preemies are told that when they pump that as soon
as the milk stops spraying, they should stop pumping, and massage the breast,
the start again, pump until the milk stops spraying and massage and then pump
one more time.
I've been meaning to watch it again, but I believe one example given was that
a mother was producing enough milk for one of her twins to be completely fed
breastmilk, but not enough for two. It took a few weeks, but she was able to
increase her supply to provide for both babies.
Medela's booklet on pumping had recommended massage, but according to time
pumping, not spray. So I've modified what I tell moms now to this spray
concept.
Peter Hartmann told us at the New Mexico cf that the mothers they've studied
have experienced multiple let-downs throughout a feeding. That often they
feel the first, but not subsequent ones. He reinforced the idea that the
let-down is necessary to obtain milk. One mother had eight let-downs during one
feeding.
Interestingly, I think it was Kittie Franz that asked us all to stand during
a 1990s cf if we had had one let-down during a feeding. Then has she extended
that number to two, three, four, etc. She had us sit down if we hadn't reached
that number. One mother was left standing who had had 8 let-downs during a
feed. I'm sure most of us used seeing our child begin to suck vigorously and
swallowing again as an indication of let-down.
So even if most of the milk is obtained earlier in the feeding, getting
subsequent let-downs allows more of the remaining milk to be had by the baby.
Mardrey Swenson LLLL DC IBCLC
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