You can always have the mother pump an ounce or so off before breastfeeding to get higher calorie milk. When I have a mother with a huge supply (I wish it were more often!!), I have her pump some off first, based on her best guess of what the amount of milk she has in her breast, as well as what the baby may take when she does give a bottle. I like her to still leave more than the baby needs so it makes it easier for the baby to get his feed. For example: If she knows that one breast has 4-5 ounces and the baby usually takes 45-60 ccs, she can pump an ounce or two off, and still leave plenty for the baby. The milk should also be higher in calories and help him gain and not be so gassy if there is an issue. I also tell them that they don't need to pump that breast after a feeding if the baby has fed well, because they will be just creating a bigger oversupply. I also say that this is not for forever, but until the baby gets more competent and skilled at breastfeeding, as well as asking them to always let their pedi in on how they are feeding their babies, so he/she has that information and help make a good feeding plan as needed. Our babies go home long before their due dates and need close and careful follow up until everyone is comfortable.
Maureen Allen RN, BSN, IBCLC
Boston, MA
-----Original Message-----
From: Joanna Koch <[log in to unmask]>
To: [log in to unmask]
Sent: Mon, 12 Sep 2005 17:27:25 -0700
Subject: Re: Nipple Shields and Premature Infants
Anne - My experience is that a nipple shield may well help bring baby to
breast but
1. Mom needs to have pumped in a great supply, and she will need to
continue some pumping even with baby at brst.
2. Milk baby will receive tends to be lower fat as low-energy infant
unlikely to nurse actively enough thru shield to draw down the fattier milk.
I've seen fore/hindmilk imbalance as result.
3. Not clear that baby is always learning bfdg skills, especially on a
small, narrow nipple shield. Mouth is not making a bfdg shape.
I see it as another option to offer mom. Am not sure breastfeeding outcome
is any better than with a **carefully** given bottle but the closeness may
be just what mom needs.
On the other hand have also seen moms struggling with shield + pump +
various tubing devices tucked under the shield to give formula supplement.
The ones who are enjoying this of course are not paying money to see me so I
only see the ones in tears over all the gadgets and major time investment.
As LCs we have a lot of tools avail to us, and the trick is to know which
options will help mom, offer them to her and then let her decide. "The
mother is always right". (A quote from Linda Smith if I remember
correctly.)
Joanna Koch, IBCLC, N. Ca.
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