There is a big difference between preemies and micro-preemies in terms of
management.  I corresponded with Dr. Rey in Bogota in the mid-eighties.  He
is the doctor who was pioneering kangaroo care in a hospital in Bogata that
was so poor they didn't have enough isolettes for their preemies.  They were
putting multiple babies in each incubator and they were getting infections
and dying.  He developed the concept of the mothers wearing the babies who
were capable of breathing room air in an upright position inside their
shirts and doing very frequent short breastfeeds.  The babies survival rates
went up and the bonding (always a risk with prems since Boudin noted this
phenomenon in the early 1900s) improved.  So the concept is a proven
possibility, although I have not personally seen and don't know what the
long term growth and health outcomes of those babies have been.

 Is this model transferable?  I'd like to think it is, because it certainly
has some very humane aspects to it.  However, culture plays such a huge
role.  Right now, the ability of most women in the US to afford this would
be questionable.  Often the most vulnerable populations don't have good
social support for such an effort in terms of transportation, housing,
financial assistance, help caring for other children at home, job
protection, etc.  This is not to say such support is impossible to develop,
just that it doesn't presently exist in our institutions, where, as Laurie
says, separation is the norm.  People like Paula Meier have made wonderful
in-roads with her Milk Club idea.  She has weekly lunch meetings (feeds the
moms for free and even has a grant to provide free taxi transport for those
with no other acess to transport.) The moms receive  education about the
needs of preemies, supported in their pumping/expressing efforts, and are
involved in making decisions about and handling their infants. They also
provide each other with emotional support.  So this is a model that has
proven efficacy, and others could be explored.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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