For premature babies, the Texas Dept of Health, WIC pamphlet on 
premature babies says that ideally mom will get started pumping within 
six hours after birth (a paraphrase). I do not have the research but I 
have read something like this in the JHL about how the women that 
started pumping after 48 hours had much lower milk supplies. I 
definitely see this -- I get many women who start pumping really late 
for their premature baby, say day 5. Most make about 8 ounces a day or 1 
ounce per pumping total of two sides together. I heard Marianne Neifert 
talk something like 7 years ago, and she said the breasts have shut down 
production by day 7 without stimulation (baby nursing or removal of milk 
by pump or hand). Since her talk, I have been watching this, and I would 
agree with her. Some moms end up ok starting out really late but mostly 
I see poor milk supply. Sometimes these bottle feeding moms get really 
engorged on day 5-7 and then pump at our WIC clinics to relieve the 
pain/pressure. They might get several ounces out on that first ever milk 
removal but if they pump again 3 hours later, they remove a teaspoon 
only. I have seen better results when mom is actually nursing but maybe 
the baby isn't removing milk well and we catch it on day 4-7. These moms 
seem to be able to increase their supply more easily when the baby 
hasn't done a good job in the first week. Seems like their hormonal 
levels are higher or they have more milk producing cells than women who 
are exclusively pumping.

Just my two cents. Kathy Eng, BSW, IBCLC

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