Thanks for your response, Jan. This is really interesting to me, because
for a long time I was seeing this bolus, and wondering if I was the only one
who noticed it! :-) I hadn't read or heard anything about it.
I suspected that Peter Hartman's work might address this "colostrum bolus"
issue; thanks for letting me know. If anyone can give me an idea of where
to look for specifics I would really appreciate it. I would really like to
know the "mechanics" of it and why it would "go back up" the ducts.
I would have to say that over 50% of the time (and that might be a
conservative estimate), I see that bolus even if it is hours later. Usually
around 10-15cc or so from each side, although I've seen more. I had a mom
this weekend pump an ounce from each side after not pumping until around 24
hours after delivery. It happens often enough that I tell our NICU moms
that they probably will get the bolus, but not to panic if after that they
just get drops for awhile. I am working on getting our NICU moms pumping
within 6 hours after birth, but right now it just is not happening (we have
to let those moms rest, you know :-(). It is usually 12-24 hours when they
first pump, unless I can catch them and get them going myself. Maybe I am
misunderstanding the amount of the bolus, and if I did see a mom pump within
that first hour I would be totally shocked at the large amount she gets!!
:-)
What about the length of time that she pumps that first time? Would that be
a factor at getting the bolus? If she pumps long enough to stimulate a
let-down of the colostrum bolus even if has "gone back up"? I usually have
moms pump for 15 minutes with a Hollister SMB.
It is extremely rare that I have a mom who gets nothing at all, even the
first time that she pumps, although it does happen. Usually they can see
drops, which gives them some hope to keep going, although so many get
discouraged, especially if they've seen that bolus and now just get the
drops. I often have moms tell me that they're getting "nothing" but when I
watch them pump, there are drops. I guess they don't think the drops
"count".
Anyway, I, too, would be interested to hear about others experiences with
this. Thanks again, Jan.
Melinda Lueck, RN, BSN, IBCLC
Toledo, Ohio, USA (where maybe there's something in the water that helps
with the colostrum bolus:-))
Jan writes:
I believe that was in some of Peter Hartmann's work -- whether stated at a
conference at ILCA some time back or in his written work, I can't be
certain.
But that is where it came from.
Interesting you are still seeing a bolus after pumping 12 to 24 hours for
the first time. I am not. And I have been doing this work for 25 years
also.
I can remember a very few moms that may have been able to pump as much as 5
or 7 cc when they pump the first time at 6 to 12 hours (but generally they
don't pump anything), and they have been few and far between. Enough that
when a mom gets that much, we comment on it and how unusual it is. Today's
mom finally pumped 5 cc, and she has now pumped 12 times since the baby was
born on Friday night. Didn't start pumping until Saturday, about noon.
How much of a bolus are you seeing when a mom pumps for the first time at
12
- 24 hours? And when you say "often will see that bolus..." what do you
mean by often? Every time? 50% of the time? 75%? 25%?
I would guess that I see a "bolus" of 5 or 7 cc about 10% of the time when
mom starts pumping later than 1 to 2 hours after birth.
How about the rest of you? What are your experiences? When I lecture
around the country, I find that when I bring this up, I've had just about
the same response of "nothing," that I've seen. Of course, I've not
lectured in Toledo in years, so maybe that's it. :>D (Joke, joke --
that's a JOKE!)
Jan Barger, RN, MA, IBCLC
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