Denise,
You asked for input from other NICU LC's on the subject of pumping
schedules for moms of babies not yet receiving full feeds at breast.
Our pumping guidelines suggest that moms pump at least 8 times in 24
hours for the first several weeks. This must include at least one
"middle of the night " pumping.
All moms are given double kits and pump with a hospital grade electric
breast pump which they rent from us when discharged from the hospital.
The Labor and Delivery staff have been educated on the importance of
early stimulation of the breasts in regard to the development of a good
milk supply. Our protocol is to have moms of NICU babies start pumping
within one hour of delivery (afterall, they make sure baby goes to
breast right away, so why not pump right away?), and every three hours
after that. The literature is pretty clear on the need for early and
frequent stimulation to establish a good milk supply, on double pumping,
and on the use of a hospital grade electric breast pump for this kind of
situation (NICU baby). Pumping in the middle of the night in those
crucial early days is also supported by what we know about prolactin
levels throughout the day and night. I wholeheartedly agree though,
that what we know about the pumping needs for a mom who has established
a good milk supply and is in the "maintenance" phase of pumping and
lactation is much less well understood. When moms have a great milk
supply after 4 weeks (I say 4 weeks because we often see a drop in
supply at the 4 week mark), we then let them know that they can go to 6
or 7 pumpings in 24 hours and see what happens. If there is a
significant drop in supply, they can go back to their original
schedule. Some moms skip the "middle of the night" pumping at this
point so that they can get more sleep. I have seen a significant number
of moms though, drop their supply when they do that, and need to go
back to an around the clock schedule, even if it's every 4 hours rather
than every 3 hours. That's just my experience.
As far as letting the moms supply drop to a level closer to the babies
present needs, knowing that it will increase as baby's needs increase
once he/she is home nursing, I have to say that makes me nervous for a
couple of reasons. First of all, many of our babies are VLBW (very low
birth weight), and are on hind milk feeds. That is, we have mom pump
about half and put that in one container labeled formilk, and then pump
the rest and label it hindmilk. We then feed the baby only the hindmilk
portion so that they get more fat and calories. They need a very good
supply to do this. Definitely more than just what baby is receiving for
feedings.
The other thing is that we are dealing with fragile babies who may or
may not go home exclusively breastfeeding. If we are counting on the
baby to bring moms supply up at home we may get into trouble. We want
moms to "wean off" pumping when they get home, as baby gets bigger and
more mature and hopefully moves toward more and more feedings at
breast. It is stressful enough, IMHO, for a mom to take home a former
NICU baby, not to mention having to work on improving her supply.
I'm sorry this was so long, this is a subject very near and dear to my
heart as I work with so many moms in this situation.
I hopes this helps. I am really looking forward to hearing from other
NICU LC's, and will read with an open mind anything that differs from my
own experience.
Sincerely,
Mary M. Lussier BSN IBCLC
Hartford, CT.
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