Denise:  First, I should state that for the most part, I do not work with
NICU babies unless the hospital staff or parents have called me in and that
means usually several days have passed).  My experience has been that most
moms don't have mature milk in the first 48 hours--they have colostrum and
then transitional milk--and that any engorgement occurs later.  Believe it
or not, my experience has actually shown that the use of electric pumps
(good, hospital grade Medela or A-E) have even exacerbated this by "getting
things going" too soon for baby to really drain the breast.  I know this
isn't going to fly with a lot of the hospital based LCs, but it's what I
see.

I use a 24-48 hour rule of watch and see, encouraging lots of skin-to-skin,
snuggling, smelling (very important in prolactin levels), licking, baby
massage, etc before introducing expression in large quantities (and I do
encourage the use of Marmet's technique with hands on teaching).  I do
encourage the use of small amounts of hand expression of colostrum to entice
the baby to lick the nipple and areola.  When I am involved from the very
beginning, the rate of engorgement is less than 5%, so I have to believe
that this technique has worked and that we don't need to be pushing the
pumping so early.

On the other side, I DO get lots of calls for engorgement because of
mismanagement, including giving babies supplementary feedings which make
them less interested in the breast.

Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
mom, wife, educator, lactation consultant, researcher, scientist, author,
organic gardener, photographer, lapidary creator, lousy cleaner.

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