Carol, you wrote:
<I am intrigued by the idea(can't remember who suggested it.) of pumping
=
colostrum prenatally and using the expressed colostrum if the baby =
needed a supplement in the early postpartum---baby unable to latch, baby
=
of a mom who is diabetic, baby is hypoglycemic, has elevated bilirubin, =
etc. I have some questions and thoughts:>

I believe it was Jack who suggested this.

I do not have an answer to all your questions, but some observations that
may be pertinent.

Over the years, I have used prenatal vacuum preparation for tissue
expansion of inverted or retracting nipples as an intervention for about
5-6 mothers.

The particular method I used did not compress over the milk sinuses
themselves, so there was little or no colostrum obtained. But I imagine
it did stimulate prolactin, (and prolactin receptors?) and some oxytocin,
although I never had one recognize contractions as a result of the 10-15
minute sessions q.i.d.

But from the '70's, I think, there is an Israeli article about using a
breast pump for induction of labor for grand multiparas whose uteri were
too sensitive for the poorly controllable manner of pitocin
administration then available.

If I remember correctly, the protocol was for unilateral pumping 15
minutes, pausing 15 minutes then using alternate side, etc., etc. It
generally took 4 or so hours to induce labor.

A universal side effect they noted was "an early, copious milk supply
with little or no engorgement." That is what I noted in many of the
mothers I followed after vacuum preparation. One mother met me on Monday
a.m. with a volufeed with a full 45 cc. of colostrum she had pumped in
the previous 12 hours or so following her delivery.

Two of my daughters, each 3-4 weeks overdue, used a double electric pump
to try to induce labor. Though each ended up with a CS for CPD, I also
noted an early, plentiful colostrum and milk supply with no real
engorgement problem that I remember being asked about.

Since the baby would technically no longer be premature at 37 weeks, the
concern over labor might grow less after this time. This would seem to
provide plenty of opportunity for advance collection for scheduled CS
mothers too.

I wonder if it is too unrealistic to suggest this might somehow be worked
into the care of the mothers who need augmentation of labor, also. A
several hour trial of the much gentler electric pump than the IV pitocin
to see if it produced the desired results, with a bonus of colostrum
collected and refrigerated prior to birth.

In fact, to avoid the necessity to freeze and possibly destroy some
components, the closer to delivery the better. I am willing to bet this
would be feasible for some moms hospitalized on the antepartum unit or
admitted several hours before an elective CS, if hospital personnel and
physicians were interested (and convinced of its value) enough to give it
a try.

My observations lead me to think that hand expression of a small amount
at a time would be more efficient than pumping when it is solely for the
purpose of collection. This might be caught directly into a very small
(sterilized) plastic cup with an airtight lid (I have seen a 2 inch tall
container made by a popular U.S. plasticware company, sold at home
parties). This is pliable enough to be used for direct cup feeding of the
infant.

This might be the most efficient way for a mother to have an advance
colostrum supply ready for this suggested prevention/treatment of
hypoglycemia. The smaller container, the less path to and from the lip of
the cup for it to cling to the side.

I hope you continue further to stimulate our collective thinking about a
protocol that willing mothers might have as a choice for avoiding the
other alternatives now in use.

Jean
*****************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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