In a message dated 11/15/02 5:05:47 AM, [log in to unmask] writes:

<< at and others, I've always wondered about how this problem should be
managed. My take with a mother of a premature is to help her get a good milk
production, even if that is an oversupply, in the first weeks. To make sure
that in the future, maybe 3, 6 months down the line she doesn't have
undersupply problems. I'm thinking along the lines of getting those
prolactin receptors optimal in the first weeks, and also so that she has a
sort of "buffer" in her milk supply incase she has trouble with expressing
etc. Pat's post is making me realise that this is maybe looking to far into
the future? But is it prudent to first build an exeptional supply, and then
temporarily reduce this supply when it looks like the infant can start
coming to the breast?

My rational is that to get the prolactin receptors well established, then
reduce the supply by letting the receptors "rest". Gee, this maybe way off
mark, and I know I tend to theorize everything to the molecular level! And
I have zero experience in helping a premature to the breast but is there any
sense in what I'm saying?

Sara Bernard
The NEtherlands (not feeling so stupid now that I've been told that there is
only one changing room at this ice rink).
 >>
Sara it makes a lot of sense to "calibrate" the breasts high for a mother of
a premie who has to pump long term. There are several reasons for this. One,
many mothers do experience a dip in supply and this early oversupply protects
for this. Also, breastfeeding is easier for premies if mother has an ample
supply and easy flow--in fact in can be the thing that makes the difference
for these babies establishing breastfeeding. Finally, we used to think that
once the baby was nursing the supply would naturally increase, but it just
ain't so.  When teaching moms I tell them that it is far easier to establish
an early good supply then to try to ramp it up later on.

That all said, however, 12 oz. every two hours is way too much milk--we're ta
lking 144 oz. per day.  Mom is going to experience all of the attendant
problems of oversupply--yeast, plugs, mastitis, constant engorgement--and
baby is going to be overwhelmed by flow.  In these situations we have mothers
very gradually decrease supply. If they are pumping 8 oz. q 3 hr. we'll have
them stop at 7.5 every three for a day, and then 7 oz. q 3 hr. for a day etc.
until supply is under control.  We like our mothers to make at least 24 oz.
per 24 hr. and I'm happier with 30.+  We spend a lot of time with NICU moms
helping them to manage supply. With mothers with high supply we can also
decrease their pumping frequency which they certainly appreciate.

Kathy Boggs, RN, IBCLC
Mountain View, CA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html