Hi Miriam,
These are all very good questions with not simple answers and you will
likely find differences of opinions from the listmembers. Here's my opinions
on your 3 questions:
1. Night pumping - it is fairly common for women to have more volume in the
mornings. I would investigate several things. Frequency of pumping. 8-10x
every 24 hrs seems to yield the best results. Going 3-4 hrs may be too long
for this woman. What kind of pump is she using. I find this is very
critical. A "hospital-grade pump" should be used, and not a store-bought
pump or not even a working mom's double pump when the baby is not nursing
very effectively. I am guessing the mother in question is pumping for a
premie or near term infant? Mother should pump after nursing, if baby is not
a very effective feeder. Some moms skip the pumping if they breastfeed, but
the feeding may have removed very little milk. Do kangaroo care as much as
possible. Also check the fit of the breastpump flange. Often the flange is
too tight on the nipple. Mother can add breast massage if possible, before
pumping, to increase milk yield.

2. I do not recommend yeast treatment for mother on nipples, unless
symptomatic. Not all mothers with vaginal yeast will experience yeast on
nipples. Good hygiene is important. I do not recommend treating the infant
unless signs or symptoms are noted. I do not even recommend treating the
mother prophylactically if baby has thrush in mouth, if mother has no s/s.
In my approx 25 yrs experience, I do not find this causes problems. Mother
should, of course, be vigilant about observing for s/s in self and baby and
begin treatment if needed.

3. Breast feeding the near term infant is a complicated subject. Some 35 wk
infants feed very well and one just has to follow the dyad closely to ensure
good milk transfer and good supply. Many 35 wks infants feed poorly and do
need to have mother express regularly (see no. 1) to provide them the milk
via alternate feeding method. That is where the major controversy comes in.
At my hospital the doctors want bottles used altho we sometimes use
supplementers at breast. It requires more time and mother support, in my
opinion, to have mothers learning bf, and to give babies their complement
milk via cup, finger feeding, or tube feeding. I beleive no bottles is a
better way, as far as long term results and I believe the literature bears
this out. Unfortunately, the goal is often getting the near term infant home
quickly. Follow up programs are not standard in USA anyway. There is a good
bit of literature about breast vs bottle feeding for premies and showing
that physiologically bf is not more tiring. If the prevailing mindset is to
use bottles, I would start with trying to at least have bf initiation done
very early and often, bottles can be used amongst the breastfeedings. I do
not think it is a good idea to wait the 2 wks before giving the breast. In
my opinion, if baby is well enough to bottle feed (as opposed to being tube
fed) then he is well enough to go to breast, however he may feed
inefficiently at first and needs assessment of feeds, and followup.
Laurie Wheeler, RN, MN, IBCLC
Mississippi, USA

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

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]