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Date: | Sun, 20 Mar 2011 12:45:14 +1300 |
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Hi Karen,
I have been a 'lurker' for a while, and this is just my opinion from
observations with clinical work and understandings I have gleaned from
conferences, especially from Hartmann reserach. It can be a bit daunting
posting here, with so many worldwide experts!
I often note that many mothers of prems (and twins in partcular), start out
well with a good supply but then 3 months later may be struggling with
their supply and have introduced more and more formula to maintain
satisfactory weight gains. I feel there may be a couple of common reasons
for this. Firstly, lack of support transitioning the prem/prems from
'managed' feeding to baby led feeding when the baby/babies are mature enough
and secondly, I observe their milk supply may not have reached and
maintained its full potential in the first 6 weeks.
To this end, I employ a little maths and encourage mothers to try and
achieve a full term milk supply (for singleton or twin) as soon as possible
and keep it pitched there until the babies are mature enough and strong
enough to take care of it themselves. This may often be around due date
plus a week or two. In other words aim for about 700 mls/24 hours for a
singleton prem and approx 1200 - 1400 for twins. If the babies go home with
an average volume of around 350 mls/24 hours (160mls/kg for 2kgm baby), then
mum needs to pump about another 300 mls per day over and above her baby's
feeding, with decreasing amounts each week as the baby is growing. Same for
twins, only double. Often this can be achieved with just 4 pumpings a day,
less in time till eventually, none.
I counsel mothers that this extra work may be challenging for a while, but
will give less work and stress in the long run. The pumpings need only be
quick and best done straight after a feed when perhaps the baby/babies are
being changed by her helper or just propped beside her (filling their nappy
no doubt!) while she takes 5 - 10 minutes to do a quick double pump. There
should be flexibility in this too - pumpings may be missed at the end of the
day when the household is especially busy, but picked up more in the early
morning. The mum will work it out.
Karen Palmer
New Zealand
----- Original Message -----
From: "Karen Foard" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, March 20, 2011 9:49 AM
Subject: Twins/34 weekers/supply
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