I wish it were routine on our ward to follow the strategies outlined
by Jean and Laurie - I have been advocating this and I think it's even
in our procedure book but there is a high tolerance for care by whim
and whimsy so it doesn't happen reliably enough.  When we do get it
organized from day one, I've never seen it fail.  I don't have a
predetermined 'deadline' for using a pump, but advise mother to watch
for increased amounts by hand expression and consider pumping when she
is spilling milk out of the cup she expresses into either because it
is overflowing or because milk is starting to spray rather than just
dribble.

Jean Ridler wrote
"We usually start with hand expression 2 hourly on day one, then a
combination of pumping (vacuum setting for mother's comfort) and hand
expression for the next couple of days. Our aim is a full supply by
day 10."

In your experience, Jean, does it usually take as long as 10 days to
get a full supply?   I can understand using 10 days as a goal to talk
about, to communicate to both staff and the woman herself that it is a
dynamic process with potential for increase far beyond the time spent
in hospital, but do you often see women who take that long to get
ample production going if you use such a plan?

I echo those who have said it doesn't take much more time to hand
express if you assume baby is STS with mother all the time.  If baby
is STS there is no defineable 'attempt to latch', it's an ongoing
thing.  If the baby is not taking any initiative while lying in what
Suzanne Colson calls a biological nurturing position, I wouldn't
bother badgering the baby in addition.  I'd cut to the chase - express
colostrum and feed it to the baby.  Often this is what gets the baby
awake and actively rooting and searching.  Encouraging mother to do
whatever she needs to do to keep the baby content is more effective
and IMO actually more empowering.  You can point out that newborns are
binary beings, either content or not.  If the mother isn't sure how to
tell if baby is content, she can simply look for signs of discontent
and if she doesn't find any, the baby is content and she can
congratulate herself for her brilliant work.  Babies STS hardly ever
show much distress (nor do their mothers!) and it helps milk supply
too.

Rachel Myr
Kristiansand, Norway

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