Nikki asks:

"Pumping, even more than weaker forms of nipple stimulation, presents
potential problems with premature labor
because of the oxytocin stimulated. I would never take the professional
risk of advising this for any reason, without
consulting her delivering doctor."

So what about all those women that breastfeed through a pregnancy? That's
never been shown to start labor.>

I'm not so sure how "evidence-based" that "never" actually is. I have actually read of breast pumps being
used in Israel in the 1970's to INDUCE labor in full-term grand multiparous mothers who were extra sensitive 
to pitocin because of their multiparity. At one time, pumps were being use for prenatal stress tests, though I don't
know if that's still being done.

Those women who breastfeed through a pregnancy are under the care of a physician or midwife. This matter is then
between the mom and the caregiver, especially if any preceding risk for premature labor is known. I have known of 
women (at least in the past when I worked full time with prenatal patients before my retirement) who were 
advised of their possible risk for premature labor and advised to wean. Some did, some didn't. 

Nevertheless, I referred specifically to taking the professional risk of an LC independently advising this, 
rather than obtaining permission from the delivering doctor, especially for the purpose stated. It does not 
seem physiological to expect to accomplish the stated goal with the placental hormones effecting the physiology
of so much of the prenatal breast. Even mothers who breastfeed through pregnancy apparently have changes in their
milk due to placental hormones. I'd have to see some pretty convincing research before I could move 
beyond my reasoning on this. And somehow, I doubt that such research would ever gain hospital or 
academic approval.

OTOH, I have several times encouraged mothers with severe inversion of the nipples to begin a limited, timed regimen 
of pumping at 37 weeks, first recommended by Egnell,  providing their doc has not given them any restriction on sexual 
activity. But even so, I took the extra precaution of getting a written permission from the doctor, especially if they
had had a previous C. Section. In those cases, it has worked quite well for those mothers to help evert nipples 
well enough to help them get off to a better start with direct breastfeeding or knowing from the start that at
least one, or both of their nipples would never evert, and thus plan for management of milk removal vs. gradually 
drying up. Plus, they were expert at pump use in case they needed to use the pump for a few
minutes before a feeding or for any other reason!


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC   Dayton OH

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