Pat says,
I think pumping initially is sending the wrong message. Gently teaching
hand expression and catching the drops in a spoon, which can be fed to baby
or stored in a sterile syringe for later use (baby NPO for some reason) is
probably the best way to go, IMHO. This surely needs to be done in first
hour if baby won't or can't latch. Those golden drops get all caught
up in pump apparatus, smeared on mom's breast, etc. and are lost.
Remember it is liquid gold. Pat in SNJ>>
Pat, I have to disagree with you here. That pumping within the first hour
garners a whole lot more than drops in a spoon. There is a bolus of
colostrum available to the baby -- if not to the baby because of immediate
transfer to the NICU, then to the pump. Just talked to one LC that did it for a
mom of a VLBW baby and they got 14 ml! People who have done this
generally find that they get anywhere from 10-20 ml -- in the collection container.
This can be sent to the NICU for the baby. If you wait the 6 hours you
do get the drops on the flange and smeared around the breast, etc etc, and I
totally agree that hand expression from then on may be a better way to go
than pumping. But that first hour -- the message to the mom is that you
have colostrum there for your baby, and we want to be able to send it to the
NICU so it will be available for his first feed.
OK -- I am talking about babies going immediately to the NICU. I am not
talking about the baby that can't or won't latch and can stay w/ mom who
may, if we leave them together, latch in the next 10 minutes. So we may be
talking about two entirely different populations here.
The colostrum is there because of the oxytocin related to the birth, and it
seems that if it isn't moved OUT, then it sort of shunts back up in the
breast....Geddes did a study on that, I believe, and then later -- at 6 hours
-- you only get drops.
That said, we really do need a study and we need some comparisons. I
think in a mom that is induced or has a repeat C/Section and doesn't go into
labor on her own at all, we may not see that bolus because Pitocin suppresses
the mom's own oxytocin, and of course w/ no labor there is no oxytocin
surge. And it may be true to a degree in a mom who is stimulated for a long
period of time.
I'd like to see a study done comparing pumping in the first hour with hand
expression. Realistically speaking, very few L&D nurses know how to hand
express or how to teach mothers hand expression. It's almost impossible to
get them to have mom pump in that first hour if the baby is in the NICU,
never mind hand expressing. And moms, unless it is a second time mom who is
proficient at hand expression may not do it long enough or effectively
enough to get all the colostrum that is available.
Short of doing ac/pc weights on babies with that very first feed, I don't
know how else to get a better picture of it. And try as I might, I can't
figure out how to do ac/pc weights without taking the baby away from the
mother before that first feed is accomplished!
Jean, I'm still thinking about your post -- wondering how soon the extra
fluid in the tissue is manifested as we don't *see* edema, as you've pointed
out, until there is a real 30% overload of fluid. So I'm wondering if
pumping within that first hour after birth is still an issue.
Lots of questions, and not very many answers. But in the Parker article I
cited before -- even though it was a pilot project and only 20 moms of
VLBW babies participated, the results over SIX weeks were astounding in terms
of milk production. The only difference being 10 moms started pumping at 6
hours and 10 pumped w/in the first hour and at every measure, the moms who
started pumping within the first hour had 2 to 3 times MORE milk than the
moms who started pumping at 6 hours.
It is certainly something we need to be looking at.
Jan Barger, RN, MA, IBCLC, FILCA
Lactation Education Consultants
Wheaton IL
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