i need to look up something else, but i could not resist adding my four cents
worth on pumping for preemies. how come nobody else but me seems to have
noticed that in R & A it says we should be teaching mothers of preemies
special pumping techniques? at least, i have not yet met a mom of a preemie
who reports the hospital staff (including LCs) ever mentioning anything to
her.

what i teach is, do breast massage before pumping (and before nursing, too),
flat of hand on chest, out to nipples, using both hands, etc. lots of
different descriptions of massage in various sources. the idea is to move more
fat into the milk.

pump until the initial letdown slows to a trickle. then stop pumping for a
couple of minutes, then pump again, for a total of 15 to 20 minutes. those
last drops are the best, as we might assume there is a higher fat level.

i really do teach breast compression to almost everybody, and it is very
helpful to moms of preemies, both during pumping (but then those that pump
usually figure out about pushing around with the pump flanges, although i try
to observe a pumping session and make suggestions if they are doing something
like this) and nursing. it seems to help increase milk supply overall.

also, i agree that a large double pump is crucial, and like pat, i am also
using goats rue with moms. i have a custom tincture i give out (yeah, yeah)
containing fenugreek, blessed thistle, goats rue and borage. works well so far
with those who have tried it. you can get a custom blend like this from some
herbal companies, including our own mechell turner, and a boulder colorado
company called wish garden.

carol brussel